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MedPage Today’s ‘dinner table’ stories: Do readers really know what they’re being served?

Mary Chris Jaklevic is a freelance health care reporter and frequent contributor to HealthNewsReview.org. She tweets as @mcjaklevic.

Kevin Lomangino is the managing editor. He tweets as @KLomangino.

On November 8, MedPage Today, one of the nation’s most widely read physician news sites, published a scathing critique of insurance industry functionaries headlined “Who is actually reviewing all those pre-authorization requests?”

The post was the most popular article on the site for more than a week.

While many readers praised the piece for exposing what they described as unethical practices in the health care payment system, others questioned the article’s accuracy and its characterization of the preauthorization process, which is a special approval insurers require before they’ll pay for certain (often costly) treatments. The piece made no mention of the author’s sizeable income from the pharmaceutical industry.

HealthNewsReview.org began looking into those questions after a reader brought them to our attention on Twitter. In response to concerns we and others raised, MedPage Today Editor-in-Chief Peggy Peck wrote a column headlined “If It’s a Blog, Is It Journalism?” where she argued that blog posts like the one in question should not be held to journalistic standards for accuracy.

She said that MedPage Today readers know not to mistake its blog content for “news” or “facts,” and that unsubstantiated stories and missing financial disclosures are “par for the course in the blogosphere.” She added:

blogs are not news articles, not editorials, not op-ed pieces, not analysis. Blogs are simply musings and opinions by the individual authors. They are stories shared about the dinner table.

We couldn’t disagree more.

Blogs vs. journalism: A distinction clear as mud

As bloggers and journalists who care about the quality of health care information presented to professionals and the public, we think it’s irresponsible for a news organization to present unvetted, unsubstantiated “dinner table” stories without better explanation of what readers are being served.

And we think it’s wrong to believe that readers understand Peck’s distinction between blog posts and journalism and the differing standards that MedPage Today applies.

MedPage Today, after all, isn’t clear on that distinction itself.

While Peck claims that blogs are not to be confused with “news,” the publication’s “Blogs and Columns” appear under the “News” tab on the MedPage Today site. This blog content looks the same to readers as any other MedPage Today article written by its journalists and op-ed contributors.

Peck further states that a “column” is different from a “blog” because it has “a timeline established and sources clearly identified.” But the blog that’s the focus of this debate – “Revolution and Revelation” — is promoted to MedPage Today readers as a “popular column.”

 

Moreover, a section called “About this content,” which seemingly applies to all content on MedPage Today, would lead readers to believe that blog posts are edited for accuracy, objectivity, and balance. It reads:

Content on this page was created or selected by the Everyday Health Media team and is funded by an advertising sponsor. The content conforms to Everyday Health Media’s editorial standards for accuracy, objectivity, and balance. The sponsor may select the topic but does not edit the content. [Everyday Health is the digital media company that owns MedPage Today; our emphasis added to the quote.]

In fact, there’s no universal definition of what a blog is or isn’t. (There are some interesting ideas about that here.) Peck argues that there’s an obvious distinction between blog content and journalism, and she told us that there’s nothing she can do “if people are stupid enough” to mistake a blog for actual reporting.

But some blogs feature journalism. And many journalists have written blogs. Some news organizations have started blogs that have morphed into something else. For example, the New York Times previously called its Well personal health column a “blog.” Similarly, NPR used the term “blog” for its Shots health news coverage. Now they both use the word “section.”

It’s hard to keep up with the changes. And average readers who live in the clinical and research world could be excused for not understanding a distinction that Peck – a journalism professional — thinks is so clear.

The backstory: Packer on pre-authorizations

The piece that sparked this discussion, written by veteran cardiologist Milton Packer, MD, is a good example of a blog post that would have benefited from more editorial oversight.

Milton Packer, MD

The post describes an exchange Packer said he had with retired physicians who are employed by health plans to make coverage determinations for drugs. He said the doctors had just listened to him deliver a talk on heart failure drugs.

