Photo: Newslighter via Flickr
In California, an initiative known as Proposition 8 asks voters to limit the revenue that kidney dialysis clinics can earn. The proposition pits health care unions against the large companies that run dialysis centers.
In Massachusetts, a ballot question asks voters to consider a proposal to limit how many patients a hospital can assign to each registered nurse at hospitals and other health care facilities. Continue reading
Photo: National Museum of Health and Medicine via FlickrA new study indicates that many reporters continue to have antiquated notions about the utility of nurses as sources.
In 2014, the Ebola outbreak was storming through West Africa and found its way to the United States via four patients medically evacuated to the United States for treatment. Then, Thomas Eric Duncan, a Liberian man visiting family in Texas, showed early symptoms of Ebola. Initially misdiagnosed before more severe symptoms developed, Duncan then was hospitalized and eventually died at Texas Health Presbyterian Hospital. Nina Phan, a nurse who cared for Duncan, made headlines when she was diagnosed with Ebola herself.
Unless the story focused on health care workers’ potential exposure and protective equipment, American journalists rarely included nurses in their stories about Ebola before Phan came down with the disease. After that, journalists could not get enough interviews with nurses and representatives of nursing organizations. When the Ebola story receded from the headlines, press inquiries stopped. Diana Mason, a co-author of this blog, was president of the American Academy of Nursing at that time and saw the difference in media requests for interviews. Continue reading
On Wednesday, I wrote about “scope of practice” – what health care providers, particularly nurse practitioners, who aren’t physicians are or are not allowed to do in their state. I provided several resources, reports and links to understand these fights, and the role nurses or physician assistants or other providers can have in providing primary care in underserved areas. Today I want to look at two stories:
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
The first was published earlier this fall online by Tina Rosenberg on The New York Times Opinionator section, part of a series called “Fixes” on solutions to social problems . She profiles a clinic in Indiana that provides full-service health care to 10,000 people – without any doctors. It’s one of about 250 clinics in the country run by nurse practitioners. Rosenberg reviews the reasons that there aren’t enough primary care doctors serving the poor or practicing in rural areas. She writes:
It might seem that offering the rural poor a clinic staffed only by nurses is to give them second-class primary care. It is not. The alternative for residents of Carroll County was not first-class primary care, but none. Before the clinic opened in 1996, the area had some family physicians, but very few accepted Medicaid or uninsured patients. When people got sick, they went to the emergency room. Or they waited it out — and then often landed in the emergency room anyway, now much sicker.
She says nurses are trained to do what many doctors do not learn – how to treat a patient more holistically, how to listen, how to “coach more, and lecture less.” All those skills are part of what’s needed to treat and manage chronic disease – which is what so much of primary care is about. Because nurses at the clinic are salaried, they aren’t stuck in the 15-minute-appointment hamster wheel of fee-for-service medicine. “At the Family Health clinics, appointments last half an hour — an hour for a new diabetic or pregnant patient.” Continue reading
One of the interesting stories to watch in the coming months in the states is the fight over “scope of practice.” That means: who gets to do what, and under whose supervision. It basically pits doctors against other health care providers – nurses, nurse practitioners, physician assistants, etc. They are sometimes called “extenders” or “non-physician providers.” (There are also big fights within dentistry.)
Joanne Kenen (@JoanneKenen) is AHCJ’s health reform topic leader. If you have questions or suggestions for future resources, please send them to joanne@healthjournalism.org.
These fights would heat up even without the Affordable Care Act – you’ve all heard about the shortage (in some communities at least) of primary care physicians. And you know there is an aging population that is going to need access to primary care. Throw in the health care law – millions of newly insured people entering the system, as well as delivery system reforms and care innovations that encourage more primary care, care coordination and team-based medicine that invites a larger role from those “extenders.” (Can you tell I don’t like that word?)
