Tag Archives: florida

Health reform battle entering a new phase

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

As I try to figure out what AHCJ members most need as they cover health reform in year two of the Affordable Care Act, I tried to see if I could detect themes at the AHCJ conference in Philadelphia. That unified theory of health reporting plan went out the door as I heard questions ranging from very basic queries about pre-existing conditions to far more technical inquiries about accountable care organizations.

My next plan was to blog about the “reporting on health reform” session.  A conference fellow  beat me to that – (also see the tip sheets Covering health reform issues, Health care reform: Litigation update, Three health reform issues to watch in the states).

What questions do you have about health reform and how to cover it?

Joanne KenenJoanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

The repeal and replace stage of the health wars isn’t over. But I think we are entering another phase. The dominant national discussion topic is the deficit and the debt – and that leads into Medicare, Medicaid and other entitlements.  I’ve done a tip sheet on Medicare and “premium support.” Medicaid is next up.

The proposals in the House-passed version of the budget are not brand new; Medicaid block-grant proposals have been around since at least the Reagan years, and they were definitely part of the Gingrich era. I remember hearing about variants of premium support and/or Medicare vouchers in the late 1990s, and I suspect they were around before that.

We don’t know every detail of what the Ryan plan would do; the budget plan is a federal framework, and the details aren’t filled in. And of course the Ryan budget won’t be accepted by the Democratic-controlled Senate or President Obama.  But this idea isn’t going to go away. We need to watch how it plays into reforms being considered at the state level, and see what kind of steam it picks up (or loses) after 2012.

If your governor or state legislature favors block granting Medicaid, it’s time to start asking questions.

  • What would Medicaid look like under a block grant?
  • Who would still get it?
  • Would there be enrollment caps and waiting lists?
  • How much of the costs would be shifted to the beneficiaries and families?
  • Would providers get paid less?

States can already get waivers for Medicaid, and that can allow for innovation in red and blue states alike.  States will have a lot more flexibility under some of the ACA provisions in the next few years, including ways of doing a better job caring for people with chronic disease and the “dual eligibles” on Medicaid and Medicare.

Here are a few articles I’ve seen recently that describe some of what the states are already doing – or considering – as they confront rising Medicaid costs today.

Looking at the coverage

Carol M. Ostrom of The Seattle Times had an April 17 piece: “Doctors: State plan to limit Medicaid ER trips risks lives.”

Several of the Florida papers have had pretty good coverage of Gov. Rick Scott’s plans to transform Medicaid. But a solid hour of Googling didn’t net me one good big clear step-back story (it may be out there somewhere … send it if you see it) that tells out-of-state readers the whole story. But I still found work by John Kennedy and Stacey Singer at The Palm Beach Post (here’s one) and Marc Caputo of The Miami Herald (click here – you have to read down a bit to get the state overview) helpful.

The Oregonian has been taking a look at some of Gov. John Kitzhaber’s agenda, which should be worth watching as he has a track record as an innovator (and knows CMS administrator Don Berwick quite well).  And of course we’ve all heard a lot about Arizona.

A lot of the stories I looked at from around the states were written by state capitol reporters, not health beat folks, so they were heavy on process and “Republican said X, Democrat said Y” kind of coverage. They didn’t always do a great job of getting beyond a fusillade of quotes.  I guess if I’ve been Googling for more than an hour and can’t find a really solid health overview story, I should stop here and invite you to send me any you’ve seen (or written).

Don’t forget about Medicaid

Medicare is getting an awful lot of ink – after all, old people vote, and most of us expect to get old someday and need Medicare. We’ve got to look harder at Medicaid which covers poor kids and their parents, some of the disabled and mentally ill, some of the HIV population, and lots of the residents of nursing homes. That isn’t who votes. That isn’t who decides what reporters cover. And it’s certainly not a benefit most of us hope to use someday.

Last comment for today – and you’ll probably hear me return to this theme frequently because, to me, it’s some of the most interesting reporting we’ll be able to do in the coming years:  Remember the Affordable Care Act, the health reform law, isn’t only about coverage and insurance exchanges. It makes countless changes to Medicare and Medicaid – changes that will affect the current fee for service model, changes that affect the private managed care sections of it and changes that will add new dimensions as we explore new ways of delivering care (medical homes, ACOs, a number of Medicaid programs aimed at getting people care in the community, not just nursing homes).

