Tag Archives: new york times

Cash-strapped Ill. goes after hospitals’ nonprofit status

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.

A New York Times article written by Bruce Japsen, an independent journalist writing for the Chicago News Co-Op, digs into Illinois’ recent challenges to the tax exemptions granted to a trio of prominent hospitals by virtue of their nonprofit status. The challenge, inspired in part by the state supreme court’s willingness to uphold the revocation of the nonprofit status of an Catholic hospital in Urbana last year, could expand to more than a dozen other institutions as the state scrambles to cover a looming revenue shortfall.

In its case, the state alleges that the hospitals aren’t providing a high enough proportion of charity care to fulfill the mission of a nonprofit.

All three of the hospitals the state is focusing on provided free and discounted medical care that ranged from 0.96 percent to 1.85 percent of patient-care revenue, according to the revenue department. The state also said that each one had been operating as a “for profit” business when the state’s Constitution says that “only charities are entitled to a tax exemption.”

The hospitals, for their part, point to the other benefits they provide the community, such as neonatal intensive care and burn units, that don’t always bolster their bottom lines. Advocates answer that paying taxes provides a community benefit as well, one that can readily be measured in dollars and cents. And Japsen found that paying those taxes doesn’t even seem to preclude the provision of charity care, especially at the parsimonious levels provided by the hospitals currently targeted by the state.

“The relative amounts of charity care provided by not-for-profit tax-exempts are not materially different from the amount provided by for-profit hospitals,” said Jim Unland, a longtime analyst of Illinois’ health care industry and president of the Health Capital Group, a consulting firm in Chicago. “This raises the issue of whether the tax-exempts are getting prejudicially favorable treatment.”

The three hospitals whose tax exemptions have been stripped by the state department of revenue plan to challenge the action in court, and state hospital organizations are gearing up for a lobbying push they hope will put their tax status on firmer ground.

NYT reporters tease hip replacement numbers from difficult data

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.

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.

kidsPhoto by Michael Simmons via Flickr

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.

Reporter FOIA’s database further exposing the toll war takes on returning vets

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.

Writing for the Bay Citizen and The New York Times, Aaron Glantz brings a new, data-based take on the mental and physical toll the wars in Iraq and Afghanistan have taken on returning veterans, thanks to what he calls “an obscure government database called the Beneficiary Identification Records Locator Subsystem death file,” which he obtained via FOIA.

The database, which reveals a high rate of suicide and fatally risky behavior, lists all veterans who earned Veterans Affairs benefits since 1973.

Records from that database, provided to The Bay Citizen under the Freedom of Information Act, show that the VA is aware of 4,194 Iraq and Afghanistan veterans who died after leaving the military. More than half died within two years of discharge. Nearly 1,200 were receiving disability compensation for a mental health condition, the most common of which was post-traumatic stress disorder.

Names were redacted, but Glantz nonetheless managed to identify a number of veterans, including a troubled 26-year-old man who threw himself under a train just three days after being turned away by the VA. In the course of his investigation, Glantz has managed to fill in some of the gaps in the federal records, a process which has shown just how lacking the VA’s data can be.

In October, The Bay Citizen, using public health records, reported that 1,000 California veterans under 35 died from 2005 to 2008 — three times the number killed in Iraq and Afghanistan during the same period. At the time, the VA said it did not keep track of the number of Iraq and Afghanistan veterans who died after leaving the military.

The VA database does not include veterans who never applied for benefits or who were not receiving benefits at the time of their death, according to the agency. The VA said it also did not keep track of the cause of death.

When confronted with his agency’s shortcomings, a VA representative responded in a manner that belied his agency’s lack of focus on recordkeeping.

David Bayard, a VA spokesman, said the agency was working hard to treat veterans with mental health issues. “VA has some pretty fine programs,” Mr. Bayard said, “but unfortunately we aren’t always successful.”

Newly named NYT editor spoke to AHCJ about health coverage

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.

