Tag Archives: cpi

Kidney disease kills thousands in sugar cane fields

In The Center for Public Integrity’s iWatch News, Sasha Chavkin and Ronnie Greene write that, “Little noticed by the rest of the world, chronic kidney disease (CKD) is cutting a swath through one of the world’s poorest populations, along a stretch of Central America’s Pacific Coast that spans six countries and nearly 700 miles. Its victims are manual laborers, mostly sugarcane workers.”

Each year from 2005 to 2009, kidney failure killed more than 2,800 men in Central America, according to the International Consortium of Investigative Journalists‘ analysis of the latest World Health Organization data. In El Salvador and Nicaragua alone over the last two decades, the number of men dying from kidney disease has risen fivefold. Now more men are dying from the ailment than from HIV/AIDS, diabetes and leukemia combined.

Unlike in more developed nations, neither diabetes nor hypertension can be blamed for the widespread kidney ailments. Instead, the duo found, scientists suspect possible environmental toxins and strenuous labor conditions, both linked to the cane fields, as well as alcohol abuse and anti-inflammatory drug use. At present, researchers seem to be focusing on heat stress as the most likely culprit, and plantation owners seem to concur

Internal studies by Nicaragua Sugar, owners of one of Central America’s largest sugar plantations, provided by the company to ICIJ, show that the company has long had evidence of an epidemic tied to heat stress and dehydration. In 2001, company doctor Felix Zelaya conducted an internal study on the causes of CKD among its workers. “Strenuous labor with exposure to high environmental temperatures without an adequate hydration program predisposes workers to heat stress syndrome [heat stroke], which is an important factor in the development of CKD,” Zelaya concluded.

Nicaragua Sugar and other companies say they have acted voluntarily to protect workers by improving hydration, reducing work hours, and strengthening oversight of labor contractors.

Chavkin and Greene dig deep into the economic and political factors underlying the global response to the epidemic, as well as the day-to-day impact it all has on workers’ lives. For more, read their full investigation.

CPI investigation details health information technology sector’s lobbying efforts

Writing for The Center for Public Integrity’s iWatch News, Josh Israel reports that, with billions of stimulus dollars still at stake, the number of health information technology lobbyists taking advantage of the lucrative “revolving door” between Capitol Hill and the private sector is sky-high, even by D.C. standards.

The Obama administration is still working to iron out the details of the “meaningful use” mandate expressed in the recovery act, and the big players in health IT are pulling out all the stops to ensure the rules are written to their advantage.

Healthcare Informatics magazine publishes an annual ranking of the 100 largest health IT companies by annual revenue. According to the Senate Office of Public Records, 15 of the companies in the 2010 ranking — most of them ranked in the top third by revenue — reported health IT-related lobbying activity in the first quarter of 2011 or the last quarter of 2010. Of the 90 lobbyists listed as having done health IT lobbying for those firms, at least 63 were former Congressional and/or executive branch staffers, many of whom worked for health-related agencies or committees.

For those interested in additional details on HIT’s lobbying efforts, Israel also included two sidebars:

Report explains doctors’ reluctance to adopt EMRs

Writing for the Center for Public Integrity’s iWatch News, Susan Jaffe spent time in the trenches to better understand how government incentives toward the adoption of electronic medical records are (or aren’t) working. She spent time with Cleveland-area small practices and government agencies to understand the real obstacles faced by physicians on the ground. It offers a picture of the reality of EMR today. Some of my favorite tidbits:

  • “570 different electronic health systems certified by private organizations for non-hospital settings may be used to qualify for the bonus.”
  • “The systems are priced in a way that does not make comparison shopping ‘easy or necessarily valid,’ said Dottie Howe, a spokeswoman for the Ohio regional extension center. There is no basic price because each company offers different components, features, options, and level of technical support.”
  • EMR systems can include more than a thousand sometimes-customizeable details, and that’s not including the myriad warnings and cross-checks.
  • Compatibility with the systems in the area’s large hospitals is tough to guarantee, yet factors as a major concern for many small practices.
  • How early adopters in the field were burned and are wary of getting fooled again.
  • When practices adopt EMRs, they typically have to go through a “learning curve,” a period of weeks or months during which they can only see about half as many patients.
  • Many major HIT companies don’t guarantee that physicians who adopt their systems will meet the standards for a government HIT bonus.
  • The VA’s proven HIT system is available for free, but can’t handle billing and insurance.
  • To get the maximum bonus payment, practices must adopt EMRs this year or next.
  • Only certified systems can earn bonus payments, yet the second and third stages of certification haven’t even been finalized yet.

An accompanying piece by Emma Schwartz looks at one physician’s concerns.