Without naming his sources, Packer wrote that the doctors told him they typically deny payment requests for life-extending medications because those drugs are “too expensive,” and one said “if I approve too many expensive drugs, I won’t get my bonus at the end of the month.”

Many people commenting online and in interviews with HealthNewsReview.org said the post conveyed multiple misconceptions about how health plans actually work.

Yet the piece drew more than 100 comments, many of which said Packer’s account affirmed a view of insurers as unscrupulous behemoths. Nine days after the post debuted it was still the most popular article on the site. Commenters called it “sad,” “disheartening” and “horrifying.” One lamented “across the board ridiculous profits of [insurance companies]. Shareholder profits are the priority, not the healthcare of policyholders.”

But most of those commenters and the presumably thousands of others who read the piece missed some important context: Packer has received more than $400,000 from drugmakers since 2013, including companies whose costly medicines are subject to pre-authorization. His financial ties weren’t disclosed on the blog until a week later, four days after the omission was flagged on Twitter and a day after HealthNewsReview.org asked about it.

Peck told HealthNewsReview.org that the missing disclosure was the result of an editing error and that it has run with his previous columns. An archived version of Packer’s Nov. 1 post, another jab at the insurance industry headlined “Are Payers the Leading Cause of Death in the United States?” suggests it initially ran without disclosure as well.

The blog depicts a ‘stereotype’ of preauthorization

MedPage Today appears to do an admirable job generally of disclosing financial relationships of its writers and sources as well as the funding sources of studies. Peck said she pioneered the idea of calling out those relationships in a colored box at the end of each story. This is commendable.

But missing disclosure wasn’t the only concern with Packer’s piece, which implies that health plan employees routinely deny claims not based on medical necessity but to protect monthly bonuses. Those claims should be supported.

We’ve tried to track down the source of the account – apparently an attendee at Packer’s talk — because we agree that Packer’s depiction, if verified, is shocking and should be investigated. In an email on November 17, Packer said he was traveling and could not provide the names of either the person who invited him to speak at the meeting or any of the attendees. He said he would look up this information when he returned to his office and added, “The story occurred exactly as I said it did.”

Tom James, MD

Tom James, MD, senior medical director for medical policy and quality at Pittsburgh-based Highmark, who has 38 years of experience working for health plans, told HealthNewsReview.org that Packer’s blog depicts a “stereotype” of pre-authorization. “This is not the way the world works today,” James said.

While time-consuming for doctors, pre-authorizations do effectively limit spending on pricey drugs. But James said simply handing out bonuses based on coverage denials would violate ethical guidelines and state laws.

Some MedPage Today commenters tried to provide the context that was missing from Packer’s story. For example, a woman who identified herself as a pharmacist working in managed care pointed out that insurers can’t easily boost profits by denying coverage for medically necessary treatment, as the piece implies. That’s in part because the Affordable Care Act requires health plans to spend at least 80 percent of premiums on medical claims and quality improvement, or at least 85 percent for large group plans.

Cindy Thomas, PhD, a professor and associate dean for research at the Brandeis University Schneider Institute for Health Policy, said that payers should be more transparent about how they decide which treatments need pre-authorization and which patients get approvals, as well as how much they pay for drugs.

Cindy Thomas, PhD

However, if Packer’s account reflects widespread practice in the insurance industry, Thomas said, there should be some evidence of that. If health plans are paying bonuses for payment denials, “someone should come forward and reveal specifics of the arrangements,” she added.

No doubt many MedPage Today readers would agree with Thomas’s call for more investigation. But that’s difficult without specific information, including names and dates, which Packer doesn’t provide.

Misleading musings that leave readers confused

It’s clear that many commenters didn’t realize this blog post was, in Peck’s terms, a mere musing and that it didn’t portray facts. They were disturbed by the portrait of corruption that Packer painted.

As a commenter who identified himself as Ronald Levy wrote in response to Peck’s editorial:

Dr. Packer’s reports are a LOT more than musings and opinions. He makes factual revelations, like his first hand reports of how preauthorization requests are casually turned down (perhaps unlawfully in some cases although he didn’t say this) that can be of life-and-death importance to thousands of patients, perhaps millions.

