Tag Archives: oklahoma

With state funds gone, Okla. dental programs still serve needy

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.

Writing for the local NPR StateImpact outlet, Logan Layden looks at how dental programs for the needy are coping in the absence of state funding. In the 2010 state budget crisis, Layden writes, “Funding for several programs, including Dentists for the Disabled and Elderly in Need of Treatment, was totally eliminated.”

Among those was Oklahoma’s D-Dent, which provides a sort of superstructure that takes care of logistics and tests in order to allow dentists to donate their work to the needy and elderly. Since the cuts, the statewide program has gone from supporting about 800 patients a year to about 600. They no longer get state funds, though they still rely on the health department for most of their referrals, as well as a little moral support.

“We here are entirely supportive of this program,” Jana Winfee, Chief of Dental Health Services the Department of Health, said. “They have our support, just no funds.”

For more on NPR’s StateImpact project and a list of current participants, check out their lab.

Behind Oklahoma’s nation-leading access-to-care problems

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 February, the New England Journal of Medicine ranked Oklahoma as the worst when it came to access to medical care. With help from a California Endowment Health Journalism Fellowship, Tulsa World reporter Shannon Muchmore sifted through reams of data to emerge with a three-part series helping readers better understand the state’s unique health care delivery challenges.

Fans of data analysis and numbers will want to dive straight into the first installment. According to Muchmore, 66 of Oklahoma’s 77 counties contain “Health Professional Shortage Areas, which means “they don’t meet the national standard of one physician for every 3,500 people.” And those doctor-patient ratios aren’t improving.

The state is facing a severe shortage of doctors as the population ages. Adding to that, as many as 180,000 people are poised to receive insurance when provisions of federal health-care reform kick in 2 1/2 years from now.

What’s behind that shortage? Muchmore enumerates the key drivers.

Medical schools are not increasing their class sizes, residency slots are hard to come by, and doctors are choosing to locate in other states.

The last two factors go hand-in-hand, as doctors often practice where they have their residencies. Without a connection, they have little reason to locate in a rural area.

The state is not well-positioned to handle a further deterioration in its health-care system. Oklahoma consistently ranks among the worst states for obesity, diabetes, smoking, heart disease and overall health. It has the least improvement in the country in age-adjusted death rate since 1990.

In the second installment, she examines the link between disparities in access to medical care and disparities in life expectancy and other indicators throughout the state, with a special focus on Oklahoma’s most rural counties.

In the final piece, Muchmore looks at the future of health care provision in Oklahoma and the key role that physician extenders, such as nurse practitioners and physician assistants, are poised to play.

Keep an eye on the AHCJ website for an upcoming “How I did it” article from Muchmore in which she shares how she did the reporting on this project.

Papers combine forces to investigate group homes

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 AHCJ's social media efforts and edits and manages production of association guides, programs and newsletters.

Reporters from The Oklahoman and the Tulsa World teamed up to report on Oklahoma’s residential care homes and “Intermediate Care Facilities for the Mentally Retarded,” which are homes for developmentally disabled people. [Oklahoman | Tulsa World]

In their review of more than 40,000 records from federal, state and local agencies, including inspection and investigative reports and letters, the reporters found more than 800 violations, including inappropriate medical care, abuse and neglect. Four cases involved the death of a patient.

Inspectors documented residents who were covered in feces, stolen from, or left to sleep on dirty mattresses.

Some were supervised by felons. Others lived in buildings infested with ants, cockroaches and mice.

At least two people were allegedly raped.

Residential care homes, intended for people who are ambulatory and don’t require routine skilled nursing care, are only inspected once every two years.

The reporters created an online database from the records. The state’s health department is in the process of scanning inspection and investigation reports of group homes to put them on its Web site, a project it expects to complete by the end of the summer.

The report also looks at what a proposed cut in funding might mean for Oklahoma’s group homes and how current shortfalls are delaying community care services for thousands.

The project was done by Tulsa World reporters Ginnie Graham, Gavin Off and Michael Overall and Oklahoman reporters Sonya Colberg, Ann Kelley and Vallery Brown. A sidebar explains more about the series.

Medical tourism expected to continue growth

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 San Francisco Chronicle‘s Carolyn Lochhead writes that the draw of medical tourism lies with both transparency and affordability and implies that its success shows the need for an overhaul of the U.S. medical system.plane-wing

She also notes that the reform efforts don’t seem likely to change those two central systematic problems, and thus medical tourism is likely to be here to stay, at least in the foreseeable future. The piece also explores the consumer side of medical tourism, profiling an Oklahoma surgeon who competes on price and transparency.

The article also cites an executive who advises that the economics of going overseas for treatment start making sense when the American price tag for a procedure reaches about $15,000.


Bundled payments may improve care, lower costs

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.

Kaiser Health News’ Phil Galewitz looks at bundling hospital payments, a possible solution to the confusion and cost of separate billing. Under these programs (now in Tulsa and San Antonio, and coming soon to Denver, Albuquerque and Oklahoma City), “Medicare makes a single reimbursement for all the hospital and doctor care for heart and joint procedures, rather than making separate payments to the facility and physicians.”

In theory, the benefits are clear:

Bundling payments moves medical charges away from the traditional fee-for-service system that pays providers separately for individual services — an arrangement critics of the current system say leads to doctors and hospitals delivering more care, but not better care.

It looks like the program’s making a difference. A hospital executive admits the bundled payments make hospitals more reluctant to consult specialists (because the payment from Medicare remains the same and doesn’t rise to meet the cost of a specialist) but says the increased attention to quality brought by the bundling has improved patient care.

Similarly, Galewitz writes that a similar program in the mid 1990s “saved $42.3 million over three years, with costs decreasing from 10% to 37% at the four hospitals participating in the test.”