Local reporters, editors, data crunchers win health journalism awards

A lot of the heath care journalism awards out there are kind of soft — they come from trade or industry groups. They have their own place on our walls, and, in some cases, we appreciate them. (In other cases, an award may represent a conflict of interest.  An award from an institutions you cover? Just say no. )

But the Association of Healthcare Journalists awards come with a lot of cred. And the  New England awards are well deserved. Congratulations colleagues. We get a chance to thank you in person when the AHCJ holds its annual meeting in Boston in two weeks.

Public Health (Large)

First: Coverage of Fungal Meningitis Outbreak Tied to Contaminated Drugs; Staff, The Boston Globe

Honorable mention: Cancer’s New Battleground: The Developing World; Joanne Silberner, David Baron, PRI’s The World

Consumer/Feature (Large)

Third: A Rampant Prescription, a Hidden Peril; Kay Lazar, Matt Carroll, The Boston Globe

Consumer/Feature (Small)

Second: Gift from Grief; Michael Morton, MetroWest Daily News (Framingham, Mass.)

Third: Demand for Home Care Workers Soaring, But Will There Be Enough Takers?; Arielle Levin Becker, The Connecticut Mirror

 Special citation: 40% of High-Prescribing Docs Get Pharma Perks; Lisa Chedekel, The Connecticut Health Investigative Team

Readmission penalties in Massachusetts hit teaching hospitals

Medscape reports on a JAMA article looking at readmission rates:

Ninety-five-bed Falmouth (Massachusetts) Hospital on Cape Cod doesn’t have the national reputation of Massachusetts General Hospital, 77 miles to the north in Boston.

But the small hospital bests the big teaching hospital in the big city on this point — it’s not getting penalized by Medicare for excessive readmissions within 30 days of discharge. Massachusetts General, in contrast, will forego about 0.5 percent of its Medicare reimbursement in fiscal year 2013 because its readmission rate was higher than what the Centers for Medicare & Medicaid Services (CMS) projected based on the case mix, or medical complexity, of their patients.

Cambridge-based Institute for Healthcare Improvement offers a little perspective:

In this Viewpoint, we suggest that it may be more advantageous to view readmissions within a broader systems and community context that effectively engages all stakeholders to cooperatively improve outcomes…The Hospital Readmission Reduction Program has raised awareness of readmissions as an indicator of a fragmented health care delivery system. Yet financial penalties alone are not likely to drive change. As the nation moves toward comprehensive payment and delivery system reforms to promote integrated care, the focus should shift toward reducing avoidable hospital use, not just readmission, by strengthening primary and preventive care and chronic disease management for populations of patients at risk of poor health outcomes.

For Halloween, tour the dark side of Massachusetts medical history

             We’re sorry we missed the last Longwood Avenue walking tour for the season. Advertised as a tour of Boston’s “world-renowned” medical centers, the trip is clearly upbeat, with an emphasis on firsts and breakthroughs.  For a bit of the seamier side of Boston health history, you can still catch the Boston by Foot “Darkside” tour, which covers sites associated with the city’s smallpox and influenza epidemics.

Maybe they could combine the two by offering a healthcare/darkside tour.  First stop: Betsy Lehman Center for Patient Safety and Medical Error Reduction – named for the Boston Globe health news reporter who died in 1994 as the result of a medication error — an overdose of chemotherapy. They would have to add a Cambridge leg to the tour to get to Mt. Auburn Hospital, where a doctor took mid-surgery break to go cash his paycheck. Or, consider the Harvard monkeys. They keep dying at Harvard’s primate research center. And, they got caught up in a case of fraud when former psychology professor embellished the results of his research.

Murderous and murdered docs? The alleged “Craig’s List killer” – a BU med student – committed suicide in jail before he could be tried for murdering an “escort” in a Copley Square hotel.  Head to the suburbs for a walk in the woods where a Wellesley allergist was convicted of beating his wife and slashing her throat. Prosecutors said he was motivated by his appetite for prostitutes and phone sex. Richard Sharpe, a so-called “cross-dressing” dermatologist”  convicted of fatally shooting his wife point blank with a hunting rifle, also committed suicide in jail.

