White House budget director Shaun Donovan called for a “more aggressive strategy” to thwart improper government payments to doctors, hospitals and insurance companies in a previously undisclosed letter to Health and Human Services Secretary Sylvia Mathews Burwell earlier this year.
Government health care programs covering millions of Americans waste billions of tax dollars every year through these “improper” payments, Donovan said in the Feb. 26, 2015 letter.
“While some progress has been made on this front,” Donovan wrote, “we believe a more aggressive strategy can be implemented to reduce the level of improper payments we are currently seeing.”
Donovan, director of the Office of Management and Budget, went to say that “we must continue to explore new and innovative ways to address the problem and attack this challenge with every tool at our disposal…”
Donovan cited problems with traditional Medicare, which pays doctors and hospitals on a “fee-for-service” basis, as well as Medicare Advantage, its fast-growing, privately run alternative. The private insurance plans are paid a set fee each month for each patient using a billing tool called a risk score.
The White House budget chief also noted in his letter that payment errors rose by $3.1 billion last year in Medicaid, the government health care plan for lower income people, which is jointly funded with the states. In addition, he directed HHS to draw up a plan for getting payments right under the Affordable Care Act. The health law, known as Obamacare, has added millions of people to insurance rolls and is slated to undergo payment-accuracy audits for the first time starting this fiscal year.
A copy of Donovan’s letter, which also directs HHS to develop a “comprehensive corrective action plan,” was released to the Center for Public Integrity earlier this week through a court order in a Freedom of Information Act lawsuit.
OMB did not respond to emails and a phone message seeking comment. The Centers for Medicare and Medicaid Services, the branch of HHS which oversees the health programs, did not immediately respond to a similar request.
The White House dubs payments as “improper” when they are “made to the wrong entity, in the wrong amount or for the wrong reason.” When errors occur, Medicare often pays too much, records show.
A Center for Public Integrity investigation published last year found that officials made nearly $70 billion in “improper” payments to Medicare Advantage plans from 2008 through 2013, mostly in overbillings triggered by inflated risk scores.
The Center also examined Medicare fee-for-service billing data in a 2012 series that documented how thousands of doctors and other medical professionals steadily billed higher rates over the past decade despite little evidence they were doing more for patients.
In total, Medicare covers more than 50 million Americans, most of them elderly. While most seniors remain on the original plan, Medicare Advantage has proven popular in recent years and enrolled some 17 million people. Both Medicare options are among 13 federal programs singled out as “high-error” due to billing abuse. (Here’s a list).
Medicare fee-for-service billing errors jumped 2.62 percent in fiscal 2014, costing $9.7 billion more than the previous year, according to Donovan.
Donovan cited progress in reducing Medicare Advantage payment errors, but said that the government estimate of $12.2 billion in these mistakes for fiscal year 2014 “remains a concern.”
Donovan directed health officials to develop a “comprehensive corrective action plan” by April 30 that describes the problem’s “root causes” and sketches out what it would take to clean things up. He also asked for a plan to improve the “integrity” of the ACA insurance programs, which he also described as a “key priority,” by May 31 of this year.
It is not clear whether HHS has yet produced such documents.
The OMB chief suggested HHS work with its Office of Inspector General to help measure the agency’s performance. Inspector General’s Office spokesman Donald White said his unit has been meeting with CMS “to describe joint actions to address program integrity, performance and improper payments."
David A. Lipschutz, an attorney with the Center for Medicare Advocacy, a non-profit law group that helps seniors navigate Medicare, said health plans that make patients appear sicker than they actually are to get higher payments present a “clear example of improper payment that should be vigorously monitored.”
But he cautioned that policy makers must be careful about turning the screws too tightly. He said some Medicare providers may “prematurely terminate care or deny services altogether out of fear of being audited and/or due to an overly restrictive interpretation of Medicare coverage guidelines.”
Reporters Without Borders condemns the many cases of violence against journalists by security forces in recent weeks in Beirut during demonstrations in protest against the collapse of garbage collection.
