Tag Archives: health and human services

#AHCJ2010 early coverage roundup

Apart from the announcement of the FDA’s infusion pump regulation push, the biggest appearances out of Health Journalism 2010 in Chicago this week have been U.S. Department of of Health and Human Services Secretary Kathleen Sebelius and Thomas Frieden, director of the Centers for Disease Control and Prevention.

Landon Hall, of The Orange County Register, covered the Sebelius and Frieden appearances for AHCJ.

sebelius2010At Health Journalism 2010, Kathleen Sebelius talked about implementing health care reform. (Photo: Pia Christensen)

Reuters’ Debra Sherman also covered both presentations.

Sebelius focused on insurers, especially those who deny coverage to those with a legal write to it, Sherman wrote. According to Sherman, “Sebelius… said to expect ‘hand-to-hand combat’ if insurers try to ‘drive patients out of plans.'”

Working from a broader perspective, New America Foundation’s Joanne Kenen wrote about how insurance fit into Sebelius’ larger task of implementing recently passed health care reform measures.

In his presentation, Frieden focused on smoking, which he called the leading preventable cause of death. Reuter’s Sherman again:

Dr. Thomas Frieden, director of the Centers for Disease Control and Prevention, said that after years of steady declines in the nation’s smoking rates, progress has stalled over the last few years and that the agency was renewing its focus.

He said government stimulus funds would be used to increase anti-smoking efforts. He said the CDC would encourage states to implement anti-smoking strategies, such as education and media campaigns, smoke-free laws and higher cigarette prices.

In other AHCJ 2010 news, Dallas Morning News reporter Robert Garrett wrote that a “siege mentality was very much on display when a trio of hospital executives spoke this morning at an Association of Health Care Journalists conflab in Chicago.”

“We’re all scared to death by health care reform,” said Advocate Health Care president and CEO Jim Skogsbergh, who runs 13 hospitals in Illinois. “We know we’re going to get paid less.”

CDC health overview: Diagnostic scans tripled

The CDC has released the 2009 version of Health, United States, their annual summary of health numbers and trends. It’s an epic heap of data; get the full PDF here.

For a 574-page, 10.22 MB government document, it’s surprisingly easy to navigate. There’s a table of contents, links and a nifty little feature which allows you to pull up a spreadsheet of the data from any chart or graph. In addition to the lead story on medical technology and scanning, the report includes 150 data tables. That’s a bit too much to summarize here, so we’ll settle for the CDC’s version of the highlights:

  • … the rate of magnetic resonance imaging, known as MRI, and computed and positron emission tomography or CT/PET scans, ordered or provided, tripled between 1996 and 2007.
  • The rate of adults aged 45 and over discharged from the hospital after receiving at least one knee replacement procedure increased 70 percent from 1996 to 2006 (26.5 per 10,000 population in 1996 to 45.2 per 10,000 in 2006).
  • From 1988-1994 to 2003-2006, use of antidiabetic drugs among adults aged 45 years and over increased about 50 percent, and the use of statin drugs to lower cholesterol among this age group increased almost tenfold.
  • The number of new organ transplantations per 1 million people increased 31 percent for kidney transplants (43.7 per 1 million in 1997 vs. 57.2 in 2006) and 42 percent for liver transplants between 1997 and 2006 (15.6 per 1 million in 1997 vs. 22.2 in 2006).
  • Life expectancy at birth increased more for the black than for the white population between 1990 and 2007, thereby narrowing the gap in life expectancy between these two racial groups. Overall U.S. life expectancy in 2007 was 77.9 years.
  • In 2007, 20 percent of U.S. adults were current cigarette smokers, a slight decrease from 21 percent in the previous three years. Men were more likely to be current cigarette smokers than women (22 percent vs. 17 percent).
  • In 2005-2006, 30 percent of adults often or almost always had trouble sleeping in the past month.
  • In 2007, 20 percent of adults 18 years and over had at least one emergency department visit in the past year, and 7 percent had two or more visits.
  • The percentage of the population taking at least one prescription drug during the previous month increased from 38 percent in 1988-1994 to 47 percent in 2003-2006, and the percentage taking three or more prescription drugs increased from 11 percent to 21 percent.

Autism news raises question: When is an embargo not an embargo?

Are embargoes yet another quaint tradition that, like so many before it, has been pushed into obsolescence by the weight of the Internet? Do so many people have access to so much information they can share so easily that artificial restrictions on publication are meaningless?

