Tag Archives: hospital data

Report: Calif. hospital chain profited from ER admissions

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

After months of investigation and updates, California Watch reporters Christina Jewett and Stephen K. Doig have unleashed their full report on California hospital chain Prime Healthcare Services and its knack for turning around failing hospitals by apparently pushing for the admission of ER patients who are insured by Medicare or insurance giant Kaiser Permanente, then keeping them in the hospital.

The report includes hyperlink sourcing, a raft of related documents and a great explainer on how they assembled the numbers behind the story. The duo took advantage of court testimony, sources and reams of public records.

The reporters say that evidence points to “an orchestrated campaign of admitting Medicare and Kaiser patients – moving them from the emergency room to a hospital bed – in the interest of changing the fortune of a money-losing hospital.”

State data shows that after the hospital chain took over 11 hospitals beginning in 2005, the percentage of Medicare patients who were admitted from the emergency room to Prime hospital beds increased from about 45 to 63 percent.

That 40 percent increase contrasts with other California hospitals that saw an average 8 percent decline from 2005 to 2009 in Medicare patients moved from the emergency rooms to hospital beds, data shows.

And, as you’ll see throughout the story, the interviews and anecdotes back up the numbers.

Tina Buchanan, the hospital’s former chief nursing officer, testified that [Prime founder and chairman Dr. Prem Reddy] began to require emergency room staff to put a yellow sheet of paper on each patient record that listed their health insurance status.

She said he would go through the “goldenrods,” as the papers were called, and point out the Medicare or Kaiser patients and say, “Make sure you get this one admitted.”

“If it was … an uninsured patient, he would tell them, ‘Get them out of my hospital,’ ” Buchanan testified.

There’s plenty more where that came from, but I will just leave you with this editor’s note, which appears alongside the main story.

It came to our attention late Friday that Prime Healthcare had issued a press release saying it had taken legal action against California Watch. We have not been served and can’t fully comment until we have reviewed any legal filings. In our dealings with Prime over the course of the past several months, the company has yet to present to us a single factual error that has merited correction or clarification. We continue to stand by our reporting.

Alarm fatigue hurts patient care, overwhelms nurses

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In the wake of several high-profile incidents, The Boston Globe‘s Liz Kowalczyk has assembled a thorough investigation of alarm fatigue in hospitals. Alarm fatigue, for the record, is the idea that the huge arsenal of patient monitors in any given hospital floor are going off so often that nurses become slower in their responses to the alarms. For example, in one 15-bed unit at Johns Hopkins, staff found that, on average, one critical alarm went off every 90 seconds throughout the day.

With the help of ECRI, Kowalczyk has managed to attach some numbers to the issue.

The Globe enlisted the ECRI Institute, a nonprofit health care research and consulting organization based in Pennsylvania, to help it analyze the Food and Drug Administration’s database of adverse events involving medical devices. The institute listed monitor alarms as the number-one health technology hazard for 2009. Its review found 216 deaths nationwide from 2005 to the middle of 2010 in which problems with monitor alarms occurred.

But ECRI, based on its work with hospitals, believes that the health care industry underreports these cases and that the number of deaths is far higher. It found 13 more cases in its own database, which it compiles from incident investigations on behalf of hospital clients and from its own voluntary reporting system.

Kowalczyk also looks at potential solutions to the problem and how some institutions are trying to make changes to eliminate alarm fatigue, including cutting back on unnecessary monitors and having monitor warnings appear on nurses’ pagers or cell phones.

To back up the numbers, Kowalcyzk got some telling quotes from frustrated nurses.

“Yes, this is real, and, yes, it’s getting worse,’’ said Carol Conley, chief nursing officer for Southcoast Health System, which includes Tobey Hospital. “We want to keep our patients safe and take advantage of all the technology. The unintended consequence is that we have a very over-stimulated environment.’’

“Everyone who walks in the door gets a monitor,’’ said Lisa Sawtelle, a nurse at Boston Medical Center. “We have 17 [types of] alarms that can go off at any time. They all have different pitches and different sounds. You hear alarms all the time. It becomes . . . background.’’

Kowalcyzk’s investigation points out that, while alarms do tend to go off when there’s a real problem, it appears that they do so at the expense of also going off when there isn’t.

Monitors can be so sensitive that alarms go off when patients sit up, turn over, or cough. Some studies have found more than 85 percent of alarms are false, meaning that the patient is not in any danger. Over time this can make nurses less and less likely to respond urgently to the sound.

For more specifics on device design issues, see the final subheading, titled “Looking for solutions.”

