Tag Archives: medicare

Judge’s decision puts Medicare data in public realm

Leave a reply
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.

A decision announced Friday would allow the public and journalists access to Medicare claims data about individual doctors.

An injunction barring release of the data had been in place for 33 years, “when a federal court in Florida sided with the American Medical Association’s contention that doctors’ right to privacy trumped the public’s interest in knowing how tax dollars were spent,” according to John Carreyrou of The Wall Street Journal.

“Dow Jones & Co., The Wall Street Journal’s parent company, challenged the injunction in 2011 after the Journal published a series of articles showing how the information could be used to expose fraud and abuse in the $549 billion health-care program for the elderly and disabled.”

Wall Street Journal reporters, who negotiated for eight years worth of data if they did not publish identities, wrote a series of stories about Medicare data, showing that the federal government isn’t taking advantage of the data it has to detect fraud. The Wall Street Journal’s articles have offered a window into the forces driving up health spending and shown that analyzing the data can reveal abuse and fraud in the Medicare system.

“The public has a right to know how much physicians are being paid by Medicare and what services they are providing patients,” said AHCJ President Charles Ornstein. “With analysis and context from journalists, the data could help patients make informed decisions and provide necessary oversight of billions of dollars in federal spending.”

Carreyrou reports the American Medical Association “is considering its options on how best to continue to defend the personal privacy interests of all physicians.”

“The Crushing Cost of Care,” by the WSJ’s Janet Adamy and Tom McGinty, won first place in the Health Policy (large) category of the 2012 Awards for Excellence in Health Care Journalism.

Read more about the Medicare data and the fight to open it to the public:

Medicare data shows dangerous prescribing habits, lack of oversight

Leave a reply
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.

ProPublica’s Tracy Weber, Charles Ornstein and Jennifer LaFleur, in an analysis of Medicare prescription records, found that “some doctors and other health professionals across the country prescribe large quantities of drugs that are potentially harmful, disorienting or addictive,” with no attempt by the federal government to monitor or deter the practices.

“… officials at the Centers for Medicare and Medicaid Services say the job of monitoring prescribing falls to the private health plans that administer the program, not the government.”

Continue reading →

CMS unveils dataset on top hospital discharge payments

1 Reply
Liz Seegert

About Liz Seegert

Liz Seegert (@lseegert), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society. If you have questions or suggestions for future resources on the topic, please send them to liz@healthjournalism.org.

The public can now compare hospital-specific charges for the top 100 most frequently billed discharges at the 3000+ hospitals across the US that receive Medicare payments.  The Center for Medicare and Medicaid Services unveiled its free Medicare provider charge dataset which can be analyzed down to ZIP code level.

Jonathan Blum, acting principal deputy administrator of CMS, said in a webinar with AHCJ members that this effort has been years in the making, as part of the agency’s effort to be more transparent.

Data for FY 2011 is on the AHCJ website, downloadable as an Excel file (a CSV file is available from CMS). From there, it can be sorted by diagnosis related group (DRG) codes, city, state, ZIP and charges. This tool allows journalists, advocates and consumers to compare costs nationally, between or among states, cities, or counties. Data is only available for Medicare Inpatient Prospective Payment System (IPPS) — the fee-for-service component — based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG). These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. It does not include data for U.S. territories or Puerto Rico, or for any Medicare Advantage payments.

Chris Powers, acting director of the Information Products Group, Office of Information Products and Data Analytics demonstrated the dataset by comparing the varying cost of a total joint replacement. Selecting the specific DRG code netted charges ranging from $321,000 to just over $20,000.

The goal is to empower consumers, particularly those who are uninsured and may have to bear the entire cost, who may be underinsured, or who have a high deductible, to ask about appropriate charges  for a given procedure and question discrepancies that cannot be explained by geography, patient population, or affiliation differences. Medicare IPPS pays a fixed cost to hospitals, however, this data can be used as a guideline for non-Medicare fee-for-service charges.

In the Q&A section of the webinar, I asked if there would be a similar data set compiled for Medicare Advantage payments so consumers insured under those plans can also compare charges. Powers said CMS is looking at what the next steps are in terms of data release. “That is a very good question and certainly those concerns are in our minds as we make those considerations.”

Join today’s webinar on newly released hospital cost data

Leave a reply
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.

The federal government released data today showing what hospitals across the country charge Medicare for the same treatment or procedure. The 2011 data includes bills submitted by 3,300 hospitals for the 100 most commonly performed treatments. This allows a basis for some local or regional comparisons and a starting point for stories on hospital costs. 

The data is available on the AHCJ website. A webinar for AHCJ members on using the data will take place today at 2 p.m. ET with Jonathan Blum, the acting principal deputy administrator at the Centers for Medicare & Medicaid Services, and Karl Stark, AHCJ vice president and Philadelphia Inquirer health editor. Register here.