But state law – some state laws – may limit what these health care workers can do or require so much supervision by a physician that it is tantamount to a limit. The nurses and physician assistants use the phrase “practice to the top of their license” to mean they want to be able to do everything they are trained and licensed to do. There also are questions about how insurance plans address these different kinds of providers, and what options/explanations/information patients are given about who they are going to see at any particular juncture in their care.
In my next Covering Health post, I will share two recent stories I liked a lot about the changing role of nursing (which isn’t the only scope-of-practice fight but it’s the one you hear most about). First I want to provide some resources and thoughts on how to cover this topic more broadly.
Keep in mind that there are national trends but it’s a state-based legal problem. Continue reading
In the Albany (N.Y.) Times Union, Matt Drange’s investigation is titled “Home health care in crisis.” Having read the piece, I can say it’s safe to take that declaration at face value. At the very time that home care is booming in New York as a cheaper, more convenient alternative to nursing homes, the state has cut back on its number of health inspectors. Meanwhile, the complexity of home care cases is rising, as hospitals release patients earlier and the population as a whole ages. The results, Drange writes, have been predictable.
Lapses have gone undetected or, in many cases, unpunished by the Department of Health, the arm of state government tasked with overseeing home health agencies. Providers are not required to notify the department when patients experience sudden or unexpected changes in their condition, including death. And even when the state does learn about these incidents, it doesn’t always act on the information, records show.
For the investigation, Drange looked at public records regarding Medicaid billing, home care agency registration and plenty of state inspection reports. He focused his review on 40 of the worst offenders, and found more than enough examples to illustrate a system in crisis. Drange’s anecdotes recount numerous egregious lapses in care, and I strongly recommend digging into the meat of the piece, if only to see what incredible detail he found in public records. For now though, at the risk of mild spoilers, I’ll just reveal that they all end in the same way: The problem goes undetected, unenforced, or underpunished.
In the end, as reporters have found in other states as well, the root of the problem seems to be a weak and vaguely defined regulatory system. In his investigation, for example, Drange found a sharp contrast between the oversight of nursing homes and home care, two institutions which often perform similar functions.
(Researcher Sam Krinsky of the United Healthcare Workers East 1199 Union) said the culture of home care differs vastly from that of nursing homes, which have received more attention in New York and elsewhere.
Statements of deficiencies issued to home care agencies by the Department of Health are “not something that we take seriously,” Krinsky said.
“In nursing homes, the inspections are a big deal. There are a lot more regulations they have to comply with … It’s just a much more robust system,” he said. “In home care, it’s more of a review of paperwork. It [Department of Health] doesn’t have any teeth.”
Drange, an AHCJ member and recent graduate of the Columbia Journalism School, did this investigation as his master’s project. He invites feedback from other health care reporters about the story and anything he could have done differently. Feel free to comment below or send your thoughts to him at mattdrange@gmail.com or on Twitter (@mattdrange).
NationalJournal’s Margot Sanger-Katz reports on the sometimes woeful state of American dental care, especially for low-income children. And yes, her piece is datelined “HAZARD, Ky.” But that’s where its anecdotal focus ends and Sanger-Katz paints the bigger picture.
Photo by dbgg1979 via FlickrThe United States faces a shortage of dentists that is particularly acute in poor, rural regions. Huge pockets of the country have few (or no) providers. The federal government counts 4,503 mostly rural regions where more than 3,000 people share one dentist, making it tough for many residents to find someone to fix their teeth.
For more than 100 years, dentistry has run on a separate—and more laissez-faire—track than the rest of medicine. Dentists have their own schools and treat patients in their own offices; fewer laws and regulations govern the field. Insurance plans typically demand high co-pays and limit their payouts for invasive procedures. About half of all dental expenses are paid out of pocket, compared with less than 10 percent of costs in the overall medical system.
In some ways, what Sanger-Katz calls a “free market” has worked. Folks shop around, and they only get dental care when they really needed. Prices don’t inflate as quickly as they do in medicine in general, and American dental health is still getting better. Continue reading