Joanne Kenen is AHCJ’s health reform topic leader. She is writing blog posts, tip sheets, articles and gathering resources to help our members cover the complex implementation of health reform. If you have questions or suggestions for future resources on the topic, please send them to joanne@healthjournalism.org.

Fla. group home’s sex policy raises questions

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.

St. Petersburg Times reporter Justin George has painstakingly assembled the story of a group home for developmentally disabled adult men in Florida which, George writes, “enacted a bold and unorthodox policy permitting sex between residents.” Many of the men in the home were sex offenders and, according to experts, the policy created “a sexually charged atmosphere that may have encouraged sexual assaults.”

While this may sound more like a story for the crime and justice beat, keep in mind that the center “received approximately $100,000 in Medicaid funding per person annually for most residents,” despite reports that it is in an advanced state of disrepair.

George pulled hundreds of records from numerous government agencies and conducted more than 40 interviews over the course of two years. It shows in his reporting. You should read the full story to understand the breadth and complexity of the issue at hand, but I’ll summarize for the time-challenged.

Center officials regard sex as a basic human right (as the World Health Organization declared in 1975) and, in one 2005 case, “staff wrote that they could not evaluate whether Kevin was learning appropriate sexual behavior because his mother wouldn’t let him have sex with other campus men,” George found.

Compounding the problem, the state agency that oversees HDC (the group home) did not object to the policy until a whistle-blower complained to a state legislator. An investigation documented multiple instances of improper sexual activity between residents.
HDC officials say that banning sex is not the answer. It would deny basic rights and simply sweep the issue under the rug, a response they say is all too common when dealing with sex abusers.
But two years later, the state still has not written an official policy concerning sex in group homes. The whistle-blower was fired, and the mentally disabled man at the center of the controversy is stuck in a facility that he — like other men there — is desperate to leave.

After it learned of George’s investigation, the state finally set out to draft a policy for sex in state-run group homes, and perhaps for private homes as well.

A draft of one policy would ensure that sexually aggressive residents don’t room with anyone else, but it doesn’t prohibit sexual activity in group homes unless the disabled are children. Prohibiting adult sex might violate civil rights, Palecki said.
The Human Development Center’s revised policy on sexual behavior states it will not promote sexual activity among residents. Condoms will still be available, but only if competent adults ask for them.

George also tells the stories of two women who lost their jobs after speaking out about the situation and suspicions that a resident has been unable to move to a different home because his mother has cooperated with an investigation.

Florida addicts priced out of private rehab

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.

In the St. Petersburg Times, reporter Leonora LaPeter Anton attempts to reconcile a local paradox: The state has suffered from epidemic of prescription drug abuse, yet Florida’s numerous private drug rehab centers remain empty. Why aren’t supply and demand coming together? The short answer, she found, is price.

… few who succumb to prescription drugs get the treatment they need. A national drug study estimated that just 10 percent of those who need treatment ever get it.

The problem is cost. Those with insurance quickly exhaust meager benefits and most don’t have $5,000 to $20,000 a month for round-the-clock rehab.

And the long answer? It comes back to insurance, then takes a sharp turn toward federal legislation. Insurers are reluctant to cover even 30-day treatment stays these days, Anton writes. “The typical plan at Blue Cross and Blue Shield of Florida, for example, offered $2,500 a year in substance abuse benefits. Anything over that was not covered.”

It’s a gap that the newly implemented Mental Health Parity and Addiction Treatment Act was designed to overcome. The new laws require that issues like substance abuse be covered at the same level that classic “medical” problems are.

Still, the new regulations apply only to companies with 51 or more employees. Though the law will likely improve care and make it more affordable, it won’t change the way insurers decide what is medically necessary. So with the push away from inpatient treatment, many addicts will try outpatient programs, which cost less, experts say.

Perhaps that is why 120 outpatient programs opened across Florida in the past two years. Florida licensed almost 400 new substance abuse treatment programs across the state, including 62 in the Tampa Bay area. Many focus on intervention, detox and the use of weaning medications such as Suboxone and methadone.

Lawsuit reveals failures in hospital hiring practices

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.

St. Petersburg Times reporter Curtis Krueger’s story about a successful whistleblower suit against a Florida hospital provides a powerful storyline about how disciplined health care workers continue to get hired. Here, he skips the government agencies and state databases and looks at communication between the hospitals themselves.

After all, don’t hospitals consult references and do background checks when hiring new doctors and nurses? In the corporate world of major hospitals, the answer is apparently “yes, but it doesn’t seem to do any good.”

