The New York Times - James Brosher Photography

‘Obamacare’ protection of pre-existing conditions

James Brosher — Mon, 12 Jun 2017 01:34:32 +0000

Last month I spent some time one afternoon photographing Debbie and Phil Carter at their farm in rural Vigo County, Indiana not far from Terre Haute for The New York Times. The article told the story of some people who have benefited from the Affordable Care Act’s regulations in regards to pre-existing conditions. Thanks to health care changes made under the ACA – also known as “Obamacare” – Debbie received a liver transplant after being diagnosed with a bile duct disease. Because of rain, the Carters were working in their barn for most of the time I was with them. After I finished shooting, I chatted with them for close to an hour. I grew up in a rural farming community in Indiana, but I hadn’t photographed on a farm in several years. It was a nice change of pace to get out in the country away from Bloomington and Indianapolis for a shoot.

Stymied by a rainy day during planting season, Debbie Carter looks for a filter as her husband Phil, not pictured, performs maintenance on one of the couple’s farm tractors on Monday, May 1, 2017, in rural Vigo County, Ind. Debbie Carter received a liver transplant after being diagnosed with a bile duct disease thanks in part to changes made under the Affordable Care Act. “We would have lost the farm,” she said. (James Brosher for The New York Times)

Debbie and Phil Carter stand in a field of butterweed on Monday, May 1, 2017, on their farm in rural Vigo County, Ind. (James Brosher for The New York Times)

Phil Carter changes a filter on one of the family’s farm tractors on Monday, May 1, 2017, in rural Vigo County, Ind. (James Brosher for The New York Times)

Phil Carter uses an air hose to blow out a cover for a tractor’s cabin filtration system on Monday, May 1, 2017, at the family’s farm in rural Vigo County, Ind. (James Brosher for The New York Times)

Stymied by a rainy day during planting season, Debbie and Phil Carter prepare to change a filter as they perform maintenance on one of their farm tractors on Monday, May 1, 2017, in rural Vigo County, Ind. (James Brosher for The New York Times)

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Patient surveys and the opioid epidemic

James Brosher — Wed, 31 Aug 2016 19:17:55 +0000

I spent a few hours back in June shadowing Dr. S. Michael Keller, the emergency room director at Marion General Hospital in Marion, Ind. The photos were for a story in The New York Times about patient satisfaction surveys and their effect on the opioid epidemic. Under the Affordable Care Act, hospitals’ Medicare reimbursements were tied to patient satisfaction surveys. The idea of this was to encourage quality care, but many health care professionals argue the surveys incentivized doctors to prescribe powerful and potentially addictive painkillers such as opioids to patients in order to score well on the surveys. Marion General bucked the trend by cutting opioid prescriptions, leading to a drastic drop in the patient satisfaction surveys.

Dr. S. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, examines William Joseph, a patient from Van Buren, Ind., in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. Marion General Hospital urged its doctors to limit opioid prescriptions resulting in lowered patient satisfaction scores, particularly in pain management. As part of the Affordable Care Act, the Centers for Medicare and Medicaid Services (CMS) incentivizes quality care by rewarding hospitals that score well on patient satisfaction surveys. (James Brosher for The New York Times)

Dr. S. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, speaks with Deseric Inman, a patient from Marion, Ind. experiencing eye discomfort, in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

Dr. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, speaks with the mother of a patient in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

A pain assessment tool hangs on a wall as Dr. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, speaks with a patient in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

Dr. S. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, examines Deseric Inman, a patient from Marion, Ind. experiencing eye discomfort, in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

Dr. Michael Keller, director of Marion General Hospital’s emergency department and ambulance services, speaks with a patient in the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

Dr. Michael Keller, left, director of Marion General Hospital’s emergency department and ambulance services, and Ann Vermilion, the hospital’s administrative director, pose outside of the Emergency Room on Wednesday, June 15, 2016, in Marion, Ind. (James Brosher for The New York Times)

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Dr. Pardeep Kumar

James Brosher — Wed, 07 Oct 2015 18:27:53 +0000

Last month I photographed Dr. Pardeep Kumar, an internist in Terre Haute, Ind., for a story in The New York Times about a new medical coding system that went into effect on Oct. 1. The new system, ICD-10, is causing health care providers anxiety because it will change the fundamental way they describe illnesses and injuries in their computer systems. As Dr. Michael R. Marks, a Connecticut orthopedic surgeon, describes it in the story: “On Oct. 1, we will be speaking a new language. It’s like switching to German, after speaking English for 30 years.”

Dr. Pardeep Kumar listens to a patient before a check up on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. Kumar and doctors nationwide are preparing to switch to a new medical coding system, ICD-10, for tracking diagnoses on Oct. 1. (James Brosher for The New York Times)

Dr. Pardeep Kumar listens to a patient’s breathing using a stethoscope on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

Dr. Pardeep Kumar performs a diabetic foot exam on a patient on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

A computer screen shows the medical coding for a patient’s diabetic foot exam on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. Doctors nationwide are preparing to switch to the new medical coding system, ICD-10, more than two decades after it was completed by the World Health Organization in 1992. (James Brosher for The New York Times)

Dr. Pardeep Kumar poses for a portrait in the office of his internal medicine practice on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

Dr. Pardeep Kumar examines a patient’s knee on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

Dr. Pardeep Kumar shares a laugh with a patient during a check up on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

Dr. Pardeep Kumar is seen on Wednesday, Sept. 9, 2015, in Terre Haute, Ind. (James Brosher for The New York Times)

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