Herald-Leader reporter wins Nieman fellowship to study at Harvard; her goal is to help other papers cover Obamacare

Photo by Pablo Alcala,
Lexington Herald-Leader

Mary Meehan, a reporter for the Lexington Herald-Leader, has been selected for the 2016 class of Nieman fellows at Harvard University.
She is one of 24 journalists chosen for this prestigious honor and will begin her year of study at Harvard in September.

"I am going to Harvard to study for nine months. I hope to learn things I didn't know I yearn to learn, learn about healthcare and the massive social experiment underway." Meehan said in her shared blog, Menopausal Moms of Kentucky. "I also hope to learn something that can help in some small way to keep the newspaper industry upright."

Meehan has been with the Herald-Leader for 15 years, but began her career as a journalist 34 years ago as a columnist for The Voice of St. Mathews in Louisville at the age of 16. Before returning to Kentucky, she worked for the Tribune Newspapers in Phoenix, AZ, The Orlando Sentinel in Florida, and also as a freelance journalist in Florida.

She said that her "life changing" experience as a Blue Cross Blue Shield of Massachusetts Foundation Health Coverage Fellow last year is what prompted her to apply for the fellowship. She said she returned from the first fellowship energized to write about health, and has written "as many stories as I could" with information from that experience.

Still, she said, "I just came across stories that I couldn't get to, that were too complicated because I didn't have a good, deep foundation of health-care reform and the complex issues involving how people access health care, or what makes them seek it out even if they have insurance, and so that prompted me to file an application for the Nieman fellowship."

Meehan said that she made it clear on her application that she is not a full-time health journalist and that during any given week she has covered "a tractor parade, monster trucks and Salem the wonder cat." But she also said that while covering health, she has found that the Patient Protection and Affordable Care Act has accountability measures that apply everywhere, but are "very difficult to digest on the fly."

Each Nieman fellow proposes a study project. Meehan plans to examine the impact of the law and barriers to sustained health improvement among the previously uninsured.

"My goal is to help mid-size and small papers cover the Affordable Care Act in a meaningful way," she said. "The other part is highlighting positive things that are happening in communities, with a critical eye. Looking at not only what works, but also the challenges."

Meehan said being selected for the top fellowship in journalism hasn't really "soaked in yet," but she anticipates, based on previous fellows' comments, that she will discover "something that is amazing" that can't be predicted yet.

She said she is looking forward to working with the other fellows, half of whom will come from all over the world, and going back to college.

"I am a 50-year-old woman with white hair; I just love the visual of me sitting in a Harvard class," she said with pure joy in her voice. She earned her bachelor's degree at Western Kentucky University where she majored in political science and journalism.

In addition to taking classes, fellows attend Nieman seminars, workshops and master classes and work closely with Harvard scholars and other leading thinkers in the Cambridge, Mass., area.

The Nieman Foundation for Journalism has educated more than 1,400 accomplished journalists from 93 countries since 1938.

Louisville's PharMerica is still a defendant in federal cases in which big drug makers have paid billions in fines

Abbott Laboratories has paid billions, and Amgen Inc. has paid millions, in fines for offering "rebates" or "kickbacks" to get pharmacy companies to increase their prescriptions of drugs in nursing homes, and PharMerica Corp. of Louisville is the remaining defendant in both civil cases, according to a detailed report by James McNair at the Kentucky Center for Investigative Reporting.

PharMerica manages drug benefits for nursing homes, hospitals and assisted living facilities. McNair paints a dismal picture of nursing homes and says they are ripe for this type of abuse, writing that they house "people with age-weakened bodies, multiple ailments and, often, severe mental impairment. Many are over-medicated. Many have no visitors. A third of them will die within a year of admission." (Click on chart for larger version)

McNair notes that a whistleblower lawsuit first called attention to Abbott Labs, which pled guilty in 2012 to a criminal charge, settled civil kickback and fraud claims, and paid $1.5 billion in fines for its role in paying millions of dollars in "rebates" to get pharmacy companies to increase prescriptions for an anti-seizure drug, Depakote, for uses beyond its Food and Drug Administration approval. Medicaid payments for this drug "went on to top $7 billion," McNair reports.

Amgen also enlisted these same pharmacy companies to promote its anemia drug, Aranesp, for uses beyond its FDA approval, and after pleading guilty settled civil kickback and fraud charges and paid a total of $762 million in fines.

These two cases brought more government attention to such schemes, which are "standard practice in the pharmaceutical industry," and also on the pharmacy companies that are on the receiving end of the payoffs, McNair writes.

McNair describes PharMerica as the "second-biggest operator of nursing home pharmacies in the country" and writes that it had " $1.9 billion in revenue last year," making it the "10th-biggest publicly traded company in Kentucky, according to rankings by The Lane Report." Since 2007, the chief executive has been Gregory Weishar (pronounced WISH-er) .

Companies like PharMerica, and its larger competitor Cincinnati-based Omnicare Inc., act on behalf of the nursing homes, buying drugs from the pharmaceutical companies in bulk and then dispensing them under the supervision of "consultant pharmacisits," McNair reports.