But, in Boston’s most notorious medical murder, the victim was doctor. In 1849, Boston Brahman Dr. George Parkman tried to collect a debt from a chemist co-worker and ended up dead. The killer chemist dismembered the body and hid it behind a wall at what was then Harvard Medical School, which was then at the site that is now Mass General Hospital. Download the app for a self guided walking tour.

Halloween ghoulishness aside, domestic violence is not to be taken lightly. Sharpe’s daughter has spoken out via a group called The R.O.S.E. Fund (Regaining One’s Self Esteem), which among other efforts seeks to transform “the lives of survivors that have physical reminders of their abusive past. In partnership with our medical affiliates we provide female survivors of domestic abuse with access to medical and dental reconstructive procedures to help them to regain their self-esteem.”  So, add one more stop to the tour — Mass Eye and Ear – where docs help heal victims of violence..

The “end of fee for service”: Health cost wars break out in in New England #hcr #mapoli #aca

More than a river divides Vermont and New Hampshire. In the state that lives by the motto, ” Live Free or Die,” regulators and politicians declined to set up a health insurance exchange mandated as part of the health reform law. From the June 22 Concord Monitor:

John Lynch signed into law a bill that prohibits New Hampshire from planning, creating or participating in a state health care exchange under the 2010 federal health care law. The Democratic governor did so with the support of the state Insurance Department and conservative Republicans dead set against the health care law passed under the Obama administration.

Opponent were predicting – at the time of this story – that the Supreme Court would rule against the individual mandate and the health law would “fall apart.” That didn’t happen and now the feds will come in and set up the exchange.

Next door in Vermont,  the Green Mountain Care Board is reviewing hospital budgets. From Vermont Public Radio:

The board has established a cap on spending increases of no more than 3.75 percent annually. But as a group, Vermont’s 14 hospitals are seeking increases of roughly 7 percent for the coming 12 month period. “We know there are some legitimate reasons that hospitals might need to grow higher than the 3.75 percent, most of those having to do with circumstances beyond their control,” said Anya Rader Wallack, the chairwoman of the Green Mountain Care Board.

The board may allow some increases above 3.75 percent, if the hospitals can prove that they are using the money to make investments that will lower costs in the long run.

But Wallack says the bottom line is that hospital spending needs to be kept under control: “We have a responsibility to hold down costs. So we’ll be looking at all of these requests with an eye toward how we can stay within that target, because we don’t think Vermonters can afford more than that.”

Welcome to your future Massachusetts.  Health care cost containment can get ugly. For reporting on the Massachusetts cost control law, go no further than the Globe’s special section. From today’s Bill signing story:

Six years after Governor Mitt Romney required every resident to obtain health insurance, Governor Deval Patrick signed a law that many consider the second phase of that groundbreaking experiment: trying to rein in the state’s health costs, which are among the highest in the nation.

The new law — which Patrick signed Monday at a State House ceremony packed with hospital executives, health care advocates, and lawmakers — seeks to keep health spending from growing faster than the state’s economy through 2017. For five years after that, the law aims to further slow spending, to half a percentage point below the growth of the economy.

Boston docs on debate over cholesterol screening for kids

A couple of Boston-area docs weigh in on charges of industry influence in the debate over whether to test kids for cholesterol.  From the Globe:

CHICAGO — Should all US children be tested for high cholesterol? Doctors are still debating that question months after a government-appointed panel recommended widespread screening that would lead to prescribing medicine for some kids.

Fresh criticism was published online Monday in the journal Pediatrics by researchers who say the guidelines are too aggressive and were influenced by panel members’ financial ties to drug makers.

