Every month we add to the resources and data sections of the health reform core topic area, with notes on how it can be used to report on reform. But I also wanted to point out a guide to data for health care reporters that our colleagues at Reporting on Health put together.
It’s going to surprise exactly nobody that the organizations that help sell plaques to physicians might just be in it for the money, but I still have to tip my hat to ABC News for investigating the living daylights out of several such outfits.
The typical business model seems to be “shamelessly flatter any doctor whose contact information you can get your hands on, then refer them to your affiliated plaque salesman. Profit, rinse, repeat.” Nevertheless some doctors and consumers seem to take them seriously, with hospitals pushing their doctors to get listed, and physicians trumpeting their listings on websites and in press releases. Following their lead, ABC treated the listings just as seriously, going so far as to match them with databases of disciplined doctors. They found plenty of matches, including a few examples that were downright spectacular.
Dr. Conrad Murray, convicted of manslaughter for administering a lethal overdose of the anesthetic propofol to Michael Jackson in 2009, is still listed as a “Top Cardiologist,” according to the Consumers’ Research Council of America.
A “Top Pediatrician” according to the Consumers’ Research Council of America is also a convicted serial child rapist charged with the molestation of 103 children. Dr. Earl Bradley is currently serving 14 life sentences in addition to a 160-year prison term, yet he remains on the Consumers’ Research Council of America “Top Pediatrician” list.
Beyond the headline-grabbing details, the reporters go to great lengths to explain the company’s business models and their screening procedures, or lack thereof. My personal favorite was a website, TopDocs.com, whose CEO says he has enticed “a couple of hundred” doctors to pay from $1,500 to $10,000 for a listing, not including the $1,600 annual fee. Yet, the ABC crew writes, “In reference to the actual name ‘TopDocs.com,’ (the CEO) told ABC News, ‘We are not inferring in any way that the doctors in the site are top doctors.’”
According to my mother, it sometimes isn’t enough to just say you’re sorry. In The Kansas City Star, Alan Bavley writes that, apparently, some physicians disagree. In particular, an organization called “Sorry Works!” thinks that apologies are powerful enough that they should provide doctors with immunity from some malpractice and disclosure rules. And, he writes, they’re campaigning to make it official.
…about five years ago, Sorry Works! changed from a coalition of doctors, lawyers, insurers and patient advocates. Now it’s a commercial consulting firm. Founder Doug Wojcieszak offers training to hospitals and doctors. And he has started crusading for new immunity for doctors who apologize.
According to Bavley, “Wojcieszak wants the (National Practitioner Data Bank) bank to keep malpractice payments secret in many cases when doctors make apologies and disclosures. Further, he wants doctors shielded from medical board discipline on these cases.”
Consumer’s Union and patient safety organizations have come out against the Sorry Works! campaign because, as Bavley writes, “proposal would give doctors who were going to settle a suit anyway an incentive to apologize just to keep it off their record.”
Under Sorry Works! three strikes rules, the vast majority of doctors (who face one or fewer malpractice suits during their career) would be able to stay clear of the data bank entirely, thus denying the public and medical boards access to crucial information that’s currently being made public.
Investigating for Reuters, Duff Wilson and Janet Roberts analyzed lobbying records and found that, in the past few years, the food industry has dramatically stepped up its spending in Washington and, they write, “largely dominated policymaking – pledging voluntary action while defeating government proposals aimed at changing the nation’s diet.” They give examples.
After aggressive lobbying, Congress declared pizza a vegetable to protect it from a nutritional overhaul of the school lunch program this year. The White House kept silent last year as Congress killed a plan by four federal agencies to reduce sugar, salt and fat in food marketed to children.
And during the past two years, each of the 24 states and five cities that considered “soda taxes” to discourage consumption of sugary drinks has seen the efforts dropped or defeated.
At every level of government, the food and beverage industries won fight after fight during the last decade. They have never lost a significant political battle in the United States despite mounting scientific evidence of the role of unhealthy food and children’s marketing in obesity.
That success has come through what the authors imply is a sort of big-tobacco model, in which the industry combines promises of self-regulation with huge amounts of money, and thus creates an irresistible package for lawmakers. For a blow-by-blow on how the lobbying muscle swayed the decision-makers in recent battles, I strongly recommend you read the full piece, which draws heavily from both data and extensive interviews. Particularly interesting? The examples of how the Citizens United decision has impacted far more than just election politics.
Among recent releases from the Agency for Healthcare Research and Quality, its data on who’s spending what on health care stands out as particularly useful to a broad audience. It has already inspired posts, graphics and stories around the web, and even journalists who don’t plan to use the data directly can get useful context from these secondary pieces.