Consider: In a Friday press conference, the Department of Health and Human Services discussed, under embargo, highly newsworthy data indicating a much higher than expected prevalence of autism in the United States. HHS didn’t mention, however, that in an earlier call it had already given the most newsworthy part of that information to members of the “autism community,” and had not restricted them from publishing the info. The incident raises serious questions about giving special interests privileged access to data at the expense of major media outlets, as well as the validity of embargoes in an era of increasing media fluidity.

Routine embargo?

Friday, at 3 p.m., HHS held a press conference announcing (among other things) that according to a CDC study, the prevalence of autism spectrum disorders, previously thought to be about 1 in every 150 children, is actually closer to 1 in every 100 children. This news, big enough that it led Monday’s health coverage, was embargoed until Monday because it reached conclusions similar to Health Resources and Services Administration (HRSA) findings that would be published in the journal Pediatrics that day.

There is some confusion as to where the embargo originated, as a Pediatrics representative said the journal only enforced an embargo of the HRSA study, and that anybody could have published the results of the CDC study. We are still awaiting a CDC response and more information from AAP, but have talked to representatives of the National Institute of Mental Health (NIMH) and this much, at least, is clear: As applied, the embargo covered both studies and every bit of data released to journalists. It was not, however, applied to information about the CDC study released in the autism community call.

“Both the CDC overview and the HRSA study were embargoed, because the subject nature was obviously so similar,” NIMH spokesman Jim McElroy said. “It just wouldn’t be appropriate to not have the CDC following the same set of guidelines as the HRSA study as it relates to the embargo.”

Special access for special interests

The 2 p.m. autism community call, a hastily organized affair for which invitations went out just hours beforehand, featured a brief appearance by HHS Secretary Kathleen Sebelius and gave autism advocates a broad overview of the CDC study, McElroy said. Because few specifics were discussed, the study’s broad conclusion (that the prevalence of autism spectrum disorders was now thought to be nearer to 1 in 100 children) was not under embargo.

McElroy again:

“The embargo was not in place for the advocacy groups but that’s why it was a far more general overview approach on the part of NIMH, HRSA and CDC… whereas with media it was clearly understood that an embargo was in place so media had the opportunity to ask questions.”

“The advocacy groups are very different by nature.. from media outlets whose job is to disseminate information. It’s two very different audiences and that’s why the embargo certainly is in place.”

In other words, the autism community got less information, but they were allowed to do as they pleased with what they got. The media, on the other hand, got much more information, but were not allowed to publish any of it, not even that part which had been given to the autism community without restrictions.

Autism advocates run with the news

Those on the “autism community” call wasted no time in running with the info they’d learned. For example, Dan Olmsted immediately posted the key stat on Age of Autism, and David Kirby posted a more thorough breakdown on Age of Autism and The Huffington Post soon after. About.com also posted the data (with a reference to the Pediatrics article, even), though it seems to have been taken down since (It’s still indexed in Google news).

Adventures in Autism blogger Ginger Taylor joined the call as well; her Friday post reveals a few key facts about the discussion.

“The conference call was not announced to the press or public, but merely in an e-mail sent out at 9 a.m. inviting around 50 people in the autism community (almost exclusively friendly to the administration) to the 2 p.m. call with a ‘sorry for the short notice,'” Taylor wrote.

Journal doesn’t budge

Meanwhile, Pediatrics didn’t drop the embargo. In a brief call Tuesday morning Susan Martin, American Academy of Pediatrics’ director of media relations, said that stories like the Age of Autism and Huffington Post pieces hadn’t broken Pediatrics‘ embargo because they only reported on the similar study to be published by the CDC, and not specifically on the journal’s embargoed article, “Prevalence of Parent-Reported Diagnosis of Autism Spectrum Disorder Among Children in the US, 2007.” Martin did acknowledge that About.com had broken the embargo.

Readers take “tardy” media to task

The comments on Kirby’s Huffington Post entry show just how much of a debacle the embargo was for major media outlets. Readers didn’t understand the media’s hands were tied, they just knew that major outlets weren’t reporting on what looked like big news. Here are the most telling entries:

“Thanks to HuffPo for covering the autism issues that are being ignored by so many.”
–Theresa Conrick (Oct. 4)

“I sent this link to all TV news stations in our viewing area,both newspapers and the most popular Newstalk..­…silence­.”
–KFuller (Oct. 4)

“Stakeholders are just crying this weekend that no news source picked up this story. Thank you from the bottom of my heart Huffington Post and David Kirby.”
–TannersDad (Oct. 4)

The fallout: Do embargoes work anymore?

