Learn from these journalists how they have covered various aspects of health care related to reform. They provide valuable tips and sources and explain how they got past the challenges to explain the complex world of health reform to their audiences.
March 2016 In March 2014, I scored an interview with the chief executive of a new health insurer called Maine Community Health Options.
The interview wasn't much of a "get" by any standard. MCHO was a little-known health plan that sold coverage to customers on Maine's state exchange. But it was exciting to me for one reason: MCHO was a consumer-oriented and operated plan, part of the first generation of nonprofit health insurers created by the Affordable Care Act and funded by taxpayers.
The co-op program, which consisted of 23 startups, offered an alternative to buying coverage from the traditional big insurance companies. The individual co-ops would ideally be more community-focused, friendlier and more accessible to the average consumer, and maybe even cheaper.
January 2016 Not-for-profit hospitals are required give back to their communities to justify their tax exempt status. Those efforts usually take the form of providing charity care to the uninsured or subsidizing the training of new doctors.
A number of health policy researchers and politicians have been putting hospital community benefit spending under the microscope. There are even examples of municipalities that have stripped hospitals of their tax-exempt status when they determined that these providers were operating like for-profit entities.
During Beth Kutscher's 2015 AHCJ Reporting Fellowship on Health Care Performance, she looked at the impact Medicaid expansion had on hospital finances. And she spent some time reporting on how not-for-profit hospitals have to give back to their communities to justify their tax exempt status. See what she found.
August 2015 Sarah Kliff's story,“Do No Harm,” began with a simple question.
She is one of AHCJ's 2015 Reporting Fellows on Health Care Performance and, while writing a series on fatal medical errors, she wanted to understand why preventable harm happens. Why do errors that we know how to stop persist?
Her attempt to answer that question became one of the largest projects she's undertaken as a journalist. “Do No Harm,” published on Vox, took about four months to research, report, and write. Kliff learned a lot about how to manage big projects — and find good sources for long narratives. Here she shares few lessons she took away from the experience.
July 2015 As senior quality editor for HealthLeaders Media, Cheryl Clark wrote more than 1,300 stories about hospitals' efforts to improve quality and safety and related issues. The story she wrote for the June 2014 issue of HealthLeaders, about how U.S. hospitals are improving recognition and treatment of sepsis — which is diagnosed in 750,000 patients a year and kills 40 percent — won the 2015 National Institute of Health Care Management prize in the trade print category.
Rates of sepsis seemed to be one more dirty little hospital horror to explore, one that the Joint Commission said cost hospitals about $16.7 billion annually. Yet hospitals' efforts to tackle it seemed hidden behind improvement initiatives attracting more attention, such as reducing hospital-acquired infections, and preventable readmissions, lowering emergency room wait times and raising patient experience scores.
Here, she explains how she did her reporting, despite a lack of data and sources who didn't want to talk.
June 2015 Lauren Sausser of The Post and Courier in South Carolina was surprised by an email from a reader asking her to write more about Medicaid expansion in South Carolina – specifically, this state’s refusal to expand the low-income health insurance program under the Affordable Care Act.
This year, health insurance subsidies have played a much more prominent role in The Post and Courier’s health care coverage. Like other news outlets, her newspaper is waiting to find out what the Supreme Court decides in King v. Burwell. If the court rules in favor of the plaintiffs, subsidies will end in states using the federal exchange.
In South Carolina, a King victory would mean that coverage will become unaffordable for an estimated 200,000 people who have purchased subsidized policies through the federal insurance marketplace. It’s been a big story. Meanwhile, Medicaid expansion, with a few exceptions, is relatively stagnant here.
January 2015 When I started following a group of residents in a primary care training program, I expected to produce a lively radio documentary on idealistic young doctors who are bucking the trend against frontline medicine. After all, pay and prestige is much lower in primary care than specialties, while workload and stress is generally higher. It must take a special kind of person to go into the field anyway.