More on medical costs

The cost of medicines, devices, tests and treatment is such an important element of health reporting that it is included in AHCJ’s Statement of Principles: “Strive to include information about cost and insurance coverage in any reporting of new ideas in medicine.”

Brenda Goodman, AHCJ’s topic leader on covering medical studies says that the runaway costs of such things are arguably one of the most important issues in medicine, but it’s one that’s often missing from health stories.

Michael Schroeder, who covers health for Angie’s List Magazine, is required to include meaningful medical pricing information in his stories. He acknowledges this is no simple task but urges reporters to have a strategy and be persistent. “You won’t always get the information you’re after, but your batting average will certainly go up, and you won’t be left to routinely settle for hollow numbers.”

To that end, Goodman and Schroeder have contributed tip sheets to help reporters get that vital information. Goodman focuses on several resources where you might find pricing information, while Schroeder shares his strategy and the specific questions he asks sources about costs.

Health Data WorkshopHealth Data Workshop

For more on using data to report on health care, journalists are invited to tap into health data in a special workshop, Oct. 3 & 4 in Anaheim, Calif.

This AHCJ workshop offers something for data newcomers and  veterans – from spreadsheet basics to visualizing data online. You’ll come away with skills and ideas on teasing stories out of datasets and tools on presenting these stories.

Shifting projections mean U.S. population is aging faster

Leave a reply
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.

New Census Bureau numbers forecast that there will be more older people in the United States than previously anticipated.

As Adele Hayutin of the Stanford Center on Longevity points out, the implications are big:

Some of the most important personal decisions that will be affected include choices about work, living arrangements, caregiving for older relatives and financial matters concerning retirement. Policymakers will need to consider how the faster pace of aging further threatens the financial viability of Social Security and Medicare.

The trend means that the financial burder of Social Security and Medicare will fall on a smaller “working-age population.”

Hayutin’s post explains the trends that account for the shift.

Related

Cost of long-term care merits coverage, discussion

1 Reply
Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

With the baby boomers aging into Medicare and heading into years when physical decline and disability gradually become more common, one thing seems certain: Long-term care will inevitably become a much more important topic of national discussion in the years ahead.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Two recent articles underscore the point. One is by Stuart Butler, director of the Center for Policy Innovations at the Heritage Foundation, a Washington, D.C.-based think tank. The other is by William Galston, a senior fellow in the governance studies program at the Brookings Institution, another think tank in the nation’s capital.

Both argue that a long-term care crisis is at hand and will only grow in scope as the baby boomers swell the ranks of older people who need assistance with household tasks (bill paying, shopping, cleaning), personal care (bathing, dressing, toileting) and custodial care.

“The growing cost of long-term care (LTC) is fast becoming a problem we can no longer ignore,” Butler writes. Continue reading →

Low interest rates affect seniors’ ability to pay medical expenses

Leave a reply
Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

A lot is written about people who don’t save enough for retirement. But what about older adults who saved diligently, only to find the value of their nest eggs depleted in this low-interest rate environment?

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

I’m not talking here about stocks that take a tumble, slicing into their value. I’m talking about the interest rates that older people earn on money put away in bonds, money market funds, or certificates of deposit – and that they count on to supplement Social Security payments in their retirement years.

When these interest rates are at historically low levels, as they are now, people who counted on earning 5 percent to 7 percent annually from their savings can find themselves instead earning instead 1 percent to 2 percent. That can make a real difference in the affordability of their retirement plans and their ability to handle expenses such as payments for housing, food, prescription medications or out-of-pocket medical expenses.

For a really good examination of the issue, look at this story in the Minneapolis Star Tribune by Jennifer Bjorhus. It’s full of detailed analysis and personal stories that illustrate this problem which, it’s safe to say, is playing out with seniors in every community across the United States. Continue reading →

Webcast explores aging adults’ contributions, widening disparities, creating ‘synthetic families’

Leave a reply
Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

You don’t often hear about how much older adults contribute to society. That’s a shame.

It allows the aging of American to be portrayed as a story of dependency: the reliance of the old upon the young. Instead, the truth is that the generations are inter-dependent, each benefiting the other.

Toni Antonucci
Antonucci

S. Jay Olshansky
Olshansky

Julie M. Zissimopoulos
Zissimopoulos

This was one of the themes articulated during AHCJ’s recent webcast with three members of the MacArthur Network on an Aging Society, a group of prominent academics exploring the opportunities as well as the challenges associated Americans’ increased life spans.

Julie Zissimopoulos, associate director of the Schaeffer Center for Health Policy and Economics at the University of Southern California, described a framework for understanding how much support older adults get and how much they give in turn. (Resources and PowerPoint presentations from the webcast are available here.)

In the “here’s what they get” column, she put government health programs such as Medicare and Medicaid, Social Security, benefits from the department of Veterans Affairs, food stamps, programs supported through the Older Americans Act, and informal caregiving, largely from children and spouses, among other smaller items.