Thanks are due to AHCJ member Eileen Beal, a Cleveland-based independent journalist, and MedCity News’ Veronica Combs for pointing us to a handy guide to the AHRQ data.
American Medical News’ Doug Trapp uses the AHRQ data to create a profile of America’s heaviest health care consumers. For the record, he reports that they’d most likely be white, female and privately insured.
They are the costliest 1% of patients in the U.S. Caring for them accounts for more than 20% of what the nation spends on all of its health care. In contrast, the least costly half of all patients are associated with only 3% of total health spending, according to an Agency for Healthcare Research and Quality analysis of spending data from 2008 and 2009 released in January.
Finally, we have the AHRQ statistical brief itself. It’s quite accessible, and reporters will find its references section to be a hyperlinked gold mine of handy numbers and research reports.
In The Wall Street Journal, John Carreyrou reports that a physician the paper spotlighted in a data-driven series on Medicare abuses has now been “indicted by a federal grand jury … for allegedly submitting more than $13 million of false claims.”
The article marks the first time the Journal has been able to print the physician’s name (Emma Poroger), even though they’ve been aware of it for more than a year.
The Journal identified Dr. Poroger, a doctor of osteopathy, as having suspicious billing patterns by mining the Medicare claims database, a computerized record of every bill submitted to the program. But her name was withheld in the October 2010 front-page article because Medicare keeps information pertaining to individual doctors confidential under a three-decade-old court injunction.
That injunction stems from a 1979 lawsuit filed by the American Medical Association, the doctors’ trade group, to keep secret how much money physicians receive from Medicare. At the time, the court said doctors’ privacy trumped the public’s interest in knowing how tax dollars are spent.
The Journal’s publisher, Dow Jones & Co., filed court papers this year seeking to overturn the injunction. In September, a federal judge in Florida ruled that Dow Jones’s case could proceed.
Carreyrou also called out a few other physicians featured anonymously in the series whose names had also been made public in various official proceedings.
Thanks are due to blogger and one-time hospital executive Paul Levy for drawing our attention to the Ohio hospital industry’s recent push to overturn much of the state’s recently passed transparency legislation.
The law required hospitals to post performance data, such as infection rates and patient satisfaction, on the Ohio Hospital Compare site.
The OHA supports the new legislation… because it wants to remove “duplicative” reporting requirements on the state’s hospitals. Ohio hospitals already report the same data to a federal Hospital Compare website maintained for the public by the Centers for Medicare & Medicaid Services, said OHA spokeswoman Tiffany Himmelreich.
The new legislation “doesn’t reduce reporting. It just eliminates reporting the same information to two different places,” she said. “We don’t want the public to feel that this is taking a step backwards in terms of data availability.”
For their part, consumer advocates say website maintenance is not an onerous burden, and that the hospital association’s push is part of a larger, statewide antitransparency trend.
As an interesting side note, Glenn found the Ohio Hospital Compare site to be rendered inoperable by apparent bugs on an initial visit but discovered that, after his inquiries to the state health department, the site was put into working order.
In The New York Times, Kevin Sack traces the series of errors and lapses in judgement that led to a large-scale data breach at Stanford Hospital, one which went unnoticed for almost a year. Sack’s lead paragraph neatly encapsulates the whole story.
Private medical data for nearly 20,000 emergency room patients at California’s prestigious Stanford Hospital were exposed to public view for nearly a year because a billing contractor’s marketing agent sent the electronic spreadsheet to a job prospect as part of a skills test, the hospital and contractors confirmed this week. The applicant then sought help by unwittingly posting the confidential data on a tutoring Web site.
Since 2009, when federal law began requiring disclosure of medical data breaches involving more than 500 people, Sack reports that about 330 incidents have been reported on an HHS website. A CSV file of the data is available.
Writing for The New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.
While processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.
The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.
The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.
As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.
Time to add another link to your “federal data clearinghouses” folder, if you haven’t already. Childstats.gov, published by the Federal Interagency Forum on Child and Family Statistics, synthesizes data from the CDC, NCHS, National Children’s Survey, AHRQ, Census and other specialized programs.
The site is anchored by its annual report, “America’s Children: Key National Indicators of Well-Being,” and the easy-to-navigate nature of its databases seems to have already inspired some discussion on Twitter, particularly in relation to child homelessness.
Many of the data tools are simply links to general surveys (like AHRQ’s National Healthcare Cost and Utilization Project) that just happen to contain child-related information, but there are some more specifically relevant data sources, the best of which I’ve listed below.