Latest Blog Entries

February 16, 2012

California is quietly abandoning a pilot project that would have brought automatic medication dispensers into the homes of thousands of Medi-Cal recipients, saying the experiment would cost more than it would save.

In an analysis of the potential costs, the state Department of Health Care Services determined that the pilot wouldn’t come close to saving the $140 million annually that legislators banked on when they approved it last year. 

“There was a great risk that not only would it not achieve the savings, but it might actually generate costs,” said Norman Williams, DHCS spokesman.

February 15, 2012

The federal government gives hospitals that care for uninsured and low-income patients more than $11 billion in funds annually, with California hospitals receiving more than $1 billion.

These hospitals, designated as Disproportionate Share Hospitals, can often be found in blue-collar, sometimes blighted, neighborhoods that have profound medical need:  Los Angeles County-USC Medical Center, San Francisco General Hospital & Trauma Center, and Tulare District Hospital in rural California, to name a few.

February 14, 2012

Andy Gee says he never thought he would see his crushing medical debt basically disappear.

We profiled Gee, of San Francisco, as part of a KQED series on medical debt in the fall. When I interviewed him he wasn’t working. And he had trouble sleeping at night because he was so worried about how he would possibly pay off $72,000 in debt to San Francisco General Hospital and the SFGH Medical Group.

He was hit by a car in October 2010 and was rushed to San Francisco General Hospital for emergency surgery. After a six-day hospital stay he was on the hook for $72,000. Gee says the most shocking thing about all of this was that he had health insurance.

February 13, 2012

Last month, we chronicled the story of Jerry Magner, a Northern California man who suffered a massive stroke as a result of a surgery that was intended to prevent stroke. Magner’s loved ones, still struggling with their loss, questioned whether the procedure should have been performed in the first place.

Shortly after the stories ran and aired, I received this letter from John Maa, a surgeon and assistant professor at the University of California, San Francisco:

February 10, 2012

It’s a triumph, no doubt about it.

There was not a single California death from whooping cough in 2011, one year after a record 10 infants died from the disease. This is truly good news, the first time since 1991 that no one in the Golden State has succumbed to the highly infectious illness.

So how did California go from such an awful record to such a good one? Let’s turn to the experts for an explanation.

February 8, 2012

Now the feds are jumping in.

This morning, the U.S. Department of Health and Human Services announced a national campaign to reduce elective deliveries of babies before 39 weeks of pregnancy, saying the effort will improve care and save millions.

Under the “Strong Start” initiative, the government will work with hospitals across the country that have joined the Partnership for Patients, a voluntary effort to reduce preventable injuries and complications.

February 7, 2012

Most people have never heard of the infection nicknamed “C.diff.” Others heard of it first at the worst of times—during a hospital stay, or at the bedside of an ailing relative or friend.

I first learned about the severity of Clostridium difficile last spring while writing a story about Tony Lewis, whose broken femur brought him to a Sacramento hospital. Within days, he was diagnosed with the infection that killed him. 

February 6, 2012

Obstetricians hear it from their pregnant patients all the time: My back hurts. I’m swollen. I’m exhausted. Get this baby out of me!

“Why do I have to wait for 39 weeks if 37 is good enough?” some have asked Elliott Main, chairman of the ob-gyn department at San Francisco’s California Pacific Medical Center. “Women think it’s fine to deliver at 37 weeks,” he said.

Who can blame them? Technically, a “term pregnancy” is one between 37 and 42 weeks of gestation.

February 2, 2012

This story originally aired on KQED Public Radio.

February 2, 2012

Not all of the California hospitals cracking down on early elective births are urban behemoths that deliver thousands of babies a year.

Small ones are taking action, too.

Banner Lassen Medical Center in the rural Northern California town of Susanville is a 25-bed hospital that delivers about 250 babies a year. In 2010, it implemented a policy prohibiting doctors from scheduling deliveries between weeks 37 and 39 of pregnancy without a medical reason, trying to put an end to deliveries scheduled for convenience.

February 1, 2012

Sometimes when a reporter listens in on a panel discussion, the eyes glaze over and the journalistic instincts shift into cruise control. That’s particularly true on a topic like health care reform, which our CHCF Center for Health Reporting has covered from its passage, to its currently tenuous fate before the U.S. Supreme Court.