To clear up any confusion about the editorial standards that apply, we encourage Peck to make her “dinner table” story disclaimer more visible on Packer’s post itself. Surprisingly, that post doesn’t currently link to her editorial that supposedly clarifies its purpose.

Ideally, MedPage Today should insist that its opinion writers back up assertions on matters of public debate with verifiable sources whenever possible. That’s something HealthNewsReview.org, with its comparably tiny staff, is always careful to do with blog posts and especially with outside contributions.

While we’re not perfect and we may miss some things, our starting and ending point is the assumption of a responsibility to verify. We would never allow unsubstantiated statements to be published without editorial scrutiny merely because they are opinions.

At the very least, we recommend that a disclaimer run on all of MedPage Today’s unvetted blog content, which should clearly be marked “commentary” with an explanation of what editorial standards apply to the content and which ones do not.

A flawed definition of ‘success’

MedPage Today bills itself as “a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.” We think that’s generally true of the site’s high-quality journalist-written news content.

But is some of MedPage Today’s most popular content “trusted and reliable” when the organization admits it does little to vet such material?

Peck seems to think this is justified because, as she told us, it’s her job “to run the kind of content that drives traffic to the site.” And according to that metric, apparently, Packer’s blog qualifies as “a success.”

We disagree.

A news organization ought to measure success by more than clicks, or even the number of comments an article generates. It’s easy to get people to read and share provocative opinions that reinforce what they already believe, or want to believe. It’s harder and more important to get them to read something that deepens understanding of a complex issue.

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Comments (7)

Please note, comments are no longer published through this website. All previously made comments are still archived and available for viewing through select posts.

Peggy Peck

November 27, 2017 at 3:31 pm

A few thoughts in response (full disclosure most of these thoughts come from MedPage Today Managing Editor, John Gever, who has an excellent mind):
–It doesn’t take a professional journalist to recognize that an article using the word “I” 19 times is the writer’s personal recollection.
– Similarly, it should be obvious from the circumstances Packer described that attribution would not be possible or ethical.
– Neither Health News Review nor anyone else has brought forth any evidence that Packer said anything that isn’t true, and therefore the suggestion that he “didn’t portray facts” is unsupported.
– Comparing what MPT does to what HNR does is pointless — the organizations’ missions and audiences are totally different.
Finally, I did say during two phone conversations with the HNR writer, that I did not think blogs rise to the standards of journalism — especially blogs written by those who are not journalists. Dr. Packer is not a journalist.
Mary Chris at one point accused me of removing a Tweeted out reference to Packer’s blog, and asked me why I had done so. I told her this was not true and that I was insulted by the implication. She also asked me if I really thought that some managed care organizations rewarded reviewers for refusing to approve expensive treatments. I told her that I did believe that there are probably some (note the word some) that do just that and I said I also thought it was naive to think otherwise.

    Kevin Lomangino

    November 27, 2017 at 5:19 pm

    Peggy,

    Thank you for this response. I’ll address the points you raised in order:

    1. We don’t think the fact that this is a personal recollection is relevant. It’s possible to verify the details of the story and we’ve asked for specifics that are verifiable.

    2. We don’t think attribution is impossible or unethical. This was a public forum where insurance company employees were apparently openly discussing practices that are unethical and possibly illegal. Why is it not possible or ethical to identify the meeting, the organizer, and who was speaking? If those details aren’t immediately available why can’t they be investigated?

    3. In your editorial, you made a distinction between “opinions (blogs)” and “facts (news).” You argued that Packer’s blog writings are “opinions” and not “facts.” We were careful to qualify the statement to make it clear that we were using your terms and we never claimed that anything Dr. Packer said wasn’t true.

    4. HealthNewsReview.org has many physician readers and we share an interest with MPT in providing accurate news about health care. We don’t think it’s pointless at all to suggest that MPT should vet its material before publication as HNR does; that’s a basic function of any news organization.

