Judges’ comments:
A smartly written, meticulously reported account of how and why the bankruptcy and closing of an iconic New York hospital is an alarming reflection of the broader ills of the city’s hospital system. A self-described novice to covering the intricacies of health policy and the hospital business, the author nevertheless weaves in plenty of perceptive insight around the economic, political and medical forces that drive the dysfunctional health-care system far beyond the five boroughs of New York.
1. Provide the title of your story or series and the names of the journalists involved.
“St. Vincent’s Is the Lehman Brothers of Hospitals” by Mark Levine.
2. List date(s) this work was published or aired.
Oct. 25, 2010.
3. Provide a brief synopsis of the story or stories, including any significant findings.
In “St. Vincent’s Is the Lehman Brothers of Hospitals,” New York magazine’s Mark Levine delivers an exclusive, alarming report about the systemic financial crisis facing the New York City hospital system that also happens to be a dramatic narrative tale of the death of a hospital. For the first time anywhere, Levine documents the crisis, unravels its causes, and makes plain its implications. By shining a light on the New York hospital system’s looming financial collapse, “St. Vincent’s Is the Lehman Brothers of Hospitals” has the potential to help avert a major public-health crisis. Millions of people use the New York City hospital system, and tens of thousands — a disproportionate number of them old, sick, or poor — are likely to lose access to quality health care if action isn’t taken to address the system’s fiscal instability. Levine’s story is a vital first step in that process.
4. Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
As background, Mark had to familiarize himself with all local coverage of hospital issues in community newspaper and blogs, in the major dailies, and in business and health care trade media that cover New York City; he studied the findings of the Berger Commission, which was empaneled by New York State; compiled all relevant research published by health care policy groups like United Hospital Fund; read reports and legislative testimony issued by hospital trade organizations; and was provided with confidential internal documents regarding hospital dealings with insurance companies and State regulators. In reporting on St. Vincent’s, he gathered financial legal documentation pertaining to the hospital’s two bankruptcy proceedings and to related lawsuits. The crux of the piece is based on detailed financial data for every hospital in New York City over a ten year period. Most of this data is public, and can be compiled from hospital financial statements, tax records, and the Department of Health database, but it is extremely technical and has, apparently, rarely if ever been gathered by media reporting on this topic. Mark was fortunate to cultivate a source who had the expertise to collect this data and the patience to help him understand it, as well as other sources with expertise in health care finance who could provide confirmation. The data on which the article rests essentially breaks down each hospital’s revenues by type and by the source of payer, in addition to providing numerous parameters of the hospital’s financial performance. Finally, for one section of the piece in which Mark provided the example of the cost of care of a patient in an NYC hospital, he used data from hospital cost reports provided to the DOH, and publicly available reports on Medicare and Medicaid reimbursement rates. This was in most ways an old-fashioned piece of reporting, relying on locating sources who had expertise and inside information, persuading them to share it, and finding other sources capable of providing elaboration, confirmation, or dispute.
5. Explain types of human sources used.
To construct an account of how St. Vincent’s went under, Mark spoke with former patients, members of the nursing and medical staffs, and bankruptcy experts. Most importantly, he acquired (off-the-record) interviews with several people who had been top level executives at the hospital over the past ten years. For the broader story of the financial state of New York City hospitals, Mark held detailed interviews with CEOs and CFOs at approximately ten major hospitals; with health care finance and policy experts at non-profit research organizations; with sources at organizations representing the interests of hospitals; with other industry insiders, particularly hospital consultants; and with the New York State Health Commissioner and members of his staff.
6. Results (if any).
In addition to being disseminated by major media outlets, the story drew the attention of all the key stakeholders on the issue and forced them to focus on the problem in a way they had not done before. The story was distributed by a number of major New York hospitals to their staffs, with some making it required reading. Levine’s article “is the best piece of health care journalism I have read in 40 years in the health care business,” wrote David Rosen, the president and CEO of Jamaica Hospital Medical Center, one of the city’s largest, in a memo to that institution’s board of trustees. James Tallon, president of the nonprofit research and philanthropic group United Hospital Fund, attended a board of directors meeting of the Greater New York Hospital Association where the story was discussed at length. “On a scale of one to ten,” he says, “this was an eleven or twelve.” Jaime Torres, a New York regional director for the Department of Health and Human Services, sent the story to the secretary of Health and Human Services, Kathleen Sebelius, for her review.
7. 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.
N/a.
8. Advice to other journalists planning a similar story or project.
“I was a novice in this issue, and had little sense of the financial and political complexities of the story at the outset of my reporting. In certain ways, this may have been helpful to me, because I had no preconceived narrative. The reporting was difficult in part because almost anyone with expertise in this area has a vested interest. My advice would simply be to maintain a high level of vigilance in evaluating the source of information, and to recognize that nearly any reporting that seems superficial or seems to confirm conventional wisdom is wrong. The politics of health care finance, and its impact on the public, is the most complicated subject I’ve encountered. I frequently questioned whether I was getting the story right, and this doubt provoked me to continue to pursue deeper reporting and analysis.” – Mark Levine.