We’ve reported what the law means to people with pre-existing medical conditions, what it means to medically isolated rural communities and what it will do to the health insurance landscape statewide. It’s sometimes easy to think that we’ve run out of things to write – particularly as the law winds toward an uncertain future.

January 31, 2012

Health officials say there’s a deadly threat to young people that most of us wouldn’t guess: murder.

According to the CDC homicide is the second leading cause of death for those between 15-24-years-old.

Overall, these deaths are a relatively small percentage of the country’s total mortality statistics. But public health experts are alarmed that gang violence continues to fuel homicides among young people.

A recently released CDC report studied five cities with high rates of gang murders.

Three of them were in California – Oakland, Long Beach and Los Angeles.

January 27, 2012

California is famous nationally for combating air pollution and its ill effects on public health.

Much of the state is also touted for balmy winter weather and blue skies.  Ironically, sometimes those sunny, mild days can produce unhealthy air.

Take this winter, when residents at two ends of the state--the Los Angeles area and Chico—are navigating new rules governing when they can fire up wood-burning stoves and fireplaces.

January 26, 2012

This is a corrected version of a blog that was published on January 25, 2012.

“Keep ‘em cooking.”

That’s what doctor organizations, advocates and hospital watchdog groups say about babies delivered before between 37 and 39 weeks gestation.

January 25, 2012

It’s been two years since I directed a Center for Health Reporting project in partnership with the Santa Cruz Sentinel. We examined the future of a county-wide health insurance program for poor children aged 0-18, most of whom are undocumented. Part of a loose statewide network called Healthy Kids, it participated in First 5 funding but otherwise took no money from any state agency. It was supported by the county, foundation grants, community dollars and community sweat.

January 20, 2012

When I first heard that some surgeons don’t know how often their patients have major complications or die from a procedure, it was hard to believe. Could it be true that I can get more information about the quality of a flat screen TV or car, than a surgery that can kill me? 

I was told about how many hospitals lack a centralized database to track complications. Beyond that, for the hospitals that do try there isn’t a standardized system to compile and analyze the data.

But patient safety experts say without this information it’s hard for doctors to know how to avoid the same mistakes in the future.

January 19, 2012

Last summer, Chuck Magner’s father had a massive stroke during a surgery that was intended to prevent stroke, and died almost two weeks later.

One of Chuck’s lingering concerns is that the hospital and surgeon hardly communicated with him or his family before the procedure. Chuck, who was in St. Louis on business at the time, only managed to get the hospital on the phone when his father, Jerry Magner, was already being prepped for surgery.

“You are putting yourself in these people’s hands and they should keep you informed at all times of everything possible,” said Chuck, 55, of Concord.

January 19, 2012

There is another One Percent.

One percent of the population accounted for 22 percent of total health care expenditures in the United States. Five percent of the population accounted for nearly 50 percent of health care expenditures.

January 13, 2012

San Francisco Chronicle readers made 130 thoughtful, funny, snarky and often informative online comments in response to my story about high rates of two common elective heart procedures among residents of the Clearlake area.

One of those comments in particular jumped out.

At 11:38 a.m. on September 6, 2011, “l8erg8or” posted this:

January 12, 2012

I didn’t know Sheryl when she wasn’t sick.

I didn’t know her as a preschool teacher, a mother, a churchgoer or dialysis support group leader. Every time I saw her, she was in a hospital bed, tethered to a dialysis machine or in a wheelchair en route to a doctor’s appointment.

She had lost one leg to amputation, was in danger or losing the other and suffered from advanced kidney disease.

January 11, 2012

What is it with nurses? Are there too few of them, with shortages looming? Or are there plenty to go around? Which is it?

A decade ago, the specter of the baby boom generation approaching old age led to predictions of a looming nursing shortage.

The AMA’s journal weighed in at the end of 2008 with a dire prediction from Dr. Peter Buerhaus, a top workforce analyst. “…A large and prolonged shortage of nurses is expected to hit the US in the latter half of the next decade,” he said.