To be sure, they were all lovely people, compassionate and clearly committed to medicine. But by the end of my year of reporting, two out of the three had changed their minds about primary care, deciding instead on more lucrative specialties. Their decisions may have been disappointing for the field, but they did make for a more compelling story. I was able to use their personal dilemmas, unfolding in real time, to illustrate the crisis in primary care.
I had help in doing this – a year-long fellowship from the Association of Health Care Journalists that paid for travel expenses and some production help. But I believe this kind of long-term project is do-able without a fellowship, as long as you have a forward-thinking editor and the patience to let the story reveal itself slowly.
January 2015 Tim Darragh, when he was with The Morning Call, of Allentown, Pa., reported and wrote a four-day series of stories about a local effort to find ways to improve care and individual health while reducing expenditures for so-called “super-utilizers.” These patients constantly use expensive emergency departments for their health care needs – in many cases, poorly controlled chronic and mental health illnesses, coupled with social isolation, unhealthy living environments and poverty.
Your community might not have a federally-funded pilot program to address super-utilizers as Allentown has. But your community has superusers and it has similarities with Allentown that you can explore in your own reporting. Read about how Darragh approached the reporting and key issues he found.
December 2014 Maryland is the only state with an “all-payer” hospital system – a system in which every health plan and every payer pay about the same rate to a given hospital for a given procedure or treatment. That includes Medicare, under a waiver from the federal government. A commission sets the costs and there’s a lot less cost-shifting in the system if everyone is playing by the same rules.
I have been fascinated with Maryland’s Medicare waiver for a little more than two and a half years. That’s when the Baltimore Business Journal hired me to write about health care and I first learned about the policy that is the lifeblood of Maryland’s $15 billion hospital industry.
October 2014 When my editor and I first discussed the idea of a hospital consolidation project, I felt my eyes glaze over at the thought of all the spreadsheets and 990 forms I would have to sift through. Consolidation is a largely financial decision, so I assumed that numbers would provide the driving force for the story.
Instead, I found that while the numbers do add weight to hospitals’ claims of desperation, the bulk of the story lay elsewhere.
Here’s the gist of it: In Yakima, Wash., the one remaining independent, nonprofit community hospital announced a year ago that it’s looking for someone to partner with to stave off financial uncertainty in the future. It reached out to several larger Seattle organizations, but only one is still engaged in talks.
July 2014 Carla K. Johnson, an AHCJ board member and Chicago-based Associated Press medical writer, describes the steps and documents requests that helped her dive deeply into the deals and contracts behind the state of Illinois’s multimillion dollar promotional campaign for the Affordable Care Act.
Read her stories and see the highlights of the documents she amassed and shared using Document Cloud.
June 2014 When the Affordable Care Act passed in 2010, there was a lot of talk about who would be covered under the legislation. Medicaid would expand in some states and more individuals would have private insurance coverage. But there were a few groups that were exempt from the requirement to purchase insurance including Indian tribal members, individuals eligible to opt out because of religious beliefs, and undocumented immigrants.
In fact, undocumented immigrants were ineligible for both of the main provisions of the law meant to extend coverage to 32 million Americans, the Medicaid expansion and the state insurance exchanges. Tammy Worth investigated how the law would affect care for this population as well as the providers who treat them.
June 2014 Kentucky received national attention when it became the only Southern state to fully embrace the Affordable Care Act by creating its own health insurance exchange and expanding Medicaid to cover hundreds of thousands more residents.
But, in impoverished rural areas that stood to gain the most from the greater access to care that the ACA promised, many residents remained fiercely opposed to the law and the president who pushed it.
Against this backdrop, a team from USA Today and The Courier-Journal in Louisville decided to launch an in-depth examination of how the law is beginning to play out in Appalachian Kentucky. Courier-Journal medical writer Laura Ungar shares how they did it.
May 2014 Daniel Chang wrote a piece for The Miami Herald on some of the hidden hospital fees that can take patients by surprise – and which insurers don’t necessarily cover.
These hidden fees are coming about because hospital executives have been preparing their institutions for payment reforms they see coming as a result of the Affordable Care Act – particularly the way the law shifts financial risk away from patients, private insurers and government payers, and to the caregivers themselves, namely hospitals, physicians and other providers.