In the latest case, reporters covering yesterday's occupation of the environment ministry were forcibly ejected by riot police when force was used to clear the building of protesters, who blame the minister for the crisis. Journalists inside and outside the building were hit by policemen, who either confiscated their equipment or rendered it inoperable.
“It is utterly unacceptable for the Lebanese police to use this kind of violence against journalists,” said Alexandra El Khazen, the head of the Reporters Without Borders Middle East and Maghreb desk.
“Journalists are not trash and they should not have been targeted. They were there just to report the facts and do what journalists are supposed to do. We condemn these attacks, which show that the authorities are bent on stopping media coverage of the use of unprecedented violence to crack down on demonstrations.”
Foutoun Raad, an LBCI TV reporter who was inside the environment ministry with about 15 demonstrators, was threatened and hit by the policemen who forcibly escorted her out of the building. In a report filmed later outside, she said she had to use her telephone to continue providing coverage after her cameraman's transmission cable was deliberately cut.
The demonstrations have been growing in intensity for the past month. In the protests held on 22 and 23 August, around ten journalists were attacked by members of the security forces, who manhandled them, hit them with batons and threw stones at them, as well as deliberately damaging their equipment.
A video showing LBCI journalist Nada Andraos being beaten and manhandled has gone viral online.
Lebanon is ranked 98th out of 180 countries in the 2015 Reporters Without Borders press freedom index.->http://index.rsf.org/#!/index-detai...]
Researchers out of Spain have developed a machine-learning model that they say can recognize when mobile phone users are bored, then push content at those users.
“Being bored makes mobile phone users more open to consume suggested content,” the researchers, three of whom are from Telefónica Research in Spain, wrote. (They’re associated with Spanish telecommunications giant Telefónica; the paper’s fourth author is from the hciLab at the University of Stuttgart.) Their paper will be released at a ubiquitous computing conference in Japan next week (h/t MIT Technology Review).
The researchers explain:
If mobile phones are able to detect when their users are killing time, i.e. when attention is not scarce, then they could suggest a better use of those idle moments by:
— recommending content, services, or activities that may help to overcome the boredom;
— suggesting to turn their attention to more useful activities, such as revisiting read later lists, going over to-do lists, or participating in a research survey; or
— helping the user to make positive use of the boredom, such as using it for introspection, since mental downtime is essential to reflection, learning, and fostering creativity
RELATED ARTICLEPush it: A look behind the scenes of a New York Times mobile alertAugust 10, 2015Introspection and mental downtime, ha! Instead, the researchers’ app pushed BuzzFeed articles at users the app determined were bored. “We chose the BuzzFeed app as suggested content, because (1) the app caches articles, so that the study did not rely on permanent availability of an internet connection, and (2) its content is designed to be interesting to a broad audience.”
Turns out that “participants were significantly more likely to open and engage with suggested content on their mobile phones when our algorithms predicted them to be bored…These findings are significant, as they show that automatically detected boredom may be an ideal way to deal with people’s increasingly scarce attention.”
The details on how, exactly, the researchers’ algorithm assessed boredom are interesting and covered in full in the paper, but in case you’re wondering what, exactly, people who are bored and on their phones do:
Our participants tended to be more bored the more time had passed since receiving phone calls, SMS, or notifications, and the less time had passed since making phone calls and sending SMS. However, the volume of notifications received in the last 5 minutes is likely to be higher when being bored.
Being bored is also correlated with more phone use: the screen was less likely to be covered (which, for example, happens when the phone is stowed away), more apps were used, the last unlocking and checking for new notifications happened more recently, and the volume of data uploaded was higher when our participants were bored. Interestingly, the amount of data download and battery drain were lower when people were bored.
Related to demographics, male participants tended to be more bored than females, and boredom was higher for participants in their 20s and 40s and lower in their 30s.
Boredom was more likely the later it was in the day and the darker the ambient lighting conditions.
Finally, apps that most strongly correlated with being bored were Instagram, email, settings, the built-in browser, and apps in the ‘other’ category. Apps that correlated most strongly with not being bored were communication apps, Facebook, SMS, and Google Chrome.