… in general, (Beth Hardy, a spokeswoman for Morton Plant Mease Hospitals) said, if a hospital calls seeking information about a former employee, the company will simply confirm the worker’s dates of employment and last position held. She said that is “a standard and accepted policy across a lot of large organizations.”

The whistleblower suit itself, which resulted in a $450,000 award, involved a nursing supervisor who was fired soon after she criticized nurse Bernard M. Moran for falsifying records, a practice which got him fired at a previous job. Moran now works at another area hospital, one which says it checks the disciplinary records of all new hires.

The story only came to light because of the lawsuit. To understand just how many blind eyes were turned toward Moran’s behavior during this series of events, just take a look at Krueger’s story.

(Hat tip to Health News Florida)

Florida pill mills spread, resist prosecution

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.

With South Florida beginning to crack down, the pain pill mills that fuel the Appalachian drug trade are moving northward. Kate Howard and Paul Pinkham of the Florida Times-Union report that the trade, which has ravaged Appalachia for a decade and exploded in recent years, has hit Jacksonville with a vengeance. There are more than 50 pain clinics in the area, and they even tell stories of 20-something clinic owners and physicians driving sports cars and intimidating each other in competition for the lucrative out-of-state trade. Florida’s first statewide steps to combat the trade haven’t yet taken hold, the duo writes.

After years of trying, Florida became the 39th state to pass a prescription monitoring bill last year, but it wasn’t funded. Amid lingering questions about its potential effectiveness, the database was slated to launch in December with $500,000 raised through grants and private funding, but is now on hold because of a bid dispute.

Even if Florida does succeed in stopping the pill mills, there are fears that tough legislation will just push the problem into neighboring (and less regulated) Georgia.

Why is it so hard to crack down on pill mills?

Across the state, Letitia Stein and Susan Taylor Martin of the St. Petersburg Times explore what makes it so impossible to shut down the handful of rogue doctors who can each put thousands of pills a day into the hands of abusers. In some ways, it’s similar to other disciplined doctors stories we’ve been seeing lately, as it carefully details the administrative wasteland that stands between local doctors and actual punishment for their actions. Cases languish for an average of 18 months, there is not always consistent communication between enforcement agencies, and disciplinary board members say they don’t have the legal power to search for problem doctors.

“The biggest problem is. we can’t discipline anybody unless a complaint is filed,” said Rosenberg, a West Palm Beach dermatologist on the Board of Medicine. “And drug addicts aren’t about to complain about their drug dealer.”

Stein and Martin looked at about 200 Florida doctors who had been disciplined or investigated for inappropriately prescribing pain pills in the past five years, and found that more than a quarter still have active licenses. Most of them are experienced doctors with specialty certifications, and some practice despite being convicted of crimes or linked to fatal overdoses.

And Florida’s new legislative crackdown on pill mills? The reporters say it specifically targets pain clinics, yet rogue physicians often operate out of other settings.

(Hat tip to Carol Gentry of Health News Florida)

Tougher concussion rules from high school assn.

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.

The National Federation of State High School Associations has released tougher rules about removing players with potential concussions from the field. The initial release outlines the changes:

helmet

Photo by Les_Stockton via Flickr

The previous rule directed officials to remove an athlete from play if “unconscious or apparently unconscious.” The previous rule also allowed for return to play based on written authorization by a medical doctor. Now, officials are charged with removing any player who shows signs, symptoms or behaviors consistent with a concussion, such as loss of consciousness, headache, dizziness, confusion or balance problems, and shall not return to play until cleared by an appropriate health-care professional.

The Tampa Tribune‘s Mary Shedden and Katherine Smith reported on how the change would affect Florida high school football and on how implementations of the new rule vary from district to district.

Language in the new rule is vague, stating a player can’t return until cleared by a “health-care representative.” In Hillsborough and Pinellas counties, players will need a doctor’s clearance, but Pasco officials may interpret the rule to include medical officials who were at the game, said Phil Bell, Pasco’s supervisor of athletic programs and facilities.

The best-known guidelines for returning to the game come from a sports medicine expert consortium in Zurich. It recommends athletes gradually return to activities, from light aerobic activity to noncontact drills to game day. Each step takes a minimum of 24 hours, and if symptoms return, an athlete must revert to the previous step.

Texas, Oregon and Washington have state laws mandating when players should be taken off the field; many other states rely on their athletic associations to format such rules. With the school year and football season getting under way, this would be a good time for reporters to check on the policies at local schools. Read more about concussions, including some recent reports and Congressional testimony.