Investigations spotlight workplace safety

Workplace safety got plenty of attention last week, from a public radio investigation in Seattle to a series by the Center for Public Integrity that includes plenty of opportunities for localizing.

KUOW’s John Ryan conducted hit the topic from all sides, with a five-part series on workplace safety in Washington. His story selection ranges from stats-directed investigations to features focusing on unique cases.

Chris Hamby did a two-part investigation in the Center for Public Integrity’s iWatch News on OSHA’s Voluntary Protection Programs, which exempt “model workplaces” from regular inspections (Part 1, Part 2).

Over the course of his eight-month investigation, Hamby pored over thousands of pages of documents which revealed, among other things, that “Since 2000, at least 80 workers have died at these sites, and investigators found serious safety violations in at least 47 of these cases.”

Workers at plants billed as the nation’s safest have died in preventable explosions, chemical releases and crane accidents. They have been pulled into machinery or asphyxiated. Investigators, called in because of deaths, have uncovered underlying safety problems — failure to follow recognized safety practices, inadequate inspections and training, lack of proper protective gear, unguarded machinery, improper handling of hazardous chemicals.

Yet these companies have rarely faced heavy fines or expulsion from the program. In death cases in which OSHA found at least one violation, VPP companies ultimately paid an average of about $8,000 in fines. And at least 65 percent of sites where a worker has died since 2000 remain in VPP today.

The program, with its emphasis on cooperation between regulators and industry, began under the Reagan administration and greatly expanded under the most recent Bush regime. There are some success stories, Hamby found, but he also uncovered a hearty helping of dirty laundry. Those included preventable deaths traced to OSHA violations, failures to self-police and an emphasis on expanding program participation at the expense of quality and safety.

In the second installment, Hamby spotlights oil refineries to illustrate what became a familiar pattern.

Recognition of “model workplace” status, missed opportunities to detect and fix hazards, a serious mishap or fatal accident, detection of safety violations and, ultimately, continuation of the government’s stamp of approval.

Hamby backs up these strong words with even stronger numbers. Here’s just one sample:

During 2009 and 2010, at least 21 of 55 fires at refineries falling under federal jurisdiction occurred at VPP sites, an iWatch News analysis of regulatory and news media reports found. VPP sites make up about 30 percent of these refineries, so these government-recognized sites have experienced more than their proportionate share of fires.

Reporters have already produced local versions of Hamby’s story throughout the country, particularly in Florida and Louisiana.

Related: OSHA lists 147 employers as “Severe Violators” of worker safety standards

WSJ explains why Medicare data is hidden

In The Wall Street Journal, reporters Mark Schoofs and Maurice Tamman have pulled off an impressive feat, weaving a tale of freedom of information and databases so compelling that it’s already attracted hundreds of comments and attention from all over. At its heart, it’s the tale of why public Medicare payment data does not identify the doctors and individual providers who receive about an eighth of its annual disbursements. If the practitioners were identified, the authors argue, the public and press would be better equipped to expose and deter fraud.

The Medicare claims database, partially available for around $18,300 a year, is one of the most powerful health data resources in the world. It’s also hamstrung:

While the services and earnings of hospitals and other institutional providers can be publicly identified, such information is kept strictly confidential for doctors and other individual providers. The reason is that the American Medical Association, the doctors’ trade group, successfully sued the government more than three decades ago to keep secret how much money individual physicians receive from Medicare. The AMA has continued to defend this ruling, including in two cases in which federal appeals courts issued decisions last year.

This time around, The Wall Street Journal and the Center for Public Integrity took the AMA on. For health journalists, their description of what followed is really the crux of the story:

The Wall Street Journal, in conjunction with the nonprofit Center for Public Integrity, attempted for nearly a year to obtain the database. As part of the effort, the CPI filed a lawsuit against the Department of Health and Human Services, which houses the Medicare program. The Journal and CPI wanted the data at no cost; the government wanted $100,000 for eight years of data. In a settlement, The Journal and CPI obtained the requested data at a substantially reduced fee. They later obtained a decryption key to identify individual providers but signed a contract agreeing not to publish such identities in most cases.

The database, technically known as the Carrier Standard Analytic File, focuses on doctors and others paid on a fee-for-service basis. It contains 5% of all beneficiaries, and includes all doctor claims that Medicare paid directly in association with their care.

There’s far more to the story including information about the Consumers’ Checkbook lawsuit and the penultimate paragraphs on just how clear-cut fraud cases can be, once you know what to look for. An article on the Center for Public Integrity’s website promises more reporting, presumably based on the database, of “some of the questionable spending that occurs in the Medicare program.”


Physician Panel Prescribes the Fees Paid by Medicare