- kaiserhealthnews.org/Stories/2011/September/26/Childrens-Hospitals-Part-One.aspx
- kaiserhealthnews.org/Stories/2011/September/27/Childrens-Hospitals-Part-Two.aspx
- kaiserhealthnews.org/Stories/2011/September/28/Childrens-Hospitals-Part-Three.aspx
- kaiserhealthnews.org/Stories/2011/September/26/Building-Ambitions-The-Big-Money-World-Of-Kids-Care.aspx
List date(s) this work was published or aired.
09/25/11, 09/26/11, 09/27/11
Provide a brief synopsis of the story or stories, including any significant findings.
Children’s hospitals relentlessly promote the good care they provide, but they don’t like to talk about how they contribute to the escalating cost of the U.S. health system. “Building Ambitions” documented the industry’s multibillion-dollar building boom as an example of government’s faltering efforts to control spiraling medical spending. The series, published at a time of heightened public interest in the rising cost of care, marked the first in-depth examination of the finances of children’s hospitals.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
There are no databases covering the finances and wealth of children’s hospitals, so KHN built its own using two principal documents: municipal bond filings used to finance new wings and other capital projects, and the hospitals Annual Form 990 tax returns. In all, we collected and analyzed more than 100 bond statements and at least as many 990s. Data on revenues, profits, investments, net assets and salaries were sorted on a series of spreadsheets. In order to chart the dramatic growth of elite children’s hospitals, we looked at a decade’s worth of financial information for the top 40 hospitals, adjusting the data for inflation, and analyzing trends. Where public records were incomplete, we collected annual reports from hospital websites, requested copies of audited financial statements and interviewed hospital chief financial officers. Many hospitals do not disclose their investment holdings of stocks, bonds, real estate, etc. We gathered these data from the lengthy bond filings and 990s for the separate tax-exempt foundations of the hospitals. The estimate for the construction boom was derived from the bond documents, Internet searches, hospital websites and annual reports.
Explain types of human sources used.
Despite their size and prominence, there is almost no academic research on the finances and operations of children’s hospitals. Nor are there any go-to economists or policy experts tracking children’s hospitals. And a surprising number of major children’s hospitals refused to talk about their finances. Nevertheless, we identified and interviewed a number of academic and private economists to backstop our findings, one former children’s hospital executive, various healthcare consultants, as well as business and health leaders in cities with prominent children’s hospitals, and several government regulators and policy analysts. One unique aspect of Building Ambitions is that it is based entirely on original research and analysis. Human sources helped to explain and enrich our findings. But the conception of the story started and ended at KHN.
Results:
The series stirred great interest within the industry, but it’s too soon to tell the impact of the findings. Children’s hospitals’ finances are not regulated by the states or federal government, and building decisions are rarely subject to critical review.
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.
None.
Advice to other journalists planning a similar story or project.
Children’s hospitals play an important role in the health care system. They are often written about in a heroic, even mythical framework. Yet reporters rarely write about their finances or great wealth, or ask questions about how they are using that wealth. There are good, important stories waiting in almost all of the major markets. Municipal bond filings are a treasure trove of information often over-looked by health care reporters. They include current and historical financial information detailing a hospital’s performance; management’s analysis of their performance; plans and forecasts for the future; frank discussion, even boasting about the hospitals’ finances and wealth; details on investments and fundraising, as well as a nice historical narrative of the hospital. They are, in short, an endless source of possible stories, as well as a quick source of information when writing on deadline or assembling a lengthier profile. And they are now all easily accessed on the Internet at www.emma.mesrb.org. Among other things we found in the most recent filing for Children’s Hospital of Boston was that it had 125 full-time, salaried fundraisers (more than the number of staff oncologists or cardiologists) and $2.6 billion in cash, stocks and bonds.