For a one year, the Joint Commission made routine alarm testing and training part of their accreditation requirements, but dropped the stipulation in 2004 when it felt the problem had been solved.

Other parts of the series:

Hospitals to start reporting infection data Jan. 1

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Hospitals are set to begin reporting information about hospital-acquired bloodstream infections to the federal government on Jan. 1, with the data becoming available to the public later in the year through the Hospital Compare website, according to an article by Tony Pugh of McClatchy Newspapers. Pugh also reports that hospitals will start reporting on surgical site infections in 2012.

The article includes a graphic that shows what states currently require public reporting of hospital-acquired infections.

While reporting to Hospital Compare will be voluntary, hospitals that fail to comply will “lose 2 percent of their Medicare funding beginning in fiscal year 2013.”

There are nearly 250,000 catheter-related bloodstream infections a year in U.S. hospitals, contributing to roughly 31,000 patient deaths annually. There are more than 290,000 surgical site infections a year, contributing to more than 8,200 deaths.

(Hat tip to FairWarning.org)

Reminder: AHCJ has compiled easy-to-use Excel spreadsheets of much of the data currently available from Hospital Compare. The up-to-date files, available to AHCJ members, are designed to allow you to compare more than three hospitals at a time – unlike the Hospital Compare look-up tool – using spreadsheet or database software to filter, sort and use other analysis tools with precision. You can look at hospital mortality and readmission data, as well as patient satisfaction.

AHCJ will be looking at making the new infection data available to members similar to what it offers for the mortality, readmission and patient satisfaction data.

AHCJ also has tip sheets to help you understand and analyze the data:

Indiana numbers show preventable errors down

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Indianapolis Star‘s Daniel Lee reports that, according to the state’s newly released 2009 numbers, preventable medical errors are down in Indiana. There were 94 reported errors last year, down from 105 each in 2007 and 2008.

Part of the decline can be attributed to the health department’s Indiana Pressure Ulcer Initiative, which appears to have helped bring bed sore occurrences down 33 percent from 2008.

The initiative, which began in June 2008 and runs through September, focuses on improving hospitals’ systems for assessing risk factors for patients developing bed sores. Efforts have included in-person and online prevention training for hospital personnel.

The real story is the Indiana error numbers, which are wonderfully extensive. They’re broken down by condition (28 different serious errors), location and specific facility.

Related

Conference presentations

AHCJ articles

Globe photographer finds medical records in landfill

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Boston Globe‘s Liz Kowalczyk tells the story of how one of the paper’s staff photographers stumbled upon a massive medical privacy breach while dumping his trash.

landfill

Photo by D’Arcy Norman via Flickr

As Tinker Ready points out on Boston Health News, it’s a reminder that stories are everywhere … and shredders are not. Kowalcyzyk traced the documents to a billing intermediary.

Kowalcyzk uses the landfill scene to demonstrate just how difficult it is for hospital officials to keep confidential information from slipping through the cracks.

The photographer said he saw health and insurance records from at least four hospitals and their pathology groups — Milford, Holyoke, Carney, and Milton — mostly dated 2009. The Globe notified the hospitals. It is unclear how many other hospitals’ records might have been discarded in the dump.

(Hat tip to Tinker Ready)

Hospital infections on rise in Nev., reporters find

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

lasvegassun

Part two of Marshall Allen and Alex Richards’ Las Vegas Sun hospital investigation series “Do No Harm” takes on hospital-acquired infections. Even though no agency in the state tracks such things, the duo managed to find 2,010 instances of drug-resistant bugs in local hospitals between 2008 and 2009. That number included 647 instances of hospital-acquired MRSA.

In the story, the explain how they overcame industry resistance to dig up the data themselves:

No health agency tracks these cases. In fact, hospitals derailed proposed legislation in 2009 that would have required them to publicly report cases of MRSA in their facilities.

However, hospitals are required by law to submit to the state billing records based on each patient visit. The Sun obtained that information from 1999 to 2009 and analyzed the 2.9 million hospital billing records as part of its two-year investigation, “Do No Harm: Hospital Care in Las Vegas.”

Because of how the records are coded, the Sun was able to identify the number of infections by the two bacteria, and for the years 2008-09 further identify the cases in which the records say the patients acquired the bacteria while hospitalized.

While it’s hard to put their numbers in a national context because of widely varying methods of measurement and reporting, the duo can say that such infections jumped 34 percent from 2008 to 2009. Allen and Richards then establish two facts:

  1. Some institutions have developed ways to keep MRSA and friends under control.
  2. None of those institutions are in Las Vegas, where inspections show that hospitals could be doing a lot more.