Here's what Chang learned while reporting this story.
April 2014 Ten days before the (expected) close of open enrollment, The Philadelphia Inquirer reported that the federal exchange's window-shopping tool – the one that the administration encourages everyone to check before applying for Marketplace insurance – was using the wrong year's poverty-level guidelines. Neither the Obama administration nor any health-care consultants or policy experts that reporter Don Sapatkin could find had noticed it and the site was corrected within hours after the story was posted.
In theory, almost anyone going on the site got slightly incorrect information for 35 days. Most seriously affected, however, were people just above the poverty line in states that have not expanded Medicaid. When they put their information into the tool, it responded: “Not eligible for help paying for coverage.” Many of them may have given up right there and not submitted the actual applications (which were using the correct poverty stats and were assessed correctly). It’s impossible to tell from the notification letter whether errors were made.
March 2014 Colorado health reporter Katie Kerwin McCrimmon is a relative newcomer to AHCJ and she shared some of her experiences in covering Colorado’s state health exchange on AHCJ’s electronic discussion list recently.
She used the Colorado Open Records Act (CORA) “to pry information out of our exchange since I dealt with obstructive PR folks and exchange managers for most of 2013.”
Not all states have the same records laws. Not all the states have structured the exchange governance in the same way. And of course, not all the states are running their own exchanges. But her experiences in Colorado are still instructive in trying to get information released.
February 2014 Modern Healthcare reporter Beth Kutscher watched the differences in Affordable Care Act implementation in her state of Tennessee and neighboring Kentucky, where the state's online health marketplace was enrolling about 1,000 people a day. Tennessee was a stark contrast. The state had defaulted to the federal exchange, which meant that even if consumers – and especially younger, healthier individuals who help dilute the risk pool for insurers – had considered buying a plan, there was a good chance they’d log off HealthCare.gov in frustration and not return. She began to think about what it meant for the hospitals in the two states – and she decided to find out. Here’s how she got her story.
January 2014 Jim Doyle, who covers the health care industry for the St. Louis Post-Dispatch, has been working on an ongoing multi-part series on health care access and the fraying safety net. What he found when he traveled around rural parts of Missouri and Arkansas is that, while the Affordable Care Act will bring changes in the health insurance marketplace to these area, it only goes so far in helping the poor get access to care. “If you report on rural hospitals, you'll soon recognize the parallels between the health care disparities the poor face in rural areas and in the inner cities and that health insurance reform only goes so far, causing many safety-net organizations to struggle,” he writes. Of particular interest to health care journalists is Doyle’s impressive list of resources he uses to inform his reporting and his willingness to tap a wide variety of sources for his work.
December 2013 Oklahoma Watch, a nonprofit investigative journalism team, recently published a two-part series on hospitals based on financial data obtained for every hospital in the state. The series revealed that between half and three-fourths of small general hospitals in Oklahoma were losing money, and that hospitals had spent only small fractions of their net patient revenues on charity care.
Reporter Clifton Adcock explains how he got the data, with some specific tips on how to find alternative sources for data when government officials are uncooperative and how to make sense of daunting hospital cost reports.
October 2013 Six years ago, a clinic in Oregon made the decision to ban representatives from the pharmaceutical companies. The doctors and staff say goodbye to free samples of expensive drugs, lavish lunches, pens, notebooks, mugs, toys for children and other "benefits."
Markian Hawryluk, a health reporter with TheBend (Ore.) Bulletin, picked up on a recent journal article about the transformation and used that as his inspiration to write about how the clinic made its decision and how it changed the way doctors there practice medicine, as well as how the move impacted the community.
As data is collected under the Physician Payments Sunshine Act, a part of the Affordable Care Act that will require pharmaceutical companies to disclose the money and gifts given to physicians, reporters may start noting similar changes in their area.
August 2013 When Kaiser Health News hired Jenni Bergal as a freelance contractor, she was given only one assignment: Write about Medicaid managed care. It’s an important topic, with millions more people expected to be enrolled as Medicaid expands under the Affordable Care Act starting next year.
