List date(s) this work was published or aired.
7/8/2012, 11/4/2012, 4/15/2012, 3/18/2012
Provide a brief synopsis of the story or stories, including any significant findings.
– Why you might pay twice for one visit to doctor (facility fees): Explains the baffling and unwelcome “facility fee” charge imposed on patients seen in clinics and doctors’ offices operated by hospitals ¬– an increasingly common practice as hospitals consolidate and buy private practices. Findings included how much the practice has increased costs of health care and that the Medicare Payment Advisory Commission was recommending a change. – Robo Docs: Use of costly surgical robots booming. Sidebar: Surgical robot is big for tiny hospital: A look at the much-hyped da Vinci surgical robot, which gives surgeons new abilities, but also costs a pile and can cause serious injuries in the hands of those not well trained. The sidebar is a frank look at the realities of medical economics that forced a tiny, small-town hospital to purchase a robot that cost twice as much as its net revenue. – Cystic-fibrosis breakthrough offers a fresh breath of hope: The story covers a three-decade span, beginning with doctor and CF patient meeting when the patient was a kid, and picking up 30 years later, when the doctor, as researcher, has been instrumental in development and FDA approval of a drug that helped him (unbeknownst to her, he volunteered for a trial of the drug, so he was getting it as an investigational drug). We arranged a meeting, just for the drama, and used the story to tell a bit about the “long journey” that began with the identification of the CF gene in 1989, and will undoubtedly continue with the search for a cure. – Autism study finds early sign in babies’ brains: Because so many people are concerned about autism, I looked at an intriguing bit of information from one study underway locally. It offered an opportunity to look broadly at the state of autism research as well as to talk about the particular study, which found that kids later diagnosed with autism tended to have larger heads very early in life.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
– Facility fee story: I collected bills from patients, hospital billing-practice statements, policy papers from the Medicare Payment Advisory Commission and other Medicare data, hospital 990s, cost information from various clinics, hospitals and insurers; I combed local blogs, Lexis/Nexis, national bloggers and local and national lawmakers’ statements and proposals on facility fees. A state study on tax-exemptions and some decisions by the state Board of Tax Appeals led me to the state Department of Revenue and tax-rebate statistics. – Robo Docs: I used hospital 990s to get a big picture, particularly with respect to the tiny hospital that bought a robot, checked hospital advertising relating to robots, and found studies that looked at the advertising. I got claim data on robotic surgeries from insurers and Medicare. With Justin Mayo, our data guru, we pulled and analyzed all the reports of injuries or deaths from the federal adverse event database to look at the types of injuries involving robots. I looked at lawsuits here and elsewhere, and studies from all sorts of specialty journals. I searched Nexis/Lexis, training information and technical documents, including the FDA/device approval documents. – Cystic Fibrosis: Technical material to understand CF and how the drug works, statistics on patients, prognosis, treatments, Washington state newborn screening information. – Autism: Mostly research material, journals, and some technical information to understand some of the research.
Explain types of human sources used.
– Facility fee story: Lots of stories and bills from angry patients, cardiologists (because hospitals acquired their practices at a high rate over the last few years), leaders of hospitals and still-independent clinics, insurers, state lawmakers, a lawyer who has sued hospitals previously for these fees. – Robo Docs: Surgeons, both critics and advocates; hospital administrators, officials of the company that makes the robot, those who train other docs on the robot, officials of company that makes a training simulator, insurance company medical directors and others, Dr. Marty Makary, who looked at robotic surgery stats for his (then) upcoming book, Unaccountable. I talked with lawyers who represented patients hurt during robotic surgeries. – Cystic Fibrosis: Researchers, patients, CF advocacy organizations. – Autism: Researchers, parents, behavioral therapists.
Results:
– Facility fees: Not sure yet, but may be an investigation by state AG into consolidations, especially where clinics and practices newly absorbed by nonprofit hospitals now pay no property tax, causing tax bills for others to rise.
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.
– Robo Docs (mainbar): According to hospitals and published information, the initial purchase of the robot was much as $2.6 million, which is how I phrased it. The company said I should have used the base price of $1.3 to $2.25 million, because the $2.6 million price tag includes instruments, add-ons such as a training module, and technical support (which is required). We published a correction listing the base price range.
Advice to other journalists planning a similar story or project.
– Facility fees: Collect string. I collected a lot of patient stories & bills long before I really began putting the story together. Also, because I have written about this issue before, it was easier to pick out the larger issues. – Robo docs: Start early. Even though, relatively speaking, there wasn’t much research on comparative safety/effectiveness of robotic surgery/, to take a sharp look at a device requires wading through a lot of material. – Cystic fibrosis: A “breakthrough” drug affecting a small number of people can provide an opportunity to look at the long, hard slog it takes research to produce clinical results. It’s a story line that’s been repeated many times, but I still find it to be a worthy framework. – Autism: Sometimes something that’s not earth-shattering can provide a pivot point for a larger, contextual story that helps readers understand the big picture of a medical or political issue.