Now, a few years later, a number of recent studies leave us wondering, well, what’s up with nurses?

January 3, 2012

With the holidays behind us, Americans are working on all-too-familiar New Year’s resolutions to hit the gym more or lose a few extra pounds. But what if the Centers for Disease Control and Prevention and your boss helped make that happen?

Under a provision in the Affordable Care Act, businesses can now apply for help to get their workforce in better shape. The idea is to prevent and cut back the rates of common and costly chronic diseases.

It’s called the National Healthy Worksite Program and the CDC will select up to 100 businesses to participate.

December 22, 2011

From salad safety to surgeries, from debt to dialysis, CHCF Center for Health Reporting journalists traveled the state pursuing stories on health and health policy.

December 20, 2011

I have been spending the last few reporting months with men and women in pressing need of comprehensive mental health services. Arguably, for their own safety, they should have an alternative -- the type of locked facilities that are no longer part of California's institutional landscape.

One man sees a bridge spanning a sun-splashed bay, and suicidal ideation, or threats of jumping off it, become part of the interview. Another offers detailed accounts of combat in Southeast Asia, but the Veteran's Administration finds nothing of the sort in service records that show a five-month stint ending with a medical discharge.

December 18, 2011

I have been spending the last few reporting months with men and women in pressing need of comprehensive mental health services. Arguably, for their own safety, they should have an alternative -- the type of locked facilities that are no longer part of California's institutional landscape.

One man sees a bridge spanning a sun-splashed bay, and suicidal ideation, or threats of jumping off it, become part of the interview. Another offers detailed accounts of combat in Southeast Asia, but the Veteran's Administration finds nothing of the sort in service records that show a five-month stint ending with a medical discharge.

Their stories will be part of an upcoming project that I won't detail here as we work to meet deadlines with our reporting partner.

December 16, 2011

The U.S. Food and Drug Administration has stumbled badly in its oversight of food safety inspections in California and other states, undermining efforts to prevent food-borne illnesses, a federal watchdog group warned this week.

The agency is increasingly outsourcing its inspection efforts, turning to state investigators to enforce food safety rules at plants that manufacture, process, pack, and store food.

For instance, 59 percent of the FDA’s food inspections were delegated to states in fiscal year 2009, up significantly from 42 percent in 2004.

December 15, 2011

Most of the mid-year budget cuts that Gov. Jerry Brown announced this week will take effect on Jan. 1.

But major reductions to In-Home Supportive Services won’t be among them. IHSS is a publicly financed program that helps some low-income elderly and disabled people receive care at home.

Disability Rights California already has filed a lawsuit challenging Brown’s proposal to reduce IHSS hours by 20 percent. Cutting the hours and eliminating funding for local anti-fraud measures would save the state $101.5 million.

December 13, 2011

Starting next month, Medicare turns its cost and waste radar on motorized wheelchairs and short hospital stays. It is launching a three-year pilot project to target questionable billing practices in several states with high error rates. Four states that CMS says top the list – Texas, New York, Florida and California – account for 40 percent of all Medicare errors. 

The project will make changes to what’s called the “Pay and Chase” system. Currently CMS pays for the motorized wheelchair or hospital stay first and then realizes the needed paperwork is missing.

Now CMS will review the claims and make sure all documentation is provided before it sends out the check.

December 9, 2011

“Dear Hospital Administrator,
 I had my baby at your hospital on 01-30-2010 and,
overall, I had a
[sic] unacceptable experience.”

A mother wrote this with the help of The Letters Project, an online program that birth doula Tracy Hartley designed to help mothers and mothers-to-be exert greater control during the hospital births of their babies. (Read the full letter here.)

December 6, 2011

I recently came across a report that takes a magnifying glass to what we already sensed -- implementing health reform will place enormous pressure on a system already in distress.

The 212-page document by the UCSF Center for Health Professions, released last month, poses hard questions about the state’s current capacity to deliver care in an era of diminished budgets and spiraling need.

December 5, 2011

When I slice open a bag of baby spinach, I do exactly what millions of other Americans do. 

We dump the contents in a salad spinner. Flood the leaves with water.  Spin them dry with vigor, determined to protect family and friends from E. coli, salmonella or worse. 

