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By Nancy Cook Lauer
The national health care debate. H1N1. Abortion. HIPAA. Medicare. Medicaid. It’s difficult for a government reporter to avoid writing about health. And who would want to? The health sector consumes a big chunk of government budgets. And it’s what people are talking about. Next to the weather, health issues are top drivers of daily conversation, even to our everyday greeting: “How are you?”
Health is an essential part of the beat for reporters covering state and local government, even more so as media shrinks and traditional health reporter slots go unfilled.
The good news: There’s a wealth of government and nongovernmental organization resources to draw from on health topics.
“Somebody who has health as a beat is blessed because there are a lot of credible health sources,” said Lou Jacobson, a staff writer for PolitiFact, the 2009 Pulitzer Prize winning subsidiary of the St. Petersburg (Fla.) Times. “A lot of groups out there do pretty good work, and because of the national debate, they’ve geared up, hiring more staff to field questions.”
PolitiFact is an online fact-checker of statements made by politicians and other public figures. Its scale runs from true to mostly true to half-truth to barely true to “pants on fire.” Jacobson said at least two-thirds of the statements being fact-checked concern health care. It’s what’s at the top of the national debate, and it’s what is of most interest to PolitiFact readers, he said.
One big plus of the health beat is that stories literally hit close to home – from the water you drink to the restaurants you frequent to the air you breathe, even how loud your neighbor is allowed to play his radio – a public health agency has had a hand in there somewhere. Nail salons, tattoo and piercing parlors. Not to mention the more obvious: the cost of insurance, the quality of doctors’ and dentists’ offices and clinics, hospitals, nursing homes.
The national health care debate is the topic du jour among the soccer moms at his local coffee shop, said John Celock, editor of The Westfield Patch, a New Jersey online daily newspaper owned by AOL.
“I think it’s actually a pretty good time to be covering health care,” Celock said. “Between health care reform and public health issues, I’m finding the beat particularly fruitful.”
Getting the lay of the land
But for the uninitiated, researching health care issues can quickly descend into a bureaucratic morass of jargon. What do you need to know and how do you find out? Who are the big players – agencies, offices – a reporter should be aware of?
You won’t get too far writing about health care without the help of some of the bigger federal and international agencies. The World Health Organization coordinates health issues worldwide for the United Nations. WHO seeks to monitor trends, shape the health research agenda, set norms and provide technical support to countries on health issues. Its primary report, the World Health Statistics Report, is published each May, but relatively current data is always available on its Web site.
The Centers for Disease Control and Prevention bills itself as the federal clearinghouse for developing and applying disease prevention and control, environmental health, and health promotion and health education activities. For some help with the massive CDC Web site, be sure to see “Navigating the CDC: A Journalist’s Guide to the Centers for Disease Control and Prevention’s Web Site.”
The CDC is a project of the U.S. Department of Health and Human Services, whose site also includes links to federal stimulus money awarded to states as well as HealthReform.gov, featuring up-to-date state-by-state information on the current debate over health care in Congress.
Feeling overwhelmed? Don’t know your SCHIP from your HIPAA? Visit the glossary put out by the Centers for Medicare and Medicaid Services, a federal agency that veteran reporters may remember as the Health Care Financing Administration. CMS, by the way, is a bible for reporters tackling the complex health coverage issues that are Medicare – federal health insurance program for: people 65 years of age or older, certain younger people with disabilities, and people with End-Stage Renal Disease – and Medicaid – joint federal and state program that helps with medical costs for some people with low incomes and limited resources. Expect to find these programs in your coverage: More than one of four Americans, or some 83 million people, are covered by Medicare, Medicaid, the State Children’s Health Insurance Program or other public programs.1
People, not just policies
But don’t let this discussion of Web sites and sources distract you from this basic truth: The sites and statistics and sources are important, but nothing beats good old-fashioned shoe leather when it comes to health care reporting. People caught up in the health care bureaucracy often have compelling stories, and they’re the ones who will bring your reporting to life. And the best way to reach them isn’t through Web sites or statistics or dry government reports. They’re out there in front of you.