In the case of the bungled HHS autism release, mainstream outlets with explicit standards and institutional policies were hamstrung while less-established outlets nimbly skipped out front of a major story. It’s a somewhat unique situation that underscores the growing weakness of the embargo process.

Do embargoes work when they don’t apply to everyone equally? What about when they’re not followed by everyone? Is it “good enough” to keep mainstream media off the news while it multiplies with impunity throughout the blogosphere?

A related consideration: How big must an embargo-breaker be before everyone else follows suit? About.com, for example, gets more American traffic than any media outlet but CNN, ESPN and The New York Times and is the 27th most popular site among American Web users. It’s even owned by The New York Times Company, though the independently contracted “guide” who posted the news wasn’t under the control of the Times‘ editorial staff, of course. Despite all that, About.com still wasn’t considered influential enough to have killed the embargo.

Everybody needs to be under the same rules

AHCJ president and ProPublica senior reporter Charles Ornstein said that “If they’re going to be sharing information, it should be shared with the premise that everybody’s under the same rules.”

“I think it’s unfair to hold an embargoed briefing for the media and a non-embargoed briefing for advocates,” Ornstein said. “In a way, I think this punishes the media for abiding by embargoes in an era where information is easily shared by blog posts and by Twitter. When information enters the public domain, embargoes should be lifted.”

“While many people believe that embargoes play a vital role, events like this should cause us to make sure they’re fair to the media, and, even more than that, ask whether they help or hinder the process of conveying information to our readers, viewers and listeners,” Ornstein said.

UPDATE: Pediatrics explains why they didn’t lift embargo

Having made clear that the organization’s embargo only extended to the HRSA study, and not the CDC study discussed on the autism community call, the AAP’s Susan Martin provided AHCJ with the following statement:

The American Academy of Pediatrics (AAP) was notified of an embargo break by About.com on Saturday, Oct. 3, by a journalist for another news organization. The AAP evaluates embargo breaks on a case-by-case basis. In the About.com case, the AAP denied a request to lift the embargo early. Lifting the embargo over the weekend would have only added to the confusion, especially as the About.com post was removed as soon as the reporter learned she had broken the embargo, and many journalists had scheduled their news reports on the study to run Monday, Oct. 5.

In a similar vein, the just-distributed Pediatrics‘ media mailing for the Oct. 12 issue contained an “Editor’s Note” laying out the terms of AAP embargoes and reminding journalists of the sanctions the academy can impose upon outlets who violate those guidelines. The note also reminds folks that “Any decision to lift an embargo early is at the sole discretion of the AAP.”

UPDATE: CDC says no numbers were given to advocates

CDC spokeswoman Artealia Gilliard told AHCJ on Tuesday afternoon that everything in the 3 p.m. press call was under embargo, while nothing that would have been covered by that embargo was mentioned in the earlier call with the autism community. In particular, Gilliard said, no specific prevalence rate numbers were given out on the call.

“We basically said ‘On Monday, two studies will come out. They will update the prevalence estimate we previously had.’ … It didn’t actually have any of the information that was embargoed.”

Gilliard, who was on both calls, specified further: “I know they didn’t put out numbers in the advocacy call. I know we didn’t say 1 in 100. What we’ve been saying is ‘approximately 1 percent of children.'”

The difference between “1 in 100” and “approximately 1 percent” is up for debate, but via e-mail, Adventures in Autism blogger Ginger Taylor outlined exactly how she and other autism-community bloggers were able to report the numbers without sitting in on the embargoed call: They’ve known them for a while.

Taylor first noted rumors of the new rate in a July blog post, David Kirby confirmed the rate and published conclusions of both the HRSA and CDC studies on the Huffington Post in August, and Tina Cruz noticed relevant changes to the CDC site late last month. So, even if the phrase “1 in 100” was never uttered, those in the know were quick to connect the dots. Kirby confirmed this via e-mail, here’s an excerpt:

According to my notes for the community call, this is what Dr. Insel said:
“Preliminary analyses indicate an increase in estimated prevalence, to around 1% of children affected.”
1%, obviously, is 1 in 100.