… Other criticism was published earlier this year in the Journal of the American Medical Association. …JAMA included additional criticism from a dissenting member of the panel that produced the kids’ cholesterol guidelines, Dr. Matthew Gillman of Harvard Medical School. He recommends more narrow screening based on family history of cholesterol problems.

… Dr. Sarah De Ferranti, an American Academy of Pediatrics spokeswoman and director of preventive cardiology at Boston Children’s Hospital, said the question should be part of a conversation parents should have with their pediatrician about heart disease risks, including weight, blood pressure, and lifestyle. She said she would have her children tested.

Most of the Peds articles are behind the pay wall. But, UCSF put out a press release on the latest comments. And the NIH guidelines are online.

From NIH: Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents

From UCSF: New lipid screening guidelines for children overly aggressive, UCSF researchers say recommendations fail to weigh benefits against potential harms

Recent guidelines recommending cholesterol tests for children fail to weigh health benefits against potential harms and costs, according to a new commentary authored by three physician-researchers at UCSF.

Moreover, the recommendations are based on expert opinion, rather than solid evidence, the researchers said, which is especially problematic since the guidelines’ authors disclosed extensive potential conflicts of interest.

The guidelines were written by a panel assembled by the National Heart, Lung and Blood Institute (NHLBI) and published in Pediatrics, in November 2011. They also were endorsed by the American Academy of Pediatrics. The guidelines call for universal screening of all 9 to 11-year-old children with a non-fasting lipid panel, and targeted screening of 30 to 40 percent of 2 to 8-year-old and 12 to 16-year old children with two fasting lipid profiles. Previous recommendations called only for children considered at high risk of elevated levels to be screened with a simple non-fasting total cholesterol test.

The call for a dramatic increase in lipid screening has the potential to transform millions of healthy children into patients labeled with so-called dyslipidemia, or bad lipid levels in the blood, according to the commentary by Thomas Newman, MD, MPH, Mark Pletcher, MD, MPH and Stephen Hulley, MD, MPH, of the UCSF Department of Epidemiology and Biostatistics and e-published on July 23 in Pediatrics.

“The panel made no attempt to estimate the magnitude of the health benefits or harms of attaching this diagnosis at this young age,” said Newman. “They acknowledged that costs are important, but then went ahead and made their recommendations without estimating what the cost would be. And it could be billions of dollars.”

Some of the push to do more screening comes from concern about the obesity epidemic in U.S. children. But this concern should not lead to more laboratory testing, said Newman.

“You don’t need a blood test to tell who needs to lose weight. And recommending a healthier diet and exercise is something doctors can do for everybody, not just overweight kids,” he said

The requirement of two fasting lipid panels in 30 to 40 percent of all 2 to 8-year olds and 12 to 16 –year- olds represents a particular burden to families, he said.

“Because these blood tests must be done while fasting, they can’t be done at the time of regularly scheduled ‘well child’ visits like vaccinations can,” said Newman. “This requires getting hungry young children to the doctor’s office to be poked with needles on two additional occasions, generally weekday mornings. Families are going to ask their doctors, ‘Is this really necessary?’ The guidelines provide no strong evidence that it is.”

The authors note that the panel chair and all members who drafted the lipid screening recommendations disclosed an “extensive assortment of financial relationships with companies making lipid lowering drugs and lipid testing instruments.” Some of those relevant relationships include paid consultancies or advisory board memberships with pharmaceuticals that produce cholesterol-lowering drugs such as Merck, Pfizer, Astra Zeneca, Bristol-Myers Squibb, Roche and Sankyo.

“The panel states that they reviewed and graded the evidence objectively,” said Newman. “But a recent Institute of Medicine report recommends that experts with conflicts of interest either be excluded from guideline panels, or, if their expertise is considered essential, should have non-voting, non-leadership, minority roles.”

Evidence is needed to estimate health benefits, risks and costs of these proposed interventions, and experts without conflicts of interest are needed to help synthesize it, according to Newman. He said that “these recommendations fall so far short of this ideal that we hope they will trigger a re-examination of the process by which they were produced.”