RELATED ARTICLEThe next stage in the battle for our attention: Our wristsMarch 5, 2015So add “boredom detection” to the list of strategies that publishers will one day be able to use when they’re deciding how to send out push notifications. And this sort of contextual detection could be important for wearables, which are both a rich potential source of behavioral data and a notification machine on your wrist.
Like all Nieman Lab stories, the one you’re reading right now will be anchored by a handful of tags connected to the themes, people, and companies mentioned within. Theoretically, keywords like “tags,” “tagging,” “article tags,” and “metadata” would be helpful in directing people to this, or other, stories, about the mechanics of news discovery.
But do all publishers use article tags the same way we do? And do tags make any difference in attracting people to a website? A new report from analytics company Parse.ly found no statistical link between the use of tags and the amount of traffic a site received — but also saw publishers using tags in creative ways to help guide strategy. (Sites that use Parse.ly include The Atlantic, Slate, Mashable, Business Insider, The Globe and Mail, The New Republic, and Upworthy, among about 400 total.)
In that network, 70 percent reported using tags and 30 percent said they go without. On average, 450 tags were published in a month, with the actual number of tags per post averaging 5.2. Parse.ly found no correlation between the number of overall tags published and audience size, and the number of tags per story didn’t change much with story length. ” Essentially, if we increase the word count of an article from one word to 10,000 words, the average number of tags in the article only increases by around 0.36,” the report found.
(Here at Nieman Lab, we’re relatively aggressive taggers, with over 13,000 tags used on our roughly 5,000 articles published since 2008. But our tag pages account for only about 1 percent of our pageviews. Our 10 most common tags? The New York Times, Twitter, business models, Facebook, advertising, social media, Google, paywalls, the Knight Foundation, and mobile.)
Despite the fact that tags are usually user-facing, their most important uses may be internal to news organizations. “In the last couple of years, we’ve noticed that tags are being used in more interesting ways,” said Andrew Montalenti, chief technical officer at Parse.ly.
Parse.ly’s findings suggest that publishers are making advances in how they use structured data in content production and audience analysis. Companies are moving beyond simply using tags as a way to surface stories on Google or in an archive. Specifically, Parse.ly found that publishers are using tags to categorize article formats (stories vs. quizzes vs. videos), paywall status, and sponsored content.
RELATED ARTICLETrials and iterations: The Globe and Mail tries to balance reinvention and familiarity in its new appJuly 8, 2015That same organizational ability to find, filter, and sort stories is being used to route different processes in the newsroom, Montalenti said. A site that runs native ads could track and report on specific campaigns based on tags for native content and the accompanying brand. Or, in the case of a site like The Globe and Mail, tags could be used to indicate which stories are only available to subscribers and which are available to everyone.
There’s a certain amount of content optimization that can be done here. Think if you were to tag articles based on whether they included a video; you could then analyze whether having this element improved article performance. This would help you to decide whether it made sense to embed more videos in the future.
RELATED ARTICLEThe New York Times built a robot to help make article tagging easierJuly 30, 2015In July, The New York Times offered a glimpse of a new automated tagging tool under development in its Research and Development Lab. Alexis Lloyd, creative director of the Lab, said that such tools will let the Times mine its archive to create new products in the future.
Photo of gift tags by Cutie Pie Company used under a Creative Commons license
Do you have an idea to advance journalism? Can Harvard help?
If yes and yes, we’d like to hear from you. We’re opening applications for our Knight Visiting Nieman Fellowships, a chance to join us here at Harvard for up to 12 weeks of work on a special project. Nieman has nearly eight decades of experience with yearlong fellowships for journalists, but added these shorter stays to reflect the changing needs of the industry and the evolving cast of journalism influencers.
This is our fourth year welcoming visiting fellows, and our first in partnership with the Knight Foundation. In that time, we’ve had developers, editors, journalism professors, and others bring their research projects to Nieman. We’ve helped a foreign correspondent plan his epic seven-year walk across the globe and a Google editorial director develop a method for mapping future news events. Some of our fellows’ projects have won funding for further development. Many have been covered in Nieman Lab or Nieman Reports and reached large international audiences. This week, Nieman published an ebook documenting visiting fellow Amy Webb’s ambitious work on rewriting the future for journalism schools.
