How I did it
Learn from these journalists how they have covered various aspects of health care related to insurance. They provide valuable tips and sources and explain how they got past the challenges to explain the complex issues to their audiences.
Reporting on junk health insurance plans
Early in May, ProPublica health care reporter Jenny Deam wrote about the financial ruin that often results when unknowing consumers enroll in short-term health insurance plans. Her article of more than 3,000 words, “He Bought Health Insurance for Emergencies. Then He