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Newman and Hulley have no disclosures. Pletcher has NIH funding to support research on targeting of cholesterol-lowering medications to prevent cardiovascular disease.

Globe: New approach to medical errors takes hold

Doctors generally don’t admit to or apologize for even the most obvious medical mistakes. For the most part, they’ve never been allowed to. Blame it on those nasty malpractice lawyers who will use it against the doc in court. Or blame it on the hospital lawyers, who need to protect the institution, even if it means not sharing the facts with patients.

So, the Globe reports on an idea that’s been kicking around for a while called DAO – Disclose, Apologize and Offer. Championed at the University of Michigan, the system encourages doctors to admit to and apologize for medical errors and offer settlements as a way to keep the cases out of court.

In most states, anything that sounds like an apology can be used against a doctor in potential malpractice lawsuit. A survey by Harvard researchers identified one barrier to the new approach as “physician discomfort with disclosure and apology.” Still  risk management lawyers at Harvard hospitals issued a consensus statement endorsing the concept six years ago. The Mass Medical Society has been  looking for ways to promote the approach beyond Harvard. A local non-profit that runs support groups for doctors and patients – Medically Induced Trauma Support Services  – is also involved in the effort. And, Gov. Deval Patrick’s pending costs containment bill includes a provision that would make apologies inadmissible in malpractice cases.

Hints that the idea is taking hold emerged in a Globe story last year story on a lawsuit over a fatal overdose of blood thinner contains this statement from Mass General.

A spokeswoman for Massachusetts General Hospital said in a statement yesterday that the hospital regrets the error, and “our hearts go out to Mrs. Oswald’s family.’’

“As soon as we understood what had happened, we apologized and explained the situation to Mrs. Oswald’s family,’’ said (spokeswoman Peggy) Slasman. “We undertook a thorough and extensive internal review of the case, and we communicated with family members throughout this process. As a result of this event, we have made some specific changes to our practices to reduce the chance of such an event from occurring again.’’

In the Globe story Linda Kenney of the  Medically Induced Trauma Support Services welcomes the change, but advises patients to have a lawyer on hand  “to make sure the patient is getting what they are entitled to.’’

“The medical malpractice insurers have tons of attorneys on retainer,’’ said Kenney, whose group belongs to the new Massachusetts coalition.

And malpractice lawyer Andrew Meyer has this to say.  “For the most part, malpractice insurers are looking for a discount from fair compensation’’ by making an early offer, Meyer said. But “if a patient’s rights are not limited in any way, I have no issue with an attempt at early resolution. Cases just drag on for years.’’

More here.

The Globe on alarm fatigue, HIT and a hit to the hospital association

From The Globe:

• Wide heart monitor use tied to missed alarms/ State reports detail 11 patient deaths linked to alarm fatigue in Massachusetts
• Steward Health Care chain quits Mass. hospital group: For-profit chain says it can better advocate for its unique interests
• Report suggests HIT, incubators as part of economic development plan.

Boston hospital CIO Halamka on his wife’s diagnosis: “We have cancer”

Beth Israel CIO John Halamka usually blogs about health information with posts like “The EHR/HIE Interoperability Workgroup,” and very occasionally, his life as a vegan or his plan to  retire to a small family farm to raise organic vegetables.

Today he reports the disturbing news of his wife’s breast cancer. They’ve decided to document her treatment in real time.

The headline “We have cancer.”

Last Thursday, my wife Kathy was diagnosed with poorly differentiated breast cancer. She is not facing this alone. We’re approaching this as a team, as if together we have cancer. She has been my best friend for 30 years. I will do whatever it takes to ensure we have another 30 years together.

She’s has agreed that I can chronicle the process, the diagnostic tests, the therapeutic decisions, the life events, and the emotions we experience with the hope it will help other patients and families on their cancer treatment journey.

