Tag Archives: surgery

Report shows how reference pricing brings down costs

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.

dollar-signsOne issued we pursued during the AHCJ webcast last month (The cost of health care: Is transparency possible?) is whether price transparency will drive costs up or down.

The members of our panel reported that price transparency will cause providers to drop their prices, and now new research shows that when reference pricing is combined with price transparency, costs tend to decline as well.

A reference pricing initiative in California motivated hospitals to reduce prices for hip and knee replacements, according to a study released earlier this month by the Center for Studying Health System Change. HSC conducted the research for the National Institute for Health Care Reform.

The HSC report, “Potential of Reference Pricing to Generate Health Care Savings: Lessons from a California Pioneer,” showed that when the California Public Employees’ Retirement System (CalPERS) introduced reference pricing for patients seeking hip and knee replacements, the initiative had two positive results. First, it helped steer patients to lower-price hospitals, and second, it motivated hospitals to reduce prices for these joint replacement procedures. Continue reading

Doctor: News coverage of face transplants has helped donors’ families to consent

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.

This is a guest post from AHCJ member Chelsea Conaboy that first appeared in “White Coat Notes” at Boston.com.

By Chelsea Conaboy

Dr. Bohdan Pomahac and others at Brigham and Women’s Hospital in Boston grappled with lots of variables as they prepared to perform some of the first-ever face transplants. One they had little control over: Would the families of potential donors support the idea?

Overwhelmingly, families have been willing to have their loved ones’ face donated for transplant, Pomahac said Wednesday night, speaking at the inaugural event of the Boston chapter of the Association of Health Care Journalists.

Pomahac credited the media in part for the response, saying journalists’ eagerness to tell the stories of patients and what the transplant has meant for them has affected public opinion.

“People have really embraced it as something important,” he said.

Pomahac and a team of plastic and transplant surgeons at the hospital performed the first full face transplant in the United States in March 2011, about two years after doing a partial transplant on James Maki. Two other full transplants have been completed since.

Pomahac said he was “scared” of the media attention early on, having heard stories of tabloid reporters and photographers trying to sneak into hospitals in Europe where the earliest procedures were done.

Body guards were posted at the doors of patient rooms, and only those surgeons and support staff on a list were allowed near the operating room, he said. But the hospital staff also worked in advance of the surgeries to create a media plan that allowed for the stories to be told, something all four patients wanted. Each posed different challenges.

During Maki’s procedure, ABC was filming Boston Med at the hospital, so Pomahac was fitted with a microphone through parts of the preparation, a stressful period. At points, he said, he “just couldn’t stand it,”

“It added another level of intensity in this very, very tight period of time,” he said.

When Dallas Wiens was in surgery for the first full transplant in the United States, a crew from a British tabloid descended on the hospital with a document alleging it had exclusive rights to his story, he said. Wiens, who is blind, thought he had signed a form allowing the newspaper to take his photo, said Brigham spokeswoman Erin McDonough, who also attended the Wednesday event at Boston University, and the hospital worked with Wiens’ attorney to call off the crew.

Charla Nash, who had had a lot of media coverage prior to her surgery, came with an agent and attorneys who worked with the hospital communications staff.

Pomahac said he became a bit of a star in the Czech Republic, with most media outlets profiling him. He said journalists there have allowed him to read their stories for fact-checking before publishing.

“That’s something I would love to see here, actually,” he said. “I hear its not going to happen.”

Pomahac compared face transplants to the first kidney transplant, performed at the Brigham in 1954, between identical twins.

People then said, “So what?” What would the procedure mean for patients without a twin?

“It seemed like this bizarre, rare operation that, okay, we’re able to do it, but it’s unlikely to lead anywhere,” he said.

For many years, it didn’t. The development of immunosuppression drugs changed that. Similarly, if the side effects of those drugs used in face transplants can be controlled, and if insurers agree to cover the costly procedure, full or partial face transplants will become more widely used, he said.

One other limiting factor, he said, is the surgeons. Face transplants are long — Mitch Hunter’s surgery, the shortest at the Brigham, ran more than 14 hours, he said. Surgeons will become more efficient as the procedure becomes more common and they develop a better workflow, Pomahac said.

Now, he added, “everyone gets tired at the same time. Everyone works slower. But no one wants to leave” the operating room.

NYT reporters tease hip replacement numbers from difficult data

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 New York Times, Barry Meier and Janet Roberts analyzed a particularly tricky batch of federal reports detailing a variety of complaints with popular metal-on-metal hip replacements. They found that, since January, the FDA has received more complaints (5,000-plus) about the devices than it did, total, from 2007 to 2010.

kidsPhoto by Michael Simmons via Flickr

While processing the data, the paper’s staff did their best to parse duplicate reports, international filings and other inconsistencies, but the reporters make it clear that the numbers are still best viewed in general terms. Even so, they demonstrate that the surge in complaints and lawsuits involving metal-on-metal hips — and the resulting mass defection of doctors who once implanted them — signals a broad shift in hip replacement surgery, one of the most common such procedures in the country. It also signals another blow for device manufacturers and patients, and a related windfall for the legal profession.

The vast majority of filings appear to reflect patients who have had an all-metal hip removed, or will soon undergo such a procedure because a device failed after only a few years; typically, replacement hips last 15 years or more.

The mounting complaints confirm what many experts have feared — that all-metal replacement hips are on a trajectory to become the biggest and most costly medical implant problem since Medtronic recalled a widely used heart device component in 2007. About 7,700 complaints have been filed in connection with that recall.

As problems and questions grow, most surgeons are abandoning the all-metal hips, saying they are unwilling to expose new patients to potential dangers when safer alternatives — mainly replacements that combine metal and plastic components — are available. Some researchers also fear that many all-metal hips suffer from a generic flaw. Current use of all metal devices has plummeted to about 5 percent of the market, though a few of the models are performing relatively well in select patients.

Laser spine clinics use Internet search ads to push unproven, costly treatment

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.

Bloomberg’s David Armstrong has put together an investigation of a simple, effective and dubious new business formula, one which begins with pain in the back. In thousands of patients, this chronic back pain leads to desperation, desperation leads to Internet searches, and Internet searches lead to rosy-sounding ads for laser spine treatments from the fast-growing, high-priced, high-volume clinics that are blossoming around the country. google-back-pain

According to Armstrong, this trend is epitomized by Laser Spine, the six-year-old industry leader with $109 million in sales last year and a monster profit margin of 34.3 percent from 2006 to 2009. It typically charges about $30,000 per procedure, or about half of what any insurer would be willing to pay for a garden-variety laser-free surgery.

Laser Spine and its competitors, part of a boom in outpatient clinics operated by entrepreneurial physicians, sell a high-tech version of procedures that have been around for years — despite a lack of independent research to show that their variations lead to better outcomes. The company commands higher prices than laser-less rivals, driving up the cost of health care. Its number of malpractice claims per 1,000 surgeries is several times the rate for all U.S. outpatient surgery centers, based on insurance industry data.

How do these companies get away with charging high prices for procedures with shaky track records? Through a gap in federal regulation that will be familiar to reporters who have investigated surgical robots and other high-tech procedures.

While the Food and Drug Administration regulates the use of drugs and medical devices, there’s virtually no federal oversight for the effectiveness of surgical techniques.

“This is an issue with surgery generally,” said Robert McDonough, head of clinical policy research and development at Aetna. “Surgeons can introduce new procedures that might be significantly different from established ones with no oversight of the claims they make.”

Drug-makers’ ads — including sponsored links that appear in response to search-engine queries — must disclose their medications’ risks, under FDA rules. Ads for surgical techniques have no similar rules.

Data: Calif. for-profits order more C-sections

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 California Watch, Nathanael Johnson leads with the numbers on his story about for-profit hospitals and C-sections. Appropriately for a story based on a hand-built database, classic health anecdotes don’t even surface until after the 20th paragraph. Instead, readers are immediately hit with this:

A database compiled from state birthing records revealed that, all factors considered, women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit. A surgical birth can bring in twice the revenue of a vaginal delivery.

It’s a powerful and nuanced – if not unexpected – finding. Johnson digs deep in the numbers, and hits on a litany of confounding factors and caveats. In the end, some of his most surprising findings were that patients at for-profit hospitals in poorer areas of Los Angeles were the most likely to receive C-sections, and that variation in these surgeries can be attributed to everything from cultural differences, patient preferences and even a desire to avoid malpractice suits.

How Johnson put it all together

For health journalists, the most exciting part of the entire package is likely Johnson’s detailed “how I did it” sidebar. He talks about how he chose which data to pursue, how he created the database behind the story, and even which specific Excel functions he used to find meaning within the numbers. Of particular interest are the sections in which he lists the sources he used to help him understand what he was seeing within the numbers, and to guide him toward his subsequent conclusions.