“The beauty of this dauntingly ‘complicated’ industry with its bulwarks of arcane and confusing lingo is that at the end of the tunnel are people,” says Paige St. John, an investigative reporter for the Sarasota (Fla.) Herald Tribune. “Sick people. Injured people. Displaced people. And it is not very hard to understand them.”
One of the best ways to find the stories? Through your local health department or state and local government.
Health care reporting isn’t about the statistics and the numbers and the rules and regulations. It’s like any other journalistic enterprise – you’ve got to make yourself known at the basic level of service. The first steps? Introduce yourself to the local health department. Community, county and municipal health departments literally have their fingers on the pulse of the populace. They’re the ones who can tell you about a new outbreak of a disease or other trends in your own town.
“Local health departments are the first people I reach out to,” said Celock. “I’ve developed a very good working relationship with the local health department.”
Tom Breen, an Associated Press reporter in Charleston, W. Va., agrees with that approach. At the local level, health departments are less likely to have a public information officer or other gatekeeper, and they may even be flattered that someone cares enough to meet with them.
“It’s good old-fashioned reporting. Get out and meet the local health departments,” Breen said. “Often they are pleasantly surprised that someone is interested in what they do.”
State health departments are a necessary resource, but you’ll often have to deal with their public information officers. It’s not a bad idea to get to know that person upfront. Then work on establishing key sources within the department whom you’ll be able to reach without having to go through the PIO. Sometimes the more scientific sources within the department – the ones who can answer the technical questions and help you fact check the science – will come around only after you’ve written a few articles that show you’ve grasped the basic concepts and aren’t out to skewer them with hyperbole.
Medical associations, health-care lobbyists, health-related unions and other advocates are an essential part of the mix as well. Make a point of getting to know the players by watching who testifies before legislative committees. The advocates often know the weaknesses in the system and are eager to point them out. They’ll also help you find people affected by the policies coming down from state and federal government.
Look for the legislation
Monitoring bills coming before legislative committees is also a good way to find the issues percolating to the surface in your community. Todd Heywood covers state government and health issues for the Michigan Messenger, an online political news site that’s part of the Washington, D.C.-based Center for Independent Media. He’s been successful analyzing the state’s 20-year-old HIV laws, pointing out how the laws have lagged far behind the science and resulted in discriminatory policies against those who are HIV positive. The best reporting results in policy changes at the state level, he said.
“I talk with legislators and find stories,” Heywood said. “I receive all the bills that go to committees. The sexual health issues especially resonate with the community. There’s always interest there.”
Among Heywood’s success stories: Using science to show that the HIV virus is not spread through exposure to food, thus opening up job opportunities to a segment of the prison population previously barred from them. Showing how a terrorism charge was wrongly levied against an HIV-positive individual who bit another person during an altercation.
And it should go without saying, but it’s amazing how many legislators, as well as reporters, ignore the most basic rule of covering legislative issues.
“Read the damn bill. All of it. And all of the amendments,” cautions St. John. “Because so few people bother to dig into insurance to understand it, even most lawmakers are happy to be lied to about what is and isn’t happening, and to adopt policy crafted by self-serving industry groups. Consumer activism is weak, if present at all, on most insurance policy. And nobody EVER checks the numbers. Thus there is always a ‘crisis’ for which the industry wants something that usually means more money, or less coverage, which means more money. But more money from whom?”
With money, come strings. And with federal money, come a lot of strings. That’s good news for reporters, because that means reports, always a great source for story ideas. The most obvious is Recovery.gov, the federal government’s attempt to track stimulus money going to states through the American Recovery and Reinvestment Act (ARRA). This unprecedented tracking project is not without its glitches, but state and federal governments are promising cleaner data as the project progresses.
In the health care arena, ARRA provides for $87 billion more in federal matching funds for Medicaid2 and more than $30 billion for health technology improvements, in particular for hospitals and physicians adopting certified electronic health record technology to exchange patient information across platforms.3
Finding those stories
Periodic checkups of your local doctors, hospitals and nursing homes are a rich source of stories. The Joint Commission, previously known as the Joint Commission on Accreditation of Healthcare Organizations, is a nonprofit offering accreditation for health care institutions. While accreditation is voluntary, most state governments require accreditation as part of their licensing and Medicaid reimbursement process. The Joint Commission generally inspects facilities every three years and posts comparison information on its Web site, Quality Check. (For more on hospital accreditations and rankings, see the AHCJ tip sheet “A road map for covering your local hospital’s quality” and the article “Making sense of hospital quality reports.”)
