- http://www.wbur.org/2012/04/06/expensive-health-patient
- http://www.wbur.org/2012/08/24/most-expensive-patient-budget
List date(s) this work was published or aired.
April 6, 2012 and August 24, 2012
Provide a brief synopsis of the story or stories, including any significant findings.
Any effort to control health care spending will have to address America’s most expensive patients, the 5% of patients on whom we spend 50% of health care dollars. In Massachusetts, there is a statewide effort to reduce spending by putting doctors and hospitals on a budget. So, is there any evidence that this is working for our most expensive patients? I trailed Sue Beder for a year. She has Multiple Sclerosis, depression and a half dozen other medical conditions. When I met Ms. Beder last January, she had just signed up with an agency that would manage her care under a global payment from Medicare and Medicaid. In our first story, I describe the massive shift to spending on prevention for Beder that is the model for care under a global budget or payment. The goal was to keep Ms. Beder out of the hospital. In our second story, I found that all these efforts failed for what may seem like simple reasons, reasons which require lots of supervision and money to fix.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
I was fortunate to have open access to Ms. Beder’s medical billing and records. It took a while to get the records with several letters, signed and notarized by Ms. Beder and executives at the agency managing her care, Senior Whole Health. All the records were reviewed by accountants for the agency and a professional working on my behalf. Ms. Beder’s pharmaceutical records are under a different accounting system, which entailed another layer of request and review. In addition, I made a records request to the fire department that was responding to calls for help when Ms. Beder would fall several times a month. Again, the Stoughton Fire chief was kind enough to fulfill this request without the need for a FOI. Any comparisons to spending Ms. Beder and other Medicare patients were done through various database sets available through Hospital Compare. This was a very time consuming process, but in the end, provided the first patient account of spending shifts under a global payment in Massachusetts and perhaps in the country.
Explain types of human sources used.
Finding Ms. Beder took months of negotiations with several agencies and then pre-interviews with several possible subjects for the story. I had to develop good working relationships with all the members of Sue’s care team, in many different settings, many of whom aren’t used to talking about patients on the record at all. I relied on several health policy experts for guidance on how to frame the story in the context of health care industry and Massachusetts political changes.
Results:
The story garnered wide praise and distribution in the health care community in Massachusetts. I know it was distributed among policy aides preparing legislation at the Massachusetts State House. I also have heard from professors at schools of public health in Massachusetts who are using the story in their curriculum.
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, the numbers are solid – we checked them many times. After the second story aired, the agency suggested that we didn’t have a enough data to draw conclusions, but this sentiment is included in the second story.
Advice to other journalists planning a similar story or project.
My advice to other journalists is to: 1) get clear, hopefully written, agreements at the start of a project about what situations and information you will have access to 2) spell out the plan for notifying you of changes in the patient’s condition or circumstances 3) be ready for lots of confusion about billing accounts, reimbursement rates and revenue streams 4) be sure you have an outside accountant/analyst who can review financial information provided by your subject