She set out to find out how well the states are overseeing and monitoring the quality of care provided by the managed care plans they contract with, and how states compare with each other. In this article for AHCJ, she explains the challenges in doing so. She also reminds us that even policy stories are about people and shows us how problems in one state's managed care program have affected its residents.
August 2013 Stephanie O’Neill, a health care reporter for Southern California Public Radio, tells the back story of her report on why California – a state that has taken the lead in combatting tobacco – had second thoughts about whether to charge smokers higher insurance premiums as permitted under the Affordable Care Act. It’s a topic you can explore with legislators, insurers and public health advocates in your state.
June 2013 Carla K. Johnson, an Associated Press medical writer and AHCJ board member, recently did an insightful piece on how the coverage expansion under the Affordable Care Act would affect treatment for substance abuse and addiction.
She analyzed several sets of federal data to find the current capacity of the addiction treatment system and the number of possible new patients. Armed with the data, she then did another round of interviews with addicts, their families and their treatment providers.
Here she shares how she got her story – and provides tips and sources that can help you explore this topic in your own community.
April 2013 Colorado Public Radio's Eric Whitney recently reported on a new program involving Walgreens pharmacists that is intended to help hospitals reduce readmission rates. It seemed like a straightforward story about improving patient care and new business opportunities created by the Affordable Care Act.
Not so straightforward was the improvising Whitney had to do when things started going awry. He writes about the challenges of putting together a piece for radio, what went wrong and how he was able to pull it all together.
As Whitney writes, there are innovative strategies being tried across the country. Broad reporting on the topic will help audiences better understand one place where health care is failing, and why solutions aren’t always simple.
December 2012 Amid all the enthusiasm over increasing the use of information technology in health, politicians and policy makers paid little attention to the implications of a gold rush sparked when billions of taxpayers’ dollars suddenly came up for grabs. Hundreds of medical technology companies scrambled to sell digital systems — often by promising doctors and hospitals they could boost revenues by billing higher rates to Medicare and other health insurers.
The fallout from those early decisions could be coming back to haunt taxpayers, according to a three-part investigative series from the Center for Public Integrity. The series documented that thousands of medical professionals steadily billed Medicare for more complex and costly health care over the past decade — adding $11 billion or more to their fees — despite little evidence elderly patients required more treatment.
Reporter Fred Schulte explains how the project came about, how the Center did its reporting and provides plenty of background on medical coding, Medicare billing and the potential fallout as health care providers install and use electronic systems.
September 2012 The Affordable Care Act honed in on hospital readmissions because many health policy experts believe they’re symptomatic of the broad dysfunction of the health care system where providers don’t work with each other as patients pass from one setting, like a hospital, to another, like a primary doctor’s oversight or a nursing home.
Readmissions penalties that begin in October are intended to prod hospitals to start making sure patients get the care they need after they walk out the door. It’s a nice window into many of the most important issues in health care, including cost, access and disparities.
Jordan Rau, of Kaiser Health News, explains the penalties, the readmission data and offers tips on how to use the data to write about hospitals with specificity and authority.
July 2012 The risks and benefits – both physical and fiscal – of cancer screening have become a burning topic, and have been absorbed into the endless political controversies surrounding the health reform law.
Are certain tests "essential benefits" or a boondoggle that can actually do more harm than good? And if they are deemed "unessential," then someone who disagrees inevitably uses the "R" word (rationing.)
We asked Reuters Health reporter Frederik Joelving to share how he reported on a high-profile doctor touting a new screening test. The test may be quicker and cheaper than the standard procedure, but hasn’t been proven to help anyone.
July 2012 In 2009, as the debate about health care reform picked up steam in Washington, D.C., an editor at The News & Observer in Raleigh, N.C., posed a question: Should the newspaper take a deep look at the cost of health care?
A series of interviews and some database work led to a memo directing the coverage to concentrate on hospitals and a key decision: Ask colleagues at The Charlotte Observer to join. North Carolina's two biggest hospital systems were based in Charlotte. The biggest, Carolinas HealthCare System, was suing thousands of its patients each year for payment. If the two papers worked together, they could pull off a series that could run statewide, with more reach and impact.