Total that up and it comes to $916 billion in public expenditures for older Americans in 2010.

In the “here’s what they give” column, Zissimopoulos included income taxes (federal and state), payroll taxes and property taxes that older adults pay, gifts and inheritances that they pass on to family and friends, the informal care they provide to spouses, elderly parents and children, and the many hours they spend volunteering, among other items.

Total that up and it comes to $646 billion in contributions by older Americans, also in 2010.

The difference, $316 billion, is a lot of money but by no means the enormous, out-of-proportion give-away portrayed by some. And the reality is all of society shares an interest in controlling health care costs, the largest item in the “debit” column for older adults.

Another theme of the web chat revolved around one of the greatest achievements of the 20th century – the extension of the human life span by more than 30 years, largely because of improvements in public health as well as advances in science and medicine. Continue reading →

Panelists: Watch state activities for stories about seniors’ health services

Leave a reply
Judith Graham

About Judith Graham

Judith Graham (@judith_graham), a Colorado-based freelancer, is AHCJ’s topic leader on aging, and as such curates related material at healthjournalism.org. She welcomes questions and suggestions on aging issue resources and tip sheets at judith@healthjournalism.org.

What lies ahead for Medicare now that election results are in?

Two words sum up the short-term outlook:  cost cutting.

Judith GrahamJudith Graham (@judith_graham), AHCJ’s topic leader on aging, is writing blog posts, editing tip sheets and articles and gathering resources to help our members cover the many issues around our aging society.

If you have questions or suggestions for future resources on the topic, please send them to judith@healthjournalism.org.

Down the road, a more ambitious and difficult task awaits: restructuring the program and realigning its incentives to create a lower-cost, higher quality, more sustainable health care system.

What isn’t on the horizon is a radical overhaul of Medicare along the lines that the Republicans proposed. Converting Medicare to a premium-support model isn’t going to happen, at least not any time in the foreseeable future.

Just after the election, AHCJ asked three distinguished experts – Karen Davis of the Commonwealth Fund, Joseph Antos of the American Enterprise Institute and John Rother of the National Coalition on Health Care – to weigh in on the outlook for health programs that serve seniors. Medicare held center stage during most of that web chat.

All three experts said that traditional Medicare isn’t sustainable and that a top priority should be reimbursement reforms that shift the program away from “paying for volume” to “paying for value.”

Although Medicare spending per capita has slowed, total spending will soar as tens of millions of baby boomers become eligible for the program, putting intense pressure on the federal budget, said Davis, president of the Commonwealth Fund.

Core Topics
Health Reform
Aging
Oral Health
Other Topics

With a 27 percent cut in Medicare reimbursement for physicians due to go into effect in January, the most immediate task for legislators is averting that, panelists agreed.

Next will come dealing with the “fiscal cliff” (a package of automatic tax hikes and spending cuts) that could throw the country into another recession, according to the panel. While an end-of-the-year deadline looms, that will surely be extended into next year, the panelists predicted.

“A key issue is whether Medicare and entitlement reform” will be part of these “fiscal cliff” discussions, Davis said. “Short term savings” in Medicare above and beyond those already proposed by the administration will likely be a focus, suggested Rother, president of the National Coalition on Health Care.

(President Obama had previously announced plans to cut projected increases in Medicare spending by $716 billion over a 10 year period. That’s now a floor for cuts that will be upcoming.) Continue reading →

Health care watchdog agency provides ideas for stories in coming year

Leave a reply
Len Bruzzese

About Len Bruzzese

Len Bruzzese is the executive director of AHCJ and its Center for Excellence in Health Care Journalism. He also is an associate professor at the Missouri School of Journalism and serves on the executive committee of the Council of National Journalism Organizations.

The HHS Office of Inspector General (OIG) has unveiled its FY 2013 OIG Work Plan , a blueprint for the watchdog agency’s work in the upcoming year and beyond.OIG 2013 Outlook Webcast at oig.hhs.gov

For enterprising health care reporters, this publication is like a catalog of story ideas, featuring hundreds of summaries of OIG’s upcoming reports, descriptions of its investigative and legal work, plus an overview of guidance it provides to the health care provider community.  Topics of upcoming reports include same-day hospital readmissions, oversight of poorly performing nursing homes, and FDA’s process for investigational new drug applications.

Also, on Oct. 24, OIG will launch its OIG Outlook 2013 webcast.  The free online event will include OIG’s senior leadership discussing emerging trends in combating fraud, waste and abuse in federal health care programs, OIG’s top priorities for 2013, and upcoming projects outlined in the Work Plan.

OIG’s mission is to protect the integrity of HHS’s 300+ programs – including Medicare and Medicaid – and the well-being of beneficiaries by conducting audits, evaluations, and investigations; providing guidance to the health care industry; and imposing civil monetary penalties, assessments and administrative sanctions.