I asked Melody Kramer, who recently finished a terrific project with us on public media, if she would talk about her fellowship as a way of helping others who are considering applying. She recorded a short video describing her proposal, her application, her interview with us, and how she spent her two months at Nieman.
Ready to apply now? You can do that online. The deadline is October 31.
Our experience with visiting fellows has taught us a lot, but here are two ingredients we’ve learned are key to success:
- A focused inquiry is better than a broad one. An applicant’s proposal can be part of a larger project, but should be a well-defined part of the whole. When visiting fellow Hong Qu came to Nieman, he wanted to build a tool to help journalists judge the reliability of Twitter during breaking news. The result was Keepr, which he tested during the aftermath of the Boston Marathon bombing. While Reddit and other forums were important forces during that complex story, his focus on one made it possible to create a tool that could have immediate impact on our use of a growing medium.
- Plan ahead. Best not to wait to land at Harvard to start researching the people and resources here that could inform your project. Some fellowships and assignments lend themselves to a more meandering pace, but not this one. You have no more than 12 weeks. I think of the time as structured exploration — setting out with clear objectives while staying open to serendipitous discovery. The question “why Harvard?” is one we often ask of candidates and we like to hear that you’ve thought that through. That includes how you might use Nieman Foundation resources — the Lab, Nieman Reports, Storyboard, and our academic-year fellows — to inform your work.
Be certain when you apply that the longer Nieman Fellowship is not a better fit. After arriving here, one or two of our visiting fellows felt a broader inquiry would have been preferable to their tailored projects. Nearly 1,500 journalists have been awarded that fellowship since our founding in 1937 and it remains a remarkably transformative experience. Applications for that fellowship will not be due until December 1 for international journalists and January 31 for U.S. applicants.
But if you have an idea for what someone called the “new Nieman,” do let us know by October 31. I look forward to reading about it.
From Nieman Reports: From earnings reports to baseball recaps, automation and algorithms are becoming a bigger part of the news
Editor’s note: Our sister publication Nieman Reports is out with its new issue. There’s lots to read, but Nieman Lab readers might be most interested in the cover story, by former Nieman Fellow Celeste LeCompte, on the state of automation and algorithms in today’s newsrooms.
Philana Patterson, assistant business editor for the Associated Press, has been covering business since the mid-1990s. Before joining the AP, she worked as a business reporter for both local newspapers and Dow Jones Newswires and as a producer at Bloomberg. “I’ve written thousands of earnings stories, and I’ve edited even more,” she says. “I’m very familiar with earnings.” Patterson manages more than a dozen staffers on the business news desk, and her expertise landed her on an AP stylebook committee that sets the guidelines for AP’s earnings stories. So last year, when the AP needed someone to train its newest newsroom member on how to write an earnings story, Patterson was an obvious choice.
RELATED ARTICLEIn media companies, the editorial staff shouldn’t be kept in the dark about financesMarch 11, 2015The trainee wasn’t a fresh-faced j-school graduate, responsible for covering a dozen companies a quarter, however. It was a piece of software called Wordsmith, and by the end of its first year on the job, it would write more stories than Patterson had in her entire career. Patterson’s job was to get it up to speed.
Patterson’s task is becoming increasingly common in newsrooms. Journalists at ProPublica, Forbes, The New York Times, Oregon Public Broadcasting, Yahoo, and others are using algorithms to help them tell stories about business and sports as well as education, inequality, public safety, and more. For most organizations, automating parts of reporting and publishing efforts is a way to both reduce reporters’ workloads and to take advantage of new data resources. In the process, automation is raising new questions about what it means to encode news judgment in algorithms, how to customize stories to target specific audiences without making ethical missteps, and how to communicate these new efforts to audiences.
Automation is also opening up new opportunities for journalists to do what they do best: tell stories that matter. With new tools for discovering and understanding massive amounts of information, journalists and publishers alike are finding new ways to identify and report important, very human tales embedded in big data.Keep reading at Nieman Reports →
Illustration by Joe Magee.