The Abbott Labs and Amgen lawsuits assert that PharMerica gave "certain drugs to nursing home patients in return for drug company kickbacks, not because they were the "right medication."" McNair reports that the suits were filed by drug company insiders who have knowledge of these payoffs disguised as "rebates" or "discounts."

"PharMerica denies the claims," writes McNair. But the company has been in this type of case many times since 2005, McNair reports: It has agreed to pay $40 million in fines to settle federal complaints, five additional closed cases connected to this company.

McNair also reports that just last week, the Justice Department said PharMerica will pay $31.5 million for dispensing addictive painkillers to nursing home patients without prescriptions, then falsely billing Medicare. As part of this settlement, PharMerica also agreed to a five year "corporate integrity agreement," which McNair notes later in the article are rarely enforced.

McNair goes on to list the details of several other cases PharMerica has been involved in, one of them "deemed so flagrant that the inspector general sought to ban PharMerica from federal health-care programs for 10 years."

PharMerica declined to make its executives available for an interview with the Kentucky Center for Investigative Reporting but said in a statement: “PharMerica is committed to outstanding compliance and the highest standards of ethical conduct, and we are diligent in ensuring that we comply with all applicable law and regulation,”

Jan Scherrer, vice president of Kentuckians for Nursing Home Reform, a non-profit advocacy group based in Lexington, told McNair that the CEOs of companies involved in kickback schemes should be held personally accountable, "These are not victimless crimes," he said.

“It’s the same players -- PharMerica and Omnicare,” Scherrer continued. “They keep doing this over and over and over, and all they get is a fine. And for them that fine is nothing more than the cost of doing business.” (Read more of this detailed report by clicking here.)

Harrodsburg Herald, a weekly newspaper, does three-part series on tobacco issues in Mercer County and statewide

In a state where more than one of every four adults smoke, tobacco is an issue in every county, but it's rare for weekly newspapers to take a detailed look at the issue. The Harrodsburg Herald did that recently, in a three-part series by Robert Moore.

Moore explored why Mercer County and the state have relatively little money for tobacco prevention, writing, "Kentucky doesn't seem all that interested in fighting tobacco. In 2014 the state will receive $158.7 million in tobacco settlement money and spend only $2.5 million to help smokers quit and prevent kids from starting, according to the Kentucky Center for Smoke-free Policy."

The states' lawsuit against cigarette manufacturers, and the Master Settlement Agreement that followed, was ostensibly to recover their costs for treating illnesses due to smoking. However, most of the money has gone to general purposes, and in Kentucky half the money was dedicated to improving the agricultural economy — but the legislature steered some of that money elsewhere, mainly for rural water lines, Moore noted.

"The largest single use of tobacco funds now is debt service," he wrote. "Every year, $28 million of the MSA payment goes to pay interest on $434,883,200 in outstanding municipal bonds. The bonds financed various construction projects over the last decade—$20 million for construction of the UK Veterinary Diagnostic Center in Lexington and $2 million for renovations to the FFA Leadership Training Center in Hardinsburg, both in 2008."

Another story explored the growing phenomenon of electronic cigarettes, and the other looked at efforts to curb smoking, statewide and locally. Moore looked at lobbying and campaign-finance reports from Altria Group, the leading cigarette manufacturer, and wrote about efforts by the Burgin High School chapter of Teens Against Tobacco Use to have smoking banned on their campus.

In a more recent story, Moore updated the Burgin issue, concluding, "Until something changes in the state legislature, schools like Burgin will be the most important battlegrounds in the fight against tobacco-related deaths."

Are nutrition rules for schools and day-care centers too much regulation, or steps in the right direction, toward better health?

Commentary by Melissa Patrick
Kentucky Health News

The Paducah Sun's editorial on Jan. 20 said the Obama administration has overstepped its bounds by expecting child day-care centers to follow stricter nutrition standards. The newspaper also called for relaxation of the requirements of the 2010 Healthy, Hunger-Free Kids Act, as Republicans hope to to when the law comes up for reauthorization this year. (The editorial is behind a paywall.)

The editorial does what any good editorial should do: stirs up a bit of controversy and makes you think a bit harder. Do you agree with the editorial's views that these nutrition standards impose "too much regulation," or are you thinking,"We have to try something to combat obesity and the best place to change health behaviors is with children?"

What most everyone probably agrees on is that we have a problem: too many fat, unhealthy children who will become fat, unhealthy adults, perpetuating a chronic health epidemic that is sweeping across Kentucky and the nation. "The heaviest children are getting even heavier" and "overweight or obese preschoolers are five times more likely than normal-weight children to be overweight or obese as adults," says the Obesity Society website.

Nationwide, one in five children is overweight and more than one in three adults are obese, according to the Centers for Disease Control and Prevention. Kentucky leads the nation in both adult and child obesity, ranking fifth for adult obesity; first for high-school obesity; eighth in obesity of 10- to 17-year-olds; and sixth in obesity among 2- to 4-year-olds in low-income families, according to the States of Obesity report. These statistics don't even include the number of adults or children who are simply "overweight."

