Tag Archives: missouri

What Missouri, Oklahoma teach us about state efforts to expand Medicaid eligibility

About Joseph Burns

Joseph Burns (@jburns18), a Massachusetts-based independent journalist, is AHCJ’s topic leader on health reform. He welcomes questions and suggestions and tip sheets at joseph@healthjournalism.org.

Projected costs

Source: Analysis of the Fiscal Impact of Medicaid Expansion in Missouri, Center for Health Economics and Policy, Institute for Public Health, Washington University in St. Louis, 2019. Reprinted with permission.

Missouri voters in August approved a ballot measure that would expand Medicaid eligibility to include healthy adults, beginning July 1, 2021.

According to reporting at NPR by Alex Smith, 53.25% of 1.2 million voters approved the measure, meaning Missouri joins 36 other states and the District of Columbia in expanding Medicaid under the Affordable Care Act. The approval came despite strong opposition from Republicans and rural voters, Smith wrote. Continue reading

Your money or your life? Missouri town had to choose

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.

On KBIA public radio, Jacob Fenston tells the story of a Missouri town faced with a brutal, impossibly high-stakes catch-22. For decades, thanks to pervasive pollution, the Doe Run lead smelter was slowly destroying Herculaneum physically. At the same time, that lead plant, the continent’s largest, was the only thing keeping Herculaneum afloat economically. Residents had to choose: fight the polluter and take their own livelihoods down in the process, or live with the pervasive, toxic lead dust and its consequences. Continue reading

Joplin hospital staff took action during disaster

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.

If you haven’t already, take 90 seconds to read Tulsa World reporter Michael Overall’s brief, powerful account of how emergency preparedness translated to emergency action at the hospital caught in the center of the May tornado in Joplin, Mo.

joplin-hospital

Photo by Red Cross: Carl Manning GKCARC via Flickr

The staff had practiced severe weather drills and evacuations hundreds of times but, as one administrator told Oklahoma colleagues, “There’s no way you can plan for an F-5 tornado.” Nevertheless, Overall writes, the well-drilled staff of St. John’s hospital “evacuated all 183 patients in just 90 minutes with no major injuries,” a sentence you won’t appreciate until you read Overall’s narrative based on a hospital administrator’s talk at a conference for regional emergency workers.

For those of you looking for story ideas, you might look into local hospitals’ disaster plans. Have they really planned for every contingency? Certainly there are things no one can plan for, but it’s worth reading the story from this hospital and evaluating disaster plans with those events in mind.

For more, read AHCJ’s roundup and review of Joplin tornado coverage.

Skyrocketing drug price is chance to examine manufacturing, FDA approval process

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. Louis Post-Dispatch reporter (and Midwest Health Journalism Program Fellow) Jim Doyle has put together a series of stories on KV Pharmaceuticals that read like a primer on the confounding economics of drug manufacture and FDA approval. In the stories, especially the first and last installments, Doyle presents the big picture and helps readers understand why the systems work they way they do.

The first story shows how FDA approval could end up sending the price of a prenatal drug skyrocketing 16-fold and earn piles of money for a local pharmaceutical company. The second involves a U.S. District judge condemning a former head of that same company for “greed, abuse of power, recklessness.” Finally, he ends his tour of pharmaceutical avarice with a stern warning about the potential longterm costs, both monetary and medical, that could result from the fast-track approval of the drug whose approval formed the basis of the first story. For lots more about KV Pharmaceuticals, be sure to check the “Related Reading” box on this page.

Further reading

If you’re looking for more on KV Pharmaceuticals and the Orphan Drug Act, check out Ed Silverman’s post on Pharmalot. There, he interviews a nonprofit advocate who helps explain how KV’s manipulations were possible, how it could happen again and how the act should be modified.

ER scribes handle EMRs, free up doctors

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. Louis Post-Dispatch reporter Michele Munz has found that some emergency rooms are easing the transition to electronic medical records by hiring “scribes” to enter information into the system, thus freeing up the doctor to focus on the actual patient.

emr-scribes

Photo by MC4 Army via Flickr

Munz reports that scribes are often young, well-trained, tech-savvy pre-med types who get $8 to $10 an hour and plenty of real-world clinical observation for their trouble. The use of one California-based company’s scribes has grown sevenfold in the past two years, expansion its CEO called “exponential.”

Munz’ story shows that the growth is driven by the desire to ameliorate productivity hits that many hospitals have faced in the wake of EMR adoption.

After the switch to computer records, emergency departments have reported a loss in productivity. At DePaul, patient wait times initially increased 28 percent and patient satisfaction declined 40 percent despite additional staffing, said Dr. Stephen Larson, director of the hospital’s emergency department. St. John’s Mercy also reported a peak in wait times.

While both hospitals have seen wait times drop as doctors get past the learning curve, the emergency physicians group at DePaul decided to begin the scribe program in December “to allow us to continue to add to our gains,” Larson said.