Efforts to force Nevada hospitals to disclose MRSA cases withered under heavy industry opposition, though the legislature is now considering a watered-down version that would not public the MRSA rates of specific facilities.

It’s worth noting that the paper has published responses from readers who have plenty of their own hospital horror stories. The website includes their input both in text and through excerpts of some of the voicemails Allen has  received since the first part of the series was published. They are heart wrenching but serve as an excellent example of how reporters can involve readers in a project.

AHRQ asks ‘Who’s paying for rising health costs?’

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The latest statistics brief out of the Agency for Healthcare Research and Quality address what researchers called the “growing burden of hospital-based medical care expenses on the government, tax payers, consumers, and employers.” In this brief, they’re looking to figure out where to put the blame for those in-patient cost jumps that occurred between 2001 and 2007 and thus divided the increases into four categories: Medicare, Medicaid, private insurance and payments from those without insurance.

payers2

The numbers hold a few interesting subplots, any one of which would benefit from further exploration. Here are a few:

  • When you compare 2001 and 2007, private insurance paid for slightly fewer stays, while stays for Medicare and Medicaid were up,respectively, by 20.1 and 29.9 percent.
  • “From 2001 to 2007, the number of stays with a principal diagnosis of blood infection nearly doubled (97.1 percent; 675,400 stays in 2007).”
  • The cost of a hospitalization for intestinal infection jumped 148 percent, yet hospital stays for such infections were up only 69.5 percent.
  • “For four of the top ten conditions—blood infection, acute kidney failure, respiratory insufficiency, arrest, or failure, and skin and subcutaneous skin infections—the uninsured demonstrated greater increases in growth in total costs and number of hospital stays than the other three payer groups.”
  • Private insurance paid 55.7 more for C-section-related hospital stays over the study period, while Medicaid costs increased 95.1 percent for the same sort of visits.

Check pages seven through 10 for summary tables, including overall numbers and two tables of the ten conditions for which costs are increasing most rapidly.

increases

Obama initiatives include VA hospital report cards

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Saying that “commitment to open government goes beyond the making of government-wide policy for the future,” the White House announced a number of “open government” initiatives on Tuesday.

The initiatives come with an “Open Government Directive” (PDF) from Peter Orszag, director of the White House’s Office of Management and Budget, that sets out steps toward creating a more open government and establishes deadlines for action:

  • Publish Government Information Online – Includes a requirement that each agency create an Open Government Web page within 60 days.
  • Improve the Quality of Government Information – Within 45 days each agency must designate an official to be accountable for the quality and objectivity of federal spending information
  • Create and Institutionalize a Culture of Open Government – Within 120 days, each agency will publish on its Open Government Web page an a plan about how it will improve transparency and public participation.
  • Create an Enabling Policy Framework for Open Government – Officials will review OMB policies to find impediments to open government and propose changes to increase openness.
report-card

Photo by Ed Dame via Flickr

The specific initiatives just announced come from all departments of the cabinet. One of the most notable is a hospital report card that will include raw data for veterans administration hospitals:

To empower Veterans and the public at large to track quality, safety, and access to Veterans Health Administration (VHA) facilities, the Department of Veterans Affairs is publishing hospital “report cards,” including raw data on care provided in outpatient and hospital settings, quality of care within given patient populations, and patient satisfaction and outcomes.

Other health-related initiatives include:

Department of Health and Human Services, Department of Agriculture, Department of Commerce, Department of Energy & the National Aeronautics and Space Administration: National Assets for High-Tech Economic Growth
Fledgling businesses need easier ways to identify and assess entrepreneurial opportunities that will create jobs and strengthen economic growth. Towards that goal, the National Institutes of Health (NIH) and Food and Drug Administration (FDA) in the Department of Health and Human Services (HHS), the Agricultural Research Service in the U.S. Department of Agriculture, the National Institute of Standards and Technology (NIST) in the Department of Commerce, the Department of Energy, and the National Aeronautics and Space Administration are increasing access to information on 1) new technologies available for commercial licensing, 2) Cooperative Research and Development (CRADA) awards and opportunities, 3) Small Business Innovation Research  (SBIR) awards and opportunities,  4) Small Business Technology Transfer (STTR) awards and opportunities, and 5) projects sponsored through grants and contracts.

Department of Veterans Affairs: Geographic Distribution of Expenditures
The National Center for Veterans Analysis and Statistics will release three years of raw data on estimated annual VA spending in each county and congressional district.  The data represent payments to Veterans and dependents, services provided to Veterans, and general operating expenses. These data will be used by state and local Veteran agencies, Veteran advocacy groups, and the public to compare to and plan for local Veteran needs. Making the raw data available will enable its combination with local-population and veteran-related data, fostering new knowledge and improved services for Veterans.