The World Health Organization says chronic disease is the leading killer in our world, with two-thirds of all deaths worldwide a result of conditions such as heart disease, cancer, diabetes and respiratory infections in 2012. Kentucky, once again, leads the way in each of these conditions.

Kentucky ranks eighth in the nation for heart-disease deaths; 17th for diabetes; fifth for high blood pressure; and first for smoking, lung cancer and lung cancer deaths.

The editorial says, "The food police are on the march again." Is it too much regulation, or could these "police" represent a concerned government trying to solve a major health-crisis that is only getting worse?

In making the day-care proposal, Agricuture Undersecretary Kevin Concannon wrote, "Providing children access to nutritious food early in life helps instill healthy habits that can serve as a foundation for a lifetime of healthy choices.”

The Department of Agriculture proposal calls for new nutritional guidelines for child and adult day-care programs, after-school programs and people who live in shelters that are part of USDA's Child and Adult Day Care Food Programs.

The guidelines would follow the Healthy, Hunger-Free Kids Act guidelines followed in schools, which require more fruits and vegetables, more whole grains, less fat and sugar, and limit calories according to age.

What seems to aggravate Sun Editor Jim Paxton the most are the proposal's suggestions to ban on-site frying and the qualification of tofu, a soybean curd, as a meat alternative. It said that while the program was originally set up to combat malnutrition, it now has decided "a little starvation is not a bad thing; ergo, tofu instead of fried chicken."

The editorial suggests that day-care facilities could no longer have french fries or fried chicken, but it fails to mention that both items could be offered with a more healthful preparation in the oven. And tofu, a cheap, low-fat protein source, would be added as an option, not a requirement.

The recommended way to lose weight is to decrease calories, eat healthful foods, and increase activity. The nutritional requirements suggested in this program include two of these efforts.

The editorial reminds us that some students are "turning up their noses at the new offerings," that "student participation in school meal programs is down," and says pre-school programs are concerned that the same thing will happen to them.

However, schools say they are tweaking their menus to find healthful foods that the kids like and purchase newer whole grain products that don't taste any different than the processed grains the kids are used to.

So, is it too much regulation or a new way to improve the health of children that will take time and tweaks to perfect?

The editorial says the Sun supports nutrition education and healthy choices on the school menu, but that the "primary responsibility for combating childhood obesity lies with parents and the rules they set in the home."

But what the editor fails to consider is that one out of three adults, many whom are parents, are obese, and are the ones responsible for teaching these lessons.

Too much regulation or a step in the right direction? You decide.

Medicare ratings for nursing homes rely heavily on self-reported data; recent inspection data are available elsewhere

Next time you look at Medicare's ratings for nursing homes, be aware that most of the information used to make the ranking is based on self-reported data and is not verified by the government.

Consumers and investors make critical decisions based on these misleading "gold standards" that are doled out by Medicare, Katie Thomas reports for The New York Times.

"Only one of the three criteria used to determine the star ratings - the results of the annual health inspections — relies on assessments from independent reviewers," Thomas writes. "The other measures — staff levels and quality statistics — are reported by the nursing homes and accepted by Medicare, with limited exceptions, at face value."

ProPublica, the nonprofit, investigative journalism enterprise, offers a program, Nursing Home Inspect, that allows consumers to search and analyze the details of recent nursing home inspections, featuring tools the federal government's Nursing Home Compare doesn't have, including the ability to search using any keywords and the ability to sort results based on the severity of the violation and by state. (Read more)

The Medicare ratings also do not account for fines and other enforcement actions by state, rather than federal, authorities,Thomas reports, or complaints filed by consumers with state agencies.

Starting this year, Medicare will use this same type of rating system not only in nursing homes, but also in hospitals, dialysis centers and home-health-care agencies, Thomas writes. And federal officials told Thomas that "while the rating system can be improved — and that they are working to make it better — it gives nursing homes incentives to get better." They cite the homes' reduced use of physical restraints, and fewer reports of bedsores, as examples of improvement.

But current and former nursing home employees, lawyers and advocacy groups say some nursing homes have "learned how to game the rating system," Thomas writes. Nursing home ratings have risen steadily since the program began, she notes. "In 2009, when the program began, 37 percent of them received four- or five-star ratings. By 2013, nearly half did."

The Times analysis also shows that even if a nursing home has a history of poor care, it self-reports better. "Of more than 50 nursing homes on a federal watch list for quality, nearly two-thirds hold four- or five-star ratings for their staff levels and quality statistics," Thomas writes. These same homes received one or two stars for the health inspection, which is conducted by state workers.

“These are among the very worst facilities, and yet they are self-reporting data that gives them very high staffing and very high quality measures,” Toby S. Edelman, a senior policy lawyer with the Center for Medicare Advocacy,told Thomas. “It seems implausible.”