Mindful of the drumbeat of recent recalls—salmonella on lettuce, listeria on Romaine—I might even soak my bagged greens, ignoring the bags’ “triple-washed” and “pre-washed” labels.

But one evening last week, I grudgingly poured bagged arugula straight into a salad bowl and ate it.

December 1, 2011

When Northern California’s Sutter Health announced recently that it had become the latest in a growing list of health care providers to lose some of its patients’ sensitive personal information, I snapped to attention.

I’m a Sutter patient, and among more than 4 million people whose personal details – including name, address, date of birth, phone number, email address and medical record number – were on an unencrypted desktop computer stolen from a Sutter building in Sacramento over the weekend of Oct. 15.

About 1 million of us lucky ones lost even more information, including dates of service and a description of medical diagnoses and/or procedures.

Yikes.

November 29, 2011

In this economy many people are feeling the pinch of paying copays for a doctor’s visit or prescription drugs, but for seniors these costs are hitting hard.

Around the country about one in six seniors are now living in poverty, according to new data released by the Census Bureau. That’s nearly double previous estimates and the largest increase for any group in the report. The main culprit: out-of-pocket medical costs.

November 23, 2011

The Banner Health system, which stretches from Alaska to Arizona, delivers about 30,000 babies a year, about a third by cesarean section.

When Banner officials scoured their data, they found wildly different patterns in how those C-sections were performed.

That was the easy part. Getting doctors to change their behavior proved more challenging.

 “We realized just asking them was not going to cut it,” said Ken Welch, chief medical officer of Banner Estrella Medical Center in Phoenix.

November 22, 2011

Officials at Intermountain Healthcare are well aware of the growing move to standardize medical treatments and rein in differences in how doctors and hospitals practice medicine.

They’re the ones teaching other hospitals and health systems how to do it.

Intermountain, which operates 23 hospitals and 155 clinics in Utah and southern Idaho, has been a trailblazer in identifying and addressing excessive use of certain outdated or unnecessary procedures.

November 18, 2011

Advocates for the ADHC program announced with great enthusiasm Thursday that their long fight to protect this vulnerable elderly and disabled population had succeeded. They had secured a settlement with the state that canceled the need for a scheduled court hearing.

That sounds like a win-win.

But the devil is always in the details. Despite the excitement, daunting problems remain for some members of this population. In fact, it was quietly said, up to half of them.

That’s right. Half of the 35,000 low-income elderly and disabled Californians who attend these places could find themselves in a less friendly environment.

November 15, 2011

At first it seemed pretty improbable.

How could six, seven, eight different ethnic media outlets (some publishing in other languages) work together on one story? What one story would be compelling enough to interest them? And how would all the pieces fit together? That’s what was swirling around my mind when Julian Do, Southern California director of New America Media (NAM), quietly suggested to me at a reception on April 1 that the CHCF Center for Health Reporting could play a big role in coordinating just such an effort. I was intrigued by the prospect, but its looming complexities caused me to just file it away.

October 18, 2011

While preparing our new series "Fault Lines,"  I couldn’t help wondering what would happen if a major earthquake rocked Alhambra, the Los Angeles area city where our offices are located.

Would the injured seek care at the small hospital up the street?  Would its doors stay open?

Last Sunday, the Pasadena Star-News and two affiliate daily newspapers started running our series, bolstered by a wealth of new reporting by their newsroom staffs.

October 10, 2011

A 1994 California law required that hospital buildings meet strict standards so that their buildings can withstand major earthquakes.   

The law consists of two parts.  First, hospitals must fix or replace buildings with structural problems that could cause them to collapse in a quake.

Second, plumbing, electricity and other non-structural features must be sturdy enough that hospitals can keep operating after the quake.

October 4, 2011

After trying for months to get some relief on $72,000 in medical debt, Andy Gee has made some progress.  

Our center profiled Gee, of San Francisco, as part of our Diagnosis of Debt series. The report aired Sept. 12th on KQED Public Radio’s The California Report.