    5. We’re sorry if you were insulted by anything that Mary Chris said. This was not meant as an accusation but as a question. Dr. Packer made insulting statements to Mary Chris, which we did not dignify with a response in our published writing. We prefer to keep the public record focused on educating and informing our readers.

    Kevin Lomangino
    Managing Editor

Tomas Bocanegra

November 28, 2017 at 9:43 am

Why spending so much space I discrediting the “messenger” and what a blog is or not? Use your energy to explain how pre-authorization “really” works. That will put the subject to rest.

    Kevin Lomangino

    November 28, 2017 at 3:04 pm

    Tomas,

    Our beat is the media and how media messages impact health care. Somebody else is going to have to write the story about how pre-authorization “really” works.

    Thanks for reading and commenting.

    Kevin Lomangino
    Managing Editor

Brant Mittler

November 28, 2017 at 1:32 pm

As a physician, attorney, journalist ( Yes, paid for print and TV work), I found Milton Packer’s revelations perfectly credible. And I am well aware of who he is and that he gets money from the pharmaceutical industry because he is an expert and distinguished clinician. And I have written a couple of pieces for MedPage Today for which I was not paid.
Having successfully sued 3 managed care entities in wrongful death cases as an attorney, and having served in my pre-attorney days as a technical advisor to a TV network that conducted a one year undercover camera investigation of the HMO industry, I found what Dr. Packer revealed to be perfectly credible. And it took courage to write what he did.
“Fake news” involves not only what is presented publicly but more importantly what is not reported. Most of the bad acts of the HMO/managed care industry are never reported. Not even the NY Times wanted to report the undercover HMO investigation that never was aired in spite of much hard copy and other media proof.
You would be better off calling for more such courageous reporting rather than trying to suppress even modest reports like this of harmful managed care behaviors that most honest practicing physicians know go on every day. My colleague, Drr. Steve Cohen, an oncologist, has in recent years documented the daily hassles he gets in trying to prescribe even the most basic medications. His documentation of these hassles to members of the media and government officials have all gone unanswered.
The thing about the press is that the owners call the shots.
It’s about time we have some honesty about the impact of managed care and obscene insurance company profits on the declining quality of U.S. healthcare.
As for blogs as journalism, sometimes the only place honest people can report the realities of what is happening to doctors and patients at the hands of managed care is in blogs. Most mainstream journalists ( via their editors and publishers) have been bought off by advertiser dollars a long time ago.

    Kevin Lomangino

    November 28, 2017 at 3:02 pm

    Brant,

    Thanks for the comment. The issue here is not whether Dr. Packer’s claims are credible. Many readers clearly think they are, and perhaps Dr. Packer will come through with the details we’ve asked him to provide in order to substantiate his story. The issue is whether MedPage Today should be publishing those claims without verifying them and without notifying readers that they haven’t been verified. MPT is a news organization, and readers have a reasonable expectation that its content will be vetted and checked. It’s not, and that’s a problem. Dr. Packer’s post is merely one instance of how imbalanced, incomplete information can reach readers when news organizations don’t apply editorial oversight. The larger issue is the standards that MPT does (or doesn’t) adhere to. As noted in the post, we think that should be addressed at an organizational level and not merely with respect to Dr. Packer’s post.

    Kevin Lomangino
    Managing Editor

Steven Bornfeld

November 28, 2017 at 2:43 pm

I don’t really have a dog in this fight. I vigorously support a free and ethical press. I also have contact with health insurance industry as both a patient, a “provider” (I’m a dentist) and as administrator of our small group insurance plan. I had no trouble identifying Packer’s piece as an opinion piece. I think anyone should be able to understand why a claims reviewer would not go on the record as receiving payment for denied claims.
I’m not naive. I know there are doctors who have unethical or frankly fraudulent billing practices. It is likewise very difficult to believe that insurance companies always fully comply with their own plan provisions–and disclosure is often poor.
It is is a cat-and-mouse game between doctors and carriers, and no one is helped by
that.
I know you think the story here is transparency, disclosure and and high journalistic principles. But for most people the issue (as Mr. Bocanegra states) of how authorization works in real life is far more important.
And get those investigative journalists working!