Jill Abramson, who will become executive editor of The New York Times in September, welcomed health journalists to AHCJ’s  2007 Urban Health Journalism Workshop. At the time (October 2007) she was the paper’s managing editor. In her brief talk, she discussed the importance of health journalism and the Times‘ expanding health coverage (MP3).
Listen to Abramson

She also was among the speakers discussing the future of science journalism at the Massachusetts Institute of Technology in April 2009.

An inside view of writing for New York Times’ Magazine

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.

On the blog The OPEN Notebook, New York Times Magazine contributor Robin Marantz Henig spoke frankly with Jeanne Erdmann about everything that went into her piece, “Understanding the Anxious Mind.” A few years have passed since the piece’s publication, which might help explain why the reporter was willing to give such a thorough postmortem.

Highlights include:

  • The difference between a magazine article and a master’s thesis.
  • How to trick your agent into letting you write a book about Valium.
  • Dealing with a jumpy editor spooked by your previous false starts.
  • This sentence: “It was difficult to get the right kind of anxious people to interview.”
  • The difficulties that even a veteran writer has in pitching New York Times Magazine and the letters to prove it.
  • 15-20 drafts, and that’s before the NYT demanded another three or four rewrites.

(Hat tip to Paul Raeburn)

NYT’s health editor takes over the science section

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.

Barbara Strauch, who has been the deputy science editor charged with coordinating The New York Times‘ health and medical coverage, is stepping up to become that newspaper’s science editor. On March 15, Strauch will take the place of Laura Chang, who led NYT science for six years. Chang will direct the paper’s “cross-departmental” coverage of the 10th anniversary of the 9/11 terrorist attacks.

According to a report from Curtis Brainard and Cristine Russell on CJR.org, Strauch will lead a 22-person department (not including freelancers) and plans to maintain the paper’s equal emphasis on both health and science.

In addition to already prominent health topics like genetics, Strauch told CJR that she thinks issues like sociology, demography and psychology will rise in profile in the coming year. She also told the reporters that she plans to hire somebody to replace her as health editor, but that she’s going to remain flexible in terms of department structure for the time being.

In an internal e-mail announcing the promotion, NYT Executive Editor Bill Keller praised Strauch’s work on the paper’s health section.

“What was already a major undertaking, discerning and covering the most important stories in a constant stream of medical research, tracking the changing worlds of physicians and pharmaceuticals, has been a gargantuan task as the costs and politics of health care have become a consuming national issue,” he wrote. “Barbara’s deep understanding of the issues, her exquisite sense of timing and her appreciation for good storytelling have enriched every part of this coverage.”

NYT’s Heffernan contrasts WebMD, MayoClinic.com

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.

New York Times Magazine columnist Virginia Heffernan has posted a take on the quality of online health information, framed as a side-by-side review of WebMD and MayoClinic.com. Her characterization of for-profit WebMD as a “hypochondria time suck” has garnered the most attention so far, but it seems almost tame compared to her attacks on the site’s ties to big pharma and her exhortation that users actively block that particular address from their web browsers.

As an example, after praising the Mayo Clinic’s restrained approach to patients looking to self-diagnose a headache (it waits until page eight to suggest OTC painkillers), Heffernan flips to WebMD and describes the site’s approach:

… if you plug “headache” and “WebMD” into Google, the Web opens to the glamorous, photo-dominated “Migraines and Headaches Health Center,” a sound-and-light show that seems itself like a headache trigger. There’s the requisite picture of a tastefully made-up young woman holding her head in exquisite agony. The headache “news,” flush right on the page, comes with more artful photos of lovely people in pain and includes scare headlines like “Headaches: When Is It an Emergency?” The first page contains no hard facts — you have to click and thereby drive up the site’s lucrative click-throughs — but instead quickly transforms visitors from Web users with headaches to hard-core migraineurs and drug consumers.

For the record, WebMD pulls in almost three times as many monthly page views as its nonprofit rival.

Related

Initiatives not improving patient safety; poor implementation to blame

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.