Cruz also notes in the comments on this post that she noticed changes to the numbers on the CDC’s Web site.

So, while the cat may already have been out of the bag, the CDC did not release embargoed information on the autism call because, Gilliard said, “There’s no such thing as embargo with the general public. The only people who respect embargoes are journalists.”

In the autism advocate call, Gilliard said the CDC carefully walked the line between respecting Pediatrics‘ embargo and alerting parents and advocates to the upcoming changes as soon as possible.

OIG: Are we ready for a flu pandemic?

The Department of Health and Human Services’ Office of Inspector General has released two reports assessing just how prepared Americans are for a flu pandemic. Their findings? Communities are on the right track when it comes to preparing for a surge in patient numbers, but they’re not as ready as they could be. Likewise, there’s still more to be done before local organizations will be ready to distribute vaccines and antiviral drugs.h1n1

A surge of flu victims

In the Southern Hemisphere, where the flu season has already struck, the biggest systemic issue was lack of space in intensive care units overwhelmed by H1N1 victims. Are American communities doomed to more of the same? After reviewing the coordination, volunteer recruitment/organization, medical equipment, alternate care and triage and admission guidelines of 10 localities as of late summer 2008, the OIG’s answer is a resounding “not quite.” (Get the full 37-page report here.)

The OIG’s to-do list for the assistant secretary for preparedness and response?

  • Keep emphasizing those five areas that we evaluated
  • Make sure that, when states and localities do medical surge preparedness exercises, they then document and address the lessons they learned from those activities.
  • Those lessons everyone just documented? Make sure they share them with everyone else too. Preferably through the CDC. Then the feds can work to address specific local issues.
  • Consider working with states (or even the federal government) to “develop appropriate legal protections for medical professionals and volunteers who respond to public health emergencies and who may need to alter standards of care.”

Getting vaccines/antivirals to the right place, at the right time

According to HHS, “even a mild pandemic could cause between 2 million and 7.4 million deaths worldwide” and H1N1 looks to be a “moderate” one. Vaccination is a key component of the prevention plan, which is why the OIG evaluated the pandemic flu plans of 10 communities in the categories of “Receiving & Staging, Dispensing, Tracking, Vulnerable Populations, Priority Groups, Security, Storage, and Transportation.” In general, they found that the communities need to practice more, plan for all eight categories and make those plans “actionable.” In general, folks were best at planning for receiving/staging and dispensing and worst at planning for security, storage and transportation.(Read the whole 57-page report here.)

Based on those findings, the OIG recommended that the CDC:

  • Work with states to figure out why folks are still in the “early stages” of planning and help them make some progress
  • Prioritize which of the eight areas states should focus on in order to improve local readiness as quickly as possible.
  • Emphasize “actionable” plans that “identify the organizations or individuals responsible for carrying out specific actions and the sources that would be necessary to staff distribution and dispensing positions” that are “supported by valid, detailed formal agreements with partnering agencies.”
  • Again, make sure locals keep track of what they’ve learned in preparedness exercises and that they make plans to correct any deficiencies. Also, make sure they share plans and “emerging promising practices.”

Key CMS database unresponsive, inadequate

The Department of Health and Human Services’ Office of Inspector General released a memo (27-page PDF) detailing an investigation that found that the effectiveness of a key database used for detecting Medicaid fraud has been compromised by slow response times and inefficient data tracking.

The Centers for Medicare and Medicaid Services’ Medicaid Statistical Information System is “the only nationwide Medicaid eligibility and claims information source.” It aggregates Medicaid from states, and its data are relied upon by a number of other federal databases and agencies. MSIS is used as a source on everything from data releases to congressional inquiries.

And, as is most relevant to the OIG’s investigation, MSIS is used by Medicaid Integrity Program to detect fraud, waste and abuse in the system. In the course of the investigation, OIG agents evaluated MSIS for immediacy, accuracy and utility. Investigators found that, between 2004 and 2006, eligibility and claims files both took almost 600 days to complete their file submission and validation process, and that “states submitted nearly two-thirds of the initial MSIS file submissions after the CMS due dates.” Furthermore, 32 states didn’t even get their submissions in within six months of the deadline.

Investigators also faulted CMS for not reporting adjustments that would affect statistical error in the data and for not tracking categories that would be useful in detecting fraud.

(Hat tip to Peter Newbatt Smith of The Center for Public Integrity)