Here, investigative reporter Joe Neff from The News & Observer, investigative reporter Ames Alexander and medical writer Karen Garloch from The Charlotte Observer share how they reported the five-day series, the most useful sources and their reporting strategies.
May 2012 Can the government change the way that doctors care for their patients?
This is one of the key questions reporters will try to answer as they cover the Obama administration’s efforts to promote comparative effectiveness research. Rochelle Sharpe, a Pulitzer Prize-winning freelance writer, has written about comparative effectiveness research that is designed to determine the most effective ways to treat disease and fill gaping holes in our medical knowledge. Here, she shares sources and questions that reporters should be asking about the topic.
February 2012 One little-known element of the health care reform law sets new rules for nonprofits. They are required to assess community needs, and inform patients of charity policies. Some legislators want tougher rules and oversight to make sure they are providing enough service to the community to justify the tax break.
Reporter Tony Leys, of the Des Moines Register, describes how he examined how much charity care is provided by hospitals in Iowa in return for the substantial tax breaks they get for operating as nonprofit organizations. Leys, a 2011-12 Regional Health Journalism Fellow, was able to compare local hospitals, using new IRS reporting requirements for nonprofit hospitals, and estimated how local property tax revenue was affected by the tax-exempt hospital properties in those areas.
November 2011 One of the goals of the health reform law is to change the payment incentives to get rid of some of the unnecessary or overly aggressive care. This is not rationing, proponents point out, but it is getting patients the care they need without getting them the care they don't need, which often carries risks, side effects and big medical bills. That's been part of the message from the Dartmouth Atlas.
Reporter Emily Bazar, of the California Health Care Foundation Center for Health Reporting, found some extremely high rates of elective heart surgery in one California community. She took data availability in California, some of the Dartmouth framework, and her own reporting and endeavored to reveal the meaning behind some surprising statistics: Citizens in one Central Valley town were five times to six times more likely to undergo elective heart surgery than other Californians.
Bazar analyzed the study to determine if external factors influenced the data, or if Clearlake residents were really receiving unnecessary (and expensive) operations.
We asked Bazar to share her experiences reporting on this data and to shed light on how journalists can transform statistics into a compelling story. While Bazar’s investigation is based on California data, all or nearly all states collect similar data that can be analyzed. Here is what Bazar learned from reporting this story.
October 2011 The 2010 health reform law is supposed to dramatically expand coverage of the uninsured. In the meantime, there are still some 50 million uninsured people. And questions remain about how underserved areas are going to absorb millions more people when they get covered. The Tulsa World Reporter Shannon Muchmore recently completed a three-part series about access to health care in Oklahoma, finding a shortage of physicians, particularly specialists, contributes to an underserved population.
"Access Denied" looks at how it affects all Oklahomans and what can be done to improve access to care. Here, she provides some tips (including some tools that can walk you through some simple data analysis) for journalists interested in pursuing similar reporting in their areas, accompanied by a number of resources about rural health care, disparities in access to care and workforce issues.
September 2011 Patients typically complain about being released from the hospital sooner than they would like. So Yanick Rice Lamb became intrigued when she heard about patients languishing in hospitals weeks and even months after being medically ready for discharge. This can happen to uninsured and underinsured patients who need long-term care.
Given the recent downturn in the economy, this could potentially happen to anyone who loses a job and the health coverage that came along with it. When she learned about AHCJ's Media Fellowships on Health Performance, she found that delayed discharge was an ideal topic: It was an underreported topic and information was fragmented and spotty, at best.
Find out what she learned from her 10-month look at this narrow slice of the population – the sickest, poorest and most invisible patients. She includes an extensive list of story ideas and angles for other reporters to look into.
July 2010 After passage of health reform, a Washington Post team wrote "Landmark: The Inside Story of America's New Health-Care Law and What It Means for Us All." Joanne Kenen interviewed two of the authors, Ceci Connolly and Alec MacGillis, who offer some of the high and low points of the passage of health care reform, as well as stories reporters should cover in the coming days.