Another reason to root for the BoSox: Help for returning soldiers

On Veteran’s Day, consider these numbers from a Rand Corporation study: More than 300,000 U.S. soldiers will return from Iraq with concussions and head injuries. That doesn’t account for civilians.

So check out the Red Sox “Home Base” program, launched after players visited injured vets. To promote research, Home Base works with The Center for Integration of Medicine and Innovative Technology. CIMIT, a cross-disciplinary, cross- town collaboration that includes researchers from Harvard, MIT and local hospitals. The group applies technology – from electronic records to medical devices –to health problems.

Traumatic Brain Injury (TBI) has long challenged caregivers, who have limited options for determining prognosis and providing treatment. Recent prevalence of severe, moderate and mild TBI from military combat has increased the visibility of these issues. TBI and spinal cord trauma are major causes of morbidity and mortality throughout the world. Associated bio-physical changes are difficult to directly measure. The pathophysiology of TBI occurs in stages over prolonged periods of time. Better methods for characterization can aid in tailoring interventions to achieve better outcomes. CIMIT encourages novel approaches to treatment through functional and metabolic imaging and electromagnetic stimuli to localize treatment sites, measure progress, and identify the stages of recovery. CIMIT’s TBI & Neurotrauma Program seeks to explore novel techniques, including systemic and focal pharmacologic regimens, applied energy from lasers and ultrasound, and neuro-technological techniques, as methods to determine the stages at which they may be best applied. This program leverages the innovations of CIMIT Neurotechnology, Traumatic Stress Disorders, and Trauma & Casualty Care Programs, recognizing that many patients suffer from combinations of conditions that require clinicians to draw on a range of specialty resources. http://www.cimit.org/programs-traumatic-brain-injury.html

How is the Boston storm impacting area hospitals?

  We’ll update this as information comes in. Also see WBZ for school closings.

The Brigham and Women’s Hospital  main campus in Boston is open during today’s snow emergency. However, many of our satellite locations will have delayed openings. Please call your doctor’s office to confirm scheduling for today.

 We’ll update this as information comes in.

Dana-Farber Cancer Institute will be open for patient care on Monday, Dec. 27.

Patients who are not able to make their appointment are asked to call their doctor’s office to notify the staff that they are canceling their appointment, as well as make arrangements for rescheduling.

Patients with medical emergencies should call 911 or go to the nearest emergency room.

Children’s

Because of the Massachusetts State of Emergency, all clinics at Children’s–including Boston, Martha Eliot Health Center and all satellite locations–will cancel all non-urgent patient appointments for Monday, Dec. 27, 2010. If you have an appointment scheduled, you will be receiving an automated message about your cancellation. Please note that all surgeries will take place as scheduled.

If you aren’t sure whether or not to come to your appointment on December 27, or have any other questions, please feel free to call your doctor’s office and leave a message and someone will get back to you this morning to clarify.

Due to the weather emergency, Joslin Clinic will be closed on Monday, December 27.

Clinic appointment staff will be contacting patients affected by the closing to re-schedule appointments.

If you prefer to re-schedule your appointment without waiting to be contacted, please call: 

Adult Clinic: 617-309-2440
Pediatrics: 617-732-2603
Beetham Eye Institute: 617-309-2552

Mass Eye and Ear via Twitter: Our Operating Rooms are humming & patient floors are busy. We don’t let a little snow stop us

 Boston VA: Due to the snow storm the Framingham and QuincyCommunity Based Outpatient Clinics are not yet open. The Lowell and Worcester shuttles are not running at this time.

The main campuses of VA BHS are open and clinics are operational. 

 Shuttle service between West Roxbury, Jamaica Plain, Brockton and Causeway St.  clinics are running.

 Please take caution driving in for your appointment.  If you need to reschedule your appointment due to the weather/driving conditions please call your clinic as soon as possible.  IN THE EVENT YOU DO NOT HAVE THE DIRECT NUMBER FOR YOUR CLINIC,  please call the Patient Call Center at 800-865-3384 for assistance.