Gee was hit by a car last October and rushed to San Francisco General Hospital, where he had emergency surgery on an open leg fracture. He then had to stay at the hospital for six days. When it was all said and done – despite having health insurance – Gee owed San Francisco General Hospital and the SFGH Medical Group $72,000.

September 28, 2011

The CHCF Center for Health Reporting is continuing to report on the fact that where you live can result in big differences in the kind of health care you receive.

Have you, a family member or someone you know had a surgery to prevent stroke, a procedure called carotid endarterectomy? What was your experience – did you have any negative side effects or complications?

This surgery removes plaque build up in the carotid artery to prevent stroke. It turns out – as is the case with elective heart procedures – the rate of use of carotid endarterectomies varies greatly around California. If this procedure is being overused it can have serious consequences for patients – the surgery can cause complications such as stroke, heart attack or death.

September 27, 2011

State health officials and vaccination experts don’t hesitate to decry the role of the Internet as a supplier of misinformation about vaccines and their effect on children’s health. But this assertion is on a collision course with plans by federal health officials and even health care providers to utilize information technology – including the web – as a centerpiece in a new, more open patient-oriented health care system.

Federal agencies are hawking the phrase, “be an active partner in your health,” and are offering up various information technology tools – via cell phone, smart phone apps, text reminders – to help consumers play that role.

September 27, 2011

In the last few years it’s become more and more apparent that making changes to the health care system is a monumental task.

As protesters for and against the federal health care law took to Washington’s Capitol before the measure passed last year…to the heated GOP primary race debates calling for the repeal of the law today, many are left wondering if it’s politically possible for the government to help them avoid mounting medical bills.

But as it stands now, the Affordable Care Act has several provisions that consumer advocates say will help keep Californians out of debt:

September 22, 2011

One of the most promising new approaches to help put the brakes on soaring medical debt is to let patients know in advance of a hospital visit how much their care will cost, and how much they’ll have to personally pay. The unique challenge of medical debt is that patients often don’t even know they’re about to owe the hospital tens of thousands of dollars.

Todd Nelson, with the Healthcare Financial Management Association, used to be a hospital executive and says trying to collect debt from patients can be maddening. And for the patients, it can be shocking.

September 9, 2011

When I started doing the reporting for our recently published series about Californians undergoing heart procedures at wildly different rates, depending on where they live, I discovered quickly that the use of elective angioplasty is still hotly debated in the medical world.

That’s because some experts believe it’s an overused – and often ineffective – way of treating stable coronary artery disease.

Angioplasty is a cardiac catheterization procedure intended to open blocked arteries that supply blood to the heart, usually with stents.

September 8, 2011

This weekend, we launched a series in The San Francisco Chronicle about variation in medical care. Variation occurs when certain medical procedures are performed at dramatically different rates from place to place, which affects the quality and cost of health care.

When I started reporting, I knew that variation was a growing concern in the healthcare policy world, and that there are increased efforts to rein it in, both to lower costs and reduce potential medical complications for patients.

What I didn’t realize was just how much.

September 6, 2011

At a time when we keep hearing about how people still aren’t getting jobs and family budgets are tighter than ever, I started thinking about how these people are affording health care. Turns out last year 73 million Americans had trouble paying off their medical bills, according to The Commonwealth Fund, a nonprofit health care research group.
 

August 19, 2011

A new effort to reduce Medicare costs will start rolling out in 10 regions of California this fall, aimed at  lowering the prices that patients and taxpayers pay for wheelchairs, walkers, oxygen and other durable medical equipment, the U.S. Centers for Medicare and Medicaid announced Friday.

The program will reduce prices, starting July 1, 2013, in and around Los Angeles, San Diego, San Francisco and seven other metropolitan areas statewide, as well as 81 other regions nationally.

“Today, we’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years,” CMS administrator Dr. Donald M. Berwick said in a media release.

August 18, 2011

The hotly contested debate continues over the health care law’s mandate that everyone must have health insurance.  The 11th Circuit Court of Appeals in Atlanta ruled last week that it was unconstitutional and the Supreme Court is expected to weigh in on the issue.

While the legal maneuvering heats up and people’s anxiety levels rise over how much they might have to fork over to buy insurance…some Christian groups are advertising that if you join them, you won’t have to comply with the mandate.