How about doctors and nurses? The federal government keeps a list of those who have been excluded from Medicaid and other subsidized programs because of fraud or felony convictions through the Health and Human Services Inspector General’s Excluded Individuals Web site.
A more comprehensive database is the National Practitioners Data Bank. The public can access grouped information on adverse incidents, medical malpractice and other issues affecting doctors, dentists and other licensed health care practitioners. You won’t be able to identify specific doctors or hospitals, but you can isolate your particular state and evaluate trends. This is a cumbersome database and you need a good computer-assisted reporting background to tackle it successfully. The Investigative Reporters and Editors’ National Institute for Computer-Assisted Reporting division has sliced and diced the data and offers it, along with other updated databases, on a sliding scale depending on your circulation size.
Some years back, I used the database during the heat of Florida’s medical-malpractice reform debate to show that malpractice claims were actually decreasing in the Sunshine State, and not experiencing the out-of-control escalation that some lawmakers claimed.
State health departments often are under contract to provide federal inspection reports of hospitals. The state should be able to provide the reports more quickly than the federal government. Here’s where establishing that early relationship can pay off. Hospitals and other health care facilities receiving Medicaid funding are also required to file financial information with state and federal agencies.
Follow the money
The hospital Certificate of Need process is also an avenue for information about hospitals and other facilities. Many states have Certificate of Need boards requiring hospitals to justify new construction and expansion. Their justifications are often a rich source of self-criticism about their current facilities.
It’s even easier to get financial information on nonprofit health care institutions. Nonprofits are required by law to provide their most recent IRS Form 990. Information includes revenues, expenses, lobbying expenses and top officers’ compensation. Form 990s are also available on Guidestar, but they tend to lag a year or so behind. (Useful tip sheets: ” How to understand a 990” and “Digging Into Hospital Finances: Recent trends and five key documents.”)
Among the best sources of information – and often fodder for good stories – are medical malpractice lawsuits filed by local attorneys. Court documents yield a wealth of information about health care facilities and doctors and plaintiffs’ attorneys are usually more than glad to share them. Or just search for the health care institution or practitioner under defendants in your circuit court system. State licensing disciplinary actions are also sources of good stories.
Strapped for a story idea? Check out the advocacy groups. Pharmaceutical Research and Manufacturers of America (PhRMA) is a powerful advocacy group driving drug laws. The National Alliance on Mental Illness (NAMI), a nonprofit grassroots mental health advocacy organization, weighs in on state and federal legislation and is a good method of finding those falling through the cracks in your area. The American Medical Association, American Academy of Pediatrics and American Hospital Association all have in-depth Web sites with up-to-date news promoting their points of view. They’re a good source for story ideas, but be sure to balance their information with other sources.
America’s Health Rankings, an annual report by health care provider United Health Group, is a 20-year-old authoritative comparison of states on a number of demographic, lifestyle and health statistics. It’s a great jumping off point for questioning your state leaders.
Fellow journalists are always a good source of story ideas. An obvious choice is the Association of Health Care Journalists and its Covering Health blog, which includes links to more than 50 health news blogs.
With all these choices, where to even start? Here’s an easy quick-hit idea: Restaurant inspections. Everybody eats. And just about everybody cares how clean the local restaurant is. Food establishment inspections conducted by the state and local health departments are often online, as in the case of New York City’s more than 20,000 restaurants and thousands of restaurants in Virginia. If your state isn’t online, you may have to do it the old-fashioned way – take a laptop and/or a portable scanner into what is typically the state’s environmental health office and create you own database. Hawaii, the state where I’m currently working, for example, still uses handwritten, almost impossible to decipher three-part carbonless forms.
For more ideas, there are a few basic Web sites that can help get a reporter started. Breen recommends Families USA, a national nonprofit, nonpartisan organization that bills itself as promoting high-quality, affordable health care for all Americans for 25 years. He also likes the Kaiser Family Foundation, a nonprofit research organization that offers a wealth of data.
More generalized public policy groups and think tanks are also getting more heavily involved in health care issues, notes Jacobson. Many of these have an agenda, so it’s easy to bring a wide range of viewpoints into your stories by tapping into the likes of the Brookings Institution, Urban Institute, Cato Institute and Heritage Foundation.
The hype about HIPAA
Blanket refusal of public information requests based on privacy provisions of HIPAA (Health Care Portability and Accountability Act) regulations is a disturbing trend among health care facilities and some government agencies. Don’t let them get away with it.
Business or agencies covered by HIPAA generally cannot disclose, without the patient’s consent, personally identifying information such as names, addresses or specific medical condition. Thus, in most cases, a hospital cannot give journalists a patient’s name. However, the hospital should be able to confirm if a patient the journalist names is in the hospital and provide some additional details such as general medical condition, an age range and a general address (including that person’s state or region). 4
The operative term here is “the patient’s consent.” That means you should be able to hang around outside hospitals or public health clinics and simply ask people if, for example, they’re satisfied with their health care or if they had any particular problems with the facility in question. A patient is much more likely to give you the information than the health care institution, and they’re almost essential in putting a face on a story.
For much more about HIPAA and reporters, see these AHCJ tip sheets: Understanding HIPAA: A brief overview, HIPAA Boot Camp: The Basics of HIPAA for Health Care Journalists, HIPAA: Good intentions and unintended consequences.
One of my most memorable stories for the Tallahassee (Fla.) Democrat detailed the frustrations of an elderly state retiree who tried to save money by cutting her pain pills in half, putting up with the discomfort in order to pay her monthly bills. The state contractor handling prescription medications subsequently cut her prescription proportionately, leaving her paying the same co-pay for less medication. The article started as single reader’s isolated problem but escalated into an in-depth look at how the state sought to save money by switching prescription services and how state contractors were legally shorting patients their precious medication.
Reform – covering a moving target
With a price tag from $849 billion to $935 billion5 over the next 10 years, Obama’s health care reform bill is among the most expensive non-military initiatives in recent history. For general information on the House and Senate versions of the initiative, the Kaiser Family Foundation has created a side-by-side comparison.
The future of Health Policy remains cloudy. It will be some time, if every, before money actually filters down to the states. But both the National Governors Association and the National Conference of State Legislatures are keeping a weather eye out, already penciling in plans to deal with the new federal mandates – and accompanying federal money – expected over the next 10 years.
Do your homework, and many of the groups will keep you up to date on the latest events and feed you story ideas.
“It’s such a hot issue, most of these groups are getting more people on board and beefing up their media relations,” Jacobson said. “Just get yourself known to all of those groups and start establishing relationships.”
What does this mean to you as a reporter? A wealth of health care stories to carry us through the next decade. We are indeed blessed.
1K. Davis and C. Schoen, “Using What Works: Medicare, Medicaid, and the State Children’s Health Insurance Program as a Base for Health Care Reform,” invited testimony, House Committee on Energy and Commerce, Subcommittee on Health hearing on “America’s Need for Health Policy,” Sept. 18, 2008.
2American Medical Association
3Cisco
4A. Mar and A. Page, HIPAA and Newsgathering, First Amendment Center, as reprinted from the Spring 2004 issue of the Davis Wright Tremaine LLP law firm’s First Amendment Law Letter.
5 R. Foster, chief actuary, estimated financial effects of the “America’s Affordable Health Choices Act of 2009” (HR 3962), as passed by the House on Nov. 7, 2009. Nov. 13, 2009, memo
Nancy Cook Lauer has covered state and local government for more than 20 years for Scripps Howard, Knight Ridder, Gannett and Stephens Media newspapers. A board member of the Society of Professional Journalists, Hawaii Chapter and former officer for Capitolbeat, the Association of Capital Reporters and Editors, Lauer has won numerous awards. She covers government for West Hawaii Today and resides in Hilo, Hawaii. |