A large-scale study that followed mistakes in health care delivery at 10 North Carolina hospitals from 2002 to 2007 found that, despite state efforts, there was no improvement in patient safety over the time period. According to The New York Times‘ Denise Grady, the problem lay primarily not in design, but in execution. Even when safeguards were in place, they were not followed.

The study, published in the New England Journal of Medicine, reviewed thousands of patient records and looked for any of 54 red flags that something had gone wrong.

Dr. [Christopher] Landrigan’s team focused on North Carolina because its hospitals, compared with those in most states, have been more involved in programs to improve patient safety.

But instead of improvements, the researchers found a high rate of problems. About 18 percent of patients were harmed by medical care, some more than once, and 63.1 percent of the injuries were judged to be preventable. Most of the problems were temporary and treatable, but some were serious, and a few — 2.4 percent — caused or contributed to a patient’s death, the study found.

The findings were a disappointment but not a surprise, Dr. Landrigan said. Many of the problems were caused by the hospitals’ failure to use measures that had been proved to avert mistakes and to prevent infections from devices like urinary catheters, ventilators and lines inserted into veins and arteries.

Problems cited in the study include a lack of electronic medical records, doctors and nurses regularly working long hours and poor compliance with even simple interventions such as hand washing. Proposed solutions include computerized drug ordering systems and a mandatory nationwide monitoring system.

Ghostwritten textbook just ‘tip of the iceberg’

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 New York Times‘ Duff Wilson has uncovered what he calls the first ghostwritten book. Published in 1999 under the names of two prominent psychiatrists, “Recognition and Treatment of Psychiatric Disorders: A Psychopharmacology Handbook for Primary Care” coyly mentioned that it was funded by an unrestricted educational grant from the company that is now GlaxoSmithKline.

What it doesn’t mention is that GSK apparently also paid ghostwriters to create the outline and text of the book, then signed off on the final version. Up to this point, ghostwriting had been restricted to journal articles.

A Washington advocacy group called the Project for Government Oversight released documents detailing the relationship on Monday, but Wilson also  explains how the Times found their copies:

The documents were separately obtained by The New York Times from the Los Angeles law firm of Baum Hedlund, which received them as part of discovery in lawsuits against the drug company, now known as GlaxoSmithKline, involving Paxil. Leemon B. McHenry, a bioethicist with California State University, Northridge, who consults for the law firm, said many similar documents remain sealed. “This is only the tip of the iceberg,” he said.

Wilson writes that the book was co-published by American Psychiatric Publishing and the American Medical Association. He does not, however, delve deeply into its content or address how it discusses Glaxo’s products.

Community-led effort sparks public health wave

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.

Writing in The New York Times, Jessica Reaves writes about how a 2000-06 Chicago community survey embodies the block-by-block, community-reliant approach to public health that it helped inspire.

In the heavily Puerto Rican Humboldt Park neighborhood, researchers worked with community leaders to write study questions, then relied on community members to conduct the actual survey. From these roots, the level of community participation snowballed, and locals demonstrated an interest and investment in public health that researchers hasn’t seen before. Today, initiatives born out of that study still provide residents with access to fresh produce, free diabetes screenings, fitness classes and more.

Now, researchers are further localizing and intensifying their effort with a block-by-block approach. The Humboldt Park model has become one that others are working to replicate across the country.

The specifics of the Sinai approach (In Humboldt Park) — change-oriented and invested in the fate of a neighborhood — are distinctive, but they also reflect a sea change in the overall strategy of public health professionals, said Janine Lewis, executive director of the Illinois Maternal and Child Health Coalition, a nonprofit advocacy organization in Chicago.

“I think the field is becoming more responsive to the idea of community-based participatory research,” Ms. Lewis said. “Those of us in the field realize that community members are experts on the needs and gifts in their communities, and should be consulted” at every phase of research.

This approach, she added, not only helps investigators devise more meaningful questions, but also means residents feel a part of the process and motivated by the results.