Maurice Tamman of The Wall Street Journal talks about quest to get the Medicare claims database.
By Sheila Hagar
Walla Walla Union-Bulletin
Not every journalist or media organization has a budget to back up long-term and expensive investigations into health care or other issues. Not anymore. Yet all can take information found in national stories and create a story relevant for local audiences, according to panelists at Health Journalism 2011.
And doing so will help make positive change for a health-care system that is "very fundamentally broken," noted Charles Ornstein, senior reporter at New York-based ProPublica, board president of Association of Health Care Journalists and moderator for Friday's session of "Localizing national health investigations."
Joining him was Robin Fields, senior editor at ProPublica, Walt Bogdanich, investigative desk assistant editor at The New York Times and Maurice Tamman, database editor and reporter with The Wall Street Journal.
The trio of presenters has published work that has brought widespread attention and change to serious health concerns and medical industry transparency.
Bogdanich, winner of three Pulitzer Prizes, wrote a series of articles in 2010 titled "The Radiation Boom," about the largely unacknowledged problems found in the medical radiation business. He spent 18 months on his investigation, he said, which was "an extraordinarily long time to work on a project."
He discovered that the danger of diagnostic radiation, in clinical medicine and dentistry, is huge. The technology is powerful and rapidly advancing while the training level of imaging technicians is not keeping up. Babies in neonatal care are most victimized by unnecessary and abundant radiation, he found.
The phenomenon has deeply impacted an untold number of lives, Bogdanich said. "It literally broke my heart to get dozens and dozens of stories of people saying their family had been destroyed by radiation."
It began with a tip from someone in a large hospital in New York, letting Bogdanich know there was an "extreme problem" with babies in neonatal care, one that had been going on for a long time.
He found weak government oversight problems and difficulty in defining the scope of the problem. The type of data reporters can typically use was not available, such as the number of radiation errors in the state.
'It was very hard to establish when an error had occurred." In addition, much of the harm caused by radiation does not show up right away and may be dismissed as a skin issue when it does.
It took Bogdanich months of working on how to get data. There is no national database, no federal requirement to report radiation errors. Medical device reports are anonymous and the industry is divided up for regulation, he said.
"Whatever state you're in, you need to know the regulatory agency. Check what kind of data they have and what the [reporting] requirements are," he advised.
His greatest ally turned out to be a profession he'd never heard of – medical physicists, who really act as representative of the patient, he said. It turned out that these professionals were delighted to help.
They always called back, they were always on the record … no one had ever called them before."
Information gleaned from them led Bogdanich to other medical disciplines that treated patients harmed by radiation, which finally revealed at least one number he could use. After that it was a matter of peeling the story one layer at a time.
Fields did the same on the nationwide dialysis picture. It's a unique health care entitlement situation, with everyone in the United States entitled to dialysis treatment regardless of income, she said. Despite the rising numbers of patients – about 400,000 – and costs spiraling "out of control," Fields could find little indication of government oversight of the mostly private treatment clinics.
One doctor told her patients were being given a therapy he would never accept for himself. "I know problems were out there."
Fields described how she decided to review the issue through inspection reports, going through eight years of records in six states. The problems were fairly universal and involved bugs, filth and prescription errors, giving her an idea of the scope of the issue, she said. She even learned of patients suffering catastrophic hemorrhages when needles broke off in their skin.
By creating a database of adverse events, Fields was able to start drilling deeper.
"It became clear most states inspected much less than every three years [as required by law], particularly in California. Many had not been inspected for five years or more, some not since the Clinton administration."
She asked for nationwide records from the Centers for Medicare and Medicaid Services and waited a year to be told the CMS was not in possession of such data. Doubting the veracity of the claim, the reporter used the Freedom of Information Act to retrieve records from all 50 states.
Her belief that CMS did have the records was confirmed by the contractors who process that data, she said. "They told me, 'We can't give you that information but the CMS owns it … you should ask them for it.'"
The next step was to send those replies to CMS. Which, in turn, sent Fields the entire database.
The resulting series of stories was the first time comparative performance and outcomes of dialysis clinics nationwide had been revealed.
Virtually any health care aspect can be done in the same manner by using tracker software to compare city and state data, Fields noted. "Look in your area to see who is doing what badly and why."
Getting Medicare and Medicaid data may not be as difficult as Fields and others have found if Wall Street Journal reporter Maurice Tamman is successful.
It was about two years ago that he and colleague David Donald, of the Center for Public Integrity, decided to try to obtain the "largest single database no journalist had ever seen" – the Medicare claims database, Tamman explained
He had never done any health care reporting but it seemed the time and issue to start, he said. "This was a time health care reform was being discussed in Congress. CMS was the only place to see trends in health care for the entire U.S. population."
It also was an excellent way to discover who was making how much money from billing Medicare.
In a series of stories called "Secrets of the System," Tamman and Mark Schoofs looked at billing fraud and abuse in the Medicare system by using an unprecedented sample of claims data.
The physical therapy industry seemed a good place to start – billings for such treatment cost Medicare almost $3.5 billion in 2008, according to one resulting story in the WSJ.
Getting that data from CMS – he asked for a decade's worth of what is also known as the Carrier Standard Analytic File – took determination and $10,000, down from the original $100,000 the agency demanded.
It took going to court, however, to win that battle, Tamman said. And then the paper had to agree to not reveal the name of any physicians, because of a long-ago lawsuit by the American Medical Association to quash any publication of physician payments.
There are other mechanisms available for similar searches, he said. Using the NPI Registry at CMS's National Plan & Provide Ennumeration System (NPPES) allows for use of criteria filters, for example.
Some ways to localize stories include:
- Finding former employees who may be disgruntled enough to dish up dirt on a company or clinic.
- Search for people using voter rolls, property and criminal records with data such as a birth date, gender or name. One piece of information can reveal a surprising number of details through those mechanisms.
- Use networking sites such as LinkedIn. Signing up as a professional journalist allows you to send users unsolicited emails. Use social media, too.
- Find online search materials already created at larger news organizations.
- Request government inspection reports.
- Email journalists who have covered similar topics for tips.
- Enlist students from universities and journalism schools for research help.
There is no question these examples of investigative reporting took financial commitment, including the single biggest expense of the time it takes to do it, the presenters agreed.
Yet the best indicator of success costs nothing, Tamman said, explaining that impassioned reporters must be willing to work off the clock for a project they are driven to do.
True, Bogdanich agreed. "That is true today and it was true yesterday – if you want to make it as a young reporter, develop it on your own time."