Department of Agriculture: Promoting a Healthier America
To unleash innovative approaches to improving the health of America’s children, the Department of Agriculture is releasing nutrition data for over 1,000 commonly consumed foods and launching a national competition for creative, mobile and web-based games. The competition will challenge entrepreneurs, software developers, and students to leverage the newly released data to develop games to help children make healthy eating decisions.

Department of Labor: Keeping America’s Workers Out of Harm’s Way
For the first time, the Occupational Safety and Health Administration in the Department of Labor is systematically publishing employer-specific information about occupational fatalities online.  Employers with reported fatalities will have an incentive to take steps to improve safety and prevent future accidents. In addition, responsible employers will be able to use the database to identify dangerous conditions and take proactive precautions.

Department of Veterans Affairs: Veteran Population Model
The Veteran Population Model – using combined data from the Department of Veterans Affairs (VA), Department of Defense (DoD), and Bureau of the Census – provides the official estimates and projections of the veteran population for each year from April 1, 2000, through September 30, 2036. Previously available only through predefined queries, access to the raw data will enable public and private-sector service organizations to incorporate VetPop data into their models to project future demand based on population and demographic estimates.

Q&A on achieving a more open government

Chief Technology Officer Aneesh Chopra and Chief Information Officer Vivek Kundra take questions on the directive and the move to a more transparent government.

When quality matters to boards, hospitals do better

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In Health Affairs, Ashish K. Jha and Arnold M. Epstein have released a study in which they found a link between hospital boards that focused on quality of care and hospital quality ratings. They also found that quality isn’t a top priority for most hospital boards. The researchers hope their findings will help those who want to improve hospital quality by demonstrating just how much influence a hospital board can have.

Jha and Epstein surveyed 1,000 board chairs from a wide sample of not-for-profit acute-care hospitals in the United States. For quality ratings, they relied on the Hospital Quality Alliance.

Related

AHCJ President Charles Ornstein, whose hospital quality coverage has earned national recognition, recently updated his comprehensive “Road map for covering your local hospital’s quality” tip sheet.

AHCJ article: Making sense of hospital quality reports

Book: Covering the Quality of Health Care: A Resource Guide for Journalists

Slim guide: Covering Hospitals: Using Tools on the Web

Free online training

On the Beat: Covering Hospitals: An innovative simulation guides you through the sources and resources you need to tackle the beat. You’ll tap into the same tools that you’ll use on the job, and you’ll have a virtual mentor to walk you through the maze of reports, statistics and sources. One story line teaches you about reporting on hospital quality

Data

Investigating hospitals: Find stories with ready-to-use Hospital Compare data: AHCJ has made it easier for journalists to compare hospitals in their regions by generating spreadsheet files from the HHS database, allowing members to compare more than a few hospitals at a time, using spreadsheet or database software. AHCJ provides key documentation and explanatory material to help you understand the data possibilities and limits.

Tip sheets

Reports

Hot Health Headlines

AHRQ interviews Ornstein, talks medical errors

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Robert Wachter, M.D., (bio), editor of AHRQ WebM&M (Morbidity and Mortality), interviewed AHCJ President Charles Ornstein, of ProPublica, for a recent issue (get the audio version here). Their conversation began as a general discussion of health journalism, then zeroed in on hospital errors and the Pulitzer Prize-winning series on King/Drew Medical Center in Los Angeles that Ornstein did with Tracy Weber when both were at the LA Times.

The whole thing is worth a read. In this excerpt Ornstein discusses how health journalists find stories:

Good reporters have a variety of sources of information. Reporters who routinely cover the hospitals in their communities should be constantly looking at state inspection reports, lawsuit data about payouts, their Joint Commission accreditation, and how they’re doing with their training program. All these types of things should be on the radar screen and monitored regularly. But nothing can replace talking to employees in the facilities and the patients that receive care there—trying to get an on-the-ground perspective.

In a companion piece, Wachter reflected on the role the media has played in shaking the medical profession out of a dangerous rut of complacency:

What do we need from reporters who cover the medical errors beat? … reporters need to know enough about error science that they appreciate the importance of searching for systems factors, without immediately zeroing in on more dramatic and obvious sharp-end errors. They need to get the facts right. And, while raising the appropriate concerns, they need to avoid sensationalism and place the error, or the topic, in broader context. When they do these things, they are providing a unique and critical service to patients and caregivers.