- postandcourier.com/news/2011/aug/08/treatment-denied/
- postandcourier.com/news/2011/oct/17/hospital-warsbattle-moves-to-berkeley/
- postandcourier.com/news/2011/jul/03/blue-cross-wins-big-in-repeal/
- postandcourier.com/news/2011/jan/16/proviso-keeping-docs-paid/
List date(s) this work was published or aired.
“Treatment Denied” August 7, 2011 “Hospital Wars” October 16, 2011 “Blue Cross wins big in repeal” July 3, 2011 “‘Proviso’ keeping docs paid” January 16, 2011
Provide a brief synopsis of the story or stories, including any significant findings.
The Post and Courier’s health beat is wide-ranging, covering policy, business, medical and feature reporting. With few dedicated health reporters statewide, Renee Dudley has become the source for health news in South Carolina. The Post and Courier’s health stories are regularly published in full in newspapers across the state. Dudley’s stories confront complex topics neglected by other reporters. She helps readers understand health insurance, hospital growth, Medicaid bureaucracy and more. Her reporting has facilitated public discourse about subjects previously discussed only among South Carolina’s academics, bureaucrats and businessmen. The pieces included in this entry highlight that work. In “Treatment Denied,” Dudley identified a legal loophole denying men Medicaid coverage under a program that provides breast cancer treatment for the uninsured. The federal law excludes men based on their gender alone. The article featured a male breast cancer patient whose treatment was not covered. “Hospital Wars” delved into the business of hospitals, helping readers understand what’s behind the explosion of health care growth in the Charleston area. Why have so many new, competing facilities sprouted so close together? Why do hospitals buy up doctors’ practices? What’s the real difference between non-profit hospitals and for-profit ones? How does expansion contribute to the rising costs of health care? What are non-profit hospitals doing to earn tax-exempt status? “Blue Cross wins big in repeal” exposes how Blue Cross Blue Shield of South Carolina manipulated the state Legislature to guard its power. The insurance giant, a target of an ongoing U.S. Justice Department antitrust probe, was behind the repeal of a law that stripped the state’s power to regulate contracts between hospitals and insurers. The repeal allowed the insurer to negotiate contracts that hobbled its competitors. Blue Cross gave big campaign contributions to the legislator who sponsored the repeal. “‘Proviso’ keeping docs paid” examined a little-known 2008 state law that shielded doctors from Medicaid rate cuts, even as Medicaid patients faced a variety of service reductions. The legislator who sponsored the law took big campaign contributions from physician and hospital groups. The reporting showed that South Carolina is among the only states in the country where the Medicaid agency could not lower provider rates.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
“Treatment Denied”: The reporter used a copy of the Breast and Cervical Cancer Prevention and Treatment Act, the federal law enacted in 2000, to verify the eligibility loophole. “Hospital Wars”: The reporter obtained Medicare Cost Reports through a public records request to the Centers for Medicare & Medicaid Services. She used information included in those reports — revenues, profits, daily patient census and more — to build a database for comparing the area’s major hospital systems. The two systems dueling for state approval to build a new facility provided copies of their proposals. The reporter used U.S. census records and reports generated by the hospitals to research population growth and expected demand for health services. “Blue Cross wins big in repeal”: Research at the S.C. law library was a key part of the reporting for this story. The reporter scoured legislative journals to show that in 2006, the state Legislature repealed a decades-old insurance code. The repeal stripped the state’s authority to regulate discounting in contracts between hospitals and insurers, enabling Blue Cross to maintain its dominance in the South Carolina market. “‘Proviso’ keeping docs paid”: Legislative journals and historical budgets showed how the “proviso” came to be. Campaign finance records showed the health care industry donated heavily to the legislator who sponsored the law.
Explain types of human sources used.
“Treatment Denied”: A source at the state Medicaid agency called with a tip that a breast cancer patient was denied coverage based on his gender alone. The source provided the name of the patient, who met all other qualifications for coverage. The reporter and a photographer visited the patient at his home, where he shared his story. Patient advocates and the ACLU criticized the coverage loophole. The Centers for Medicare and Medicaid Services offered no explanation for why it exists. “Hospital Wars”: Over the course of a month, the reporter had open-ended, in-person interviews with the CEOs and CFOs of all the Chraleston-area hospitals. These discussions allowed the reporter to hear each system’s gripes against the others and helped her understand the intensity of health care competition in the area. She also interviewed both local and out-of-state hospital finance experts, who offered independent thoughts on the area’s “hospital wars.” Local elected officials, who want the industry’s jobs in their communities, also sounded off. “Blue Cross wins big in repeal”: The greatest source on this story was a former Department of Insurance employee. She e-mailed the reporter after reading a story about an insurance company’s insolvency. During several phone conversations, she described the intensity of Blue Cross Blue Shield’s influence in the state. During an eventual meeting in Columbia, she helped the reporter sort through Blue Cross’ financial statements. The reporter interviewed national antitrust experts, health care economists, the state’s top five insurance carriers, local hospitals, legislators and medical associations in South Carolina and other states. “‘Proviso’ keeping docs paid”: A source at the state Medicaid agency called to complain about negative media coverage of service cuts for people with disabilities. He said agency officials wouldn’t need to cut services so drastically if they instead could lower provider rates, like other states had done during the recession. The reporter eventually discovered the little-known 2008 law that forbid the state from cutting provider rates. She interviewed national health policy experts, legislators, physician and hospital associations, patient advocates and money-in-politics watchdogs.
Results:
“Treatment Denied”: Two weeks after the article’s publication, the South Carolina Medicaid agency announced it would extend coverage to male breast cancer patients. The man featured in the original story received coverage. “Hospital Wars”: The article included in this submission is the first in a series that answered readers’ questions about how growth in the health care industry — evident all around Charleston — affects them. “Blue Cross wins big in repeal”: This reporting shined a bright light on the insurance industry in South Carolina, a topic no other newspaper in the state has covered in depth in recent history. It made a complex topic accessible to average readers. Other large newspapers in the state published this piece in its entirety. It caused reader outrage, generated dozens of letters to the editor and prompted editorials. “‘Proviso’ keeping docs paid”: A legislator filed a bill to repeal the law in the days that followed publication of this story. Shortly after that, Gov. Nikki Haley said in her State of the State address that she would make a repeal of the law a priority. The governor signed the repeal bill into law in April.
Follow-up (if any). Have you run a correction or clarification on the report or has anyone come forward to challenge its accuracy? If so, please explain.
No corrections or clarification. See response to previous question for details about follow-up.
Advice to other journalists planning a similar story or project.
Reading historical documents about laws and budgets can be eye opening. In two pieces submitted here — “Blue Cross wins big in repeal” and “‘Proviso’ keeping docs paid” — those records helped me understand the genesis of current issues. The S.C. law library was an invaluable asset. Understanding lawmakers’ motives for sponsoring legislation is crucial. Usually it can be traced, at least in part, to money. “Hospital Wars” started with a question: Why do we need another hospital in an area already saturated with health care facilities? Readers, too, probably are curious about big construction projects that affect their communities.