- heartandsoul.com/2011/06/stuck-in-the-hospital-some-uninsured-patients-wait-weeks-and-months-for-long-term-care/#1
- stuckinthehospital.wordpress.com/
- healthjournalism.org/blog/2011/10/why-are-some-patients-stuck-in-hospitals-for-weeks-months/
- healthjournalism.org/blog/2011/08/uninsured-face-delays-increased-risks-en-route-to-long-term-care/
List date(s) this work was published or aired.
June/July 2011
Provide a brief synopsis of the story or stories, including any significant findings.
Patients typically complain about being released from the hospital sooner than they would like. Over the last two decades, U.S. hospitals have reduced the average length of stay from 7.2 days in 1989 to 5.4 days in 2009, according to the American Hospital Association. However, uninsured and underinsured patients who need long-term care are often stuck in hospitals weeks and even months after being medically ready for discharge. They can’t go to another facility or home with a nurse if they can’t pay their bills. Given the recent downturn in the economy, this could potentially happen to anyone who loses a job and/or insurance to cover an injury or illness. “Stuck in the Hospital: Discharge Delays Leave Chronically Ill Patients Waiting Weeks and Months for Long-Term Care” by Yanick Rice Lamb was one of four projects selected for the year-long Health Performance Fellowship, sponsored by the Association of Health Care Journalists and the Commonwealth Fund. It merits a Public Health Award for shedding light on an under-reported topic and explaining the toll of delayed discharge on patients, the health-care system and the general public as well as the potential impact of health-care reform. Uninsured hospital patients between the ages of 18 and 64 in need of long-term care increased 16 percent over the last five years. This problem affects a small, almost invisible pool of patients. However, this group is time-consuming and increasingly on the radar of hospital administrators who are being pressured to lower costs, raise profits and turn over beds. Some patients have run up thousands of dollars in unpaid medical bills–$3.1 million in one case. Information on this topic was fragmented and spotty at best. The project required visits to hospitals nationwide, dozens of interviews, database reporting and months of in-depth research to delve into Medicare, Medicaid, hospital stays, overall discharge, insurance issues, uncompensated care, and transitions to long-term care at nursing homes, rehabilitation centers and residences.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I obtained public records without FOI requests through local, state and federal agencies. This included analyzing AHRQ, CMS and census stats as well as hospital data, for example, from the Office of Statewide Health Planning and Development in California. I also used data from researchers, journal articles, non-profits, hospitals and health sites such as Kaiser.
Explain types of human sources used.
Patients, family members, medical professionals, patient advocates, policy makers, researchers, and visits to hospitals around the country
Results:
The response from readers, journalists, medical professionals and policy-makers has been great. The project was also cited in MuckReads, ProPublica’s “ongoing collection of the best watchdog journalism.” Other websites are also re-publishing or linking to the project, and The New York Times followed with a similar story. Public health and other groups have invited Lamb to discuss discharge issues, and she has also extended the impact of her reporting by hosting Tweetchats and sharing story ideas with other journalists through the Association of Health Care Journalists’ website. AHCJ review: https://healthjournalism.org/blog/2011/08/uninsured-face-delays-increased-risks-en-route-to-long-term-care/ Healthy Buzz by Charles Ornstein: http://cornstein.tumblr.com/post/11008939809/the-hospital-patients-no-one-wants
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
There were no corrections, bu I updated the story online: http://www.heartandsoul.com/2011/06/stuck-in-the-hospital-some-uninsured-patients-wait-weeks-and-months-for-long-term-care/#1 http://stuckinthehospital.wordpress.com/
Advice to other journalists planning a similar story or project.
https://healthjournalism.org/blog/2011/10/why-are-some-patients-stuck-in-hospitals-for-weeks-months/ Covering Stories in Your Community Discharge is a multilayered topic that’s ripe with story ideas that can be localized or examined nationally. Here are a few suggestions along with other ideas that popped up along the way: • Find out if hospitals in your community have established teams to focus on complex discharges. These groups function as high-level SWAT teams that spring into action to resolve the most difficult cases with the lengthiest hospital stays. They often include the chief medical officer and a range of other top administrators who have the power to make decisions quickly. They might approve non-traditional housing arrangements, for example. Their solutions can be altruistic, but keep in mind that they’re also motivated by the bottom line. • Ask about internal discharge studies. Some hospitals are doing more tracking and trying to go behind the numbers. You might still have to go hospital by hospital to determine how long patients stay beyond the time they’re deemed medically ready for discharge. In some cases, I watched people flip through clipboards to give me data. • Talk to people on the frontlines of discharge. Many social workers, nurses, doctors and others have stories to tell, and they are eager to talk about the highs and lows of their work. • Explore the ongoing debate on readmissions and the cost. Hospitals are under pressure to prevent them, but they complain that some readmissions are unavoidable and actually warranted. (Ironically, I witnessed an avoidable one when my mother was prematurely discharged and immediately readmitted while I was on the road visiting one of the dozen hospitals featured in this project.) • Look into regulations as well as reimbursements. We hear lots of complaints about slow and low reimbursements from hospitals and nursing homes. Which complaints are warranted? Which ones could be eased with better practices and more efficiency? Some experts complain that nursing homes, in particular, find ways to work around regulations and game the system. • Check out observational care. While some hospitals keep it in check, it can affect patients’ eligibility for long-term care if they don’t meet the three-day inpatient requirement for Medicare approval. Do patients know that they’re outpatients? Some don’t, patient advocates say. • Assess the growth in primary-care delivery at hospitals as well as the transition of some doctors from private practice to hospital staffs. What does this mean for your community? • Don’t believe the hype. For example, are immigrants really driving up health-care costs? Yes, there are some extreme examples (i.e., delayed discharge to a certain extent), but the numbers don’t always support the complaints. • Keep an eye on the increase in the level of care required as people age. Some people are in worse shape at younger ages. What’s the future outlook? • Get an idea of the availability of long-term care beds in your community. Are hospitals in your area expanding into long-term care? How much money are they making? • Consider caregiving issues. Families are more fragmented, and they’re expected to do more in term of home care. They aren’t always ready, willing and/or available. • Calculate the cost, financial and otherwise, of hospitals that close or cut services. How are do people have to go to be treated for trauma? • Assess the impact of health care reform.