Judges’ comments: By pulling together government databases and other source materials, Jordan Rau presents an informed analysis of how efforts by the federal government to rein in health care costs may produce unintended effects.
List date(s) this work was published or aired.
June 27, July 30, Nov. 7 and Dec. 19, 2011
- Medicare Prepares Rule To Penalize Hospitals With High Readmission Rates
- When TLC Doesn’t Satisfy Patients, Elite Hospitals May Pay A Price
- Medicare Penalties For Readmissions Could Be A Tough Hit On Hospitals Serving The Poor
- Growing Hospice Care Costs Bring Concerns About Misuse
Provide a brief synopsis of the story or stories, including any significant findings.
Jordan Rau covers health care providers, including hospitals and hospices. These stories looked at troubling trends that influence the cost and quality of health care providers and how efforts by the federal government may help or backfire. Many of the pieces were based on new data analyses. Two stories looked at new government penalties against hospitals with high readmission rates, and how places that treat many poor patients may end up being excessively punished for things beyond their control. Another story examined how efforts to judge and pay hospitals based on the views of their patients may penalize those places in large urban areas and those that treat extremely complex cases. A fourth story looked at how for-profit hospices are pushing up the costs of Medicare’s hospice benefit, in part because those hospitals were admitting patients who weren’t dying and keeping them for long periods of time.
Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?
The hospital stories were based on Kaiser Health News’ analyses of Centers for Medicare & Medicaid Services hospital data. No FOI or PRA requests were necessary. For the December readmissions story, Rau analyzed readmissions rates and patient poverty levels at more than 3,000 hospitals – the first such review done on an individual hospital level.
In the patient satisfaction story, Kaiser Health News showed the wide variation among 295 different hospital markets in patient experience survey reports, and published that geographic analysis. They also used the data to identify hospitals that received poor patient satisfaction scores even though their quality of care – as judged by adherence to evidence-based protocols, mortality and readmission rates – was average or superior. The hospice story relied on whistleblower lawsuits and internal hospice documents to show how some for-profit hospice chains were seeking out questionable patients in order to higher reimbursement rates from Medicare.
Explain types of human sources used.
Policy experts, hospital officials, government officials, plaintiff’s lawyers, consultants, doctors, nurses and patients. The hospice story included whistleblowers who had filed “qui tam” lawsuits. For the patient satisfaction story, one hospital, NYU Langone Medical Center, gave Kaiser health News unprecedented access to patients, doctors and other workers to talk about why so many patients were dissatisfied with their experience at the hospital.
Results (if any).
The interactive data and reporting for the patient satisfaction and readmissions stories were used for articles in The Chicago Tribune, the Huffington Post, Georgia Health News, The Tuscaloosa News, Houma Today and Health News Florida.
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.
CMS updates much of its hospital data quarterly, so be prepared for the data to change between the inception and completion of a project. Find outside experts, such as consultants or academics who have published on your topic to vet your analytical approach and, if possible, look at the raw data. Share the data results with the hospitals you are writing about early on in the reporting. Make sure you understand the limitations of the sources of the data and also what statistical caveats have to be applied. For instance, CMS’s Hospital Compare provides a specific readmission rate for each hospital. But those rates are an estimate and have some pretty wide upper and lower bounds, so you need to be very careful when comparing hospitals to make sure the differences between them are significant.