- http://well.blogs.nytimes.com/2012/04/23/the-confusion-of-hospital-pricing/
- http://well.blogs.nytimes.com/2012/05/28/waking-up-to-major-colonoscopy-bills/
- http://well.blogs.nytimes.com/2012/05/14/tv-show-girls-adds-to-the-muddle-on-hpv-testing/
Provide names of other journalists involved.
(none)
List date(s) this work was published or aired.
April 24, 2012; May 15, 2012; May 29, 2012.
Provide a brief synopsis of the story or stories, including any significant findings.
Each of The Consumer columns stands on its own. “Confusion on Pricing” illustrates the wide variation in hospital charges — using appendectomy, a common surgical procedure, as an example — and the lack of transparency in pricing that makes it difficult, if not impossible, for consumers to shop around. “Waking up to Major Colonoscopy Bills” zeroes in on hidden anesthesia charges that are being tacked on to a routinely recommended cancer screening test that is supposed to be covered as a preventive service by most policies, driving the cost up to $5,000 in some cases. It points to two widespread and disturbing trends: the tendency of American medicine to adopt expensive new drugs and procedures even when there is no proof of added benefit, as well as the continued resistance of specialists who provide ancillary services such as pathology or anesthesia to join insurance panels and accept negotiated fees. The third column, “TV Show Adds to the Muddle on HPV Testing,” describes how a popular TV show aimed at 20-somethings disseminated inaccurate, potentially panic-inducing information about the HPV virus in its storyline; the column attempts to provide clear information and set viewers straight.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I rely extensively on published studies from the medical literature and health policy journals; For these columns I also used information from the American Cancer Society, the RAND Corporation, the government website on the Affordable Care Act, and consumer sites like the Healthcare Blue Book (www,healthcarebluebook.com). I use these in my reporting but also list them for consumers in the advice section of the column.
Explain types of human sources used.
Patients and medical experts are used in most of the columns. In the two columns about medical bills, I was able to find and interview the patients who had the procedures, including a 36-year-old San Francisco man who was charged $59,283 for a simple appendectomy and a Long Island couple who had colon cancer screenings performed by participating providers but still ended up with thousands of dollars in unpaid bills for anesthesia. I also interviewed medical experts as part of my reporting for all of the columns (not all are quoted in the pieces because of space considerations). For the column on HPV, I interviewed experts on HPV and cervical cancer as well as a journalism professor who studies how to effectively communicate and disseminate health messages. For the billing columns, I interviewed the physicians who performed the procedures, a physician practice manager, insurance and hospital executives, consumer advocates and physician-researchers who study health charges.
Results:
After the column on colonoscopies ran, the Freelancers Union health plan started compiling a list of participating gastroenterologists who perform the cancer screening without an anesthesiologist; the insurance plan is now able to refer covered members to these providers. It has also been taking other steps in an effort to reduce balance billing of its members. After my column on the HBO series ‘Girls’ criticized the inaccurate information about HPV in the show, the writer embedded corrections of misinformation into the story lines of subsequent episodes. In one follow-up segment, for example, the main character’s ex-boyfriend states that there is no HPV test for men; In a later episode, the characters discussed how ubiquitous the HPV virus is in a casual, unthreatening tone.
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.
The column on anesthesia bills struck a nerve: it drew 839 comments from readers, including many who had had similar experiences with anesthesia bills. However, one health reporter who had covered the topic was very critical of the column, saying that as of Sept. 23, 2010, insurers have been required by the Affordable Care Act to cover the entire cost of preventive screenings such as colonoscopy. While that is true, the provision applies only to job-related health plans or individual health insurance policies created after March 23, 2010. In addition, these plans are only required to cover participating in-network providers, and many anesthesiologists do not participate in insurance panels. This perhaps should have been explained in the column.
Advice to other journalists planning a similar story or project.
I write The Consumer column every two weeks, and it often draws many comments — and follow-up questions. One of the toughest challenges is to both offer practical suggestions and advice while underscoring the message to “talk to your doctor” and emphasizing that every patient is different and every case is unique. I would advise all reporters writing advice columns on health to be extremely careful to insert caveats and repeatedly remind readers that there are many exceptions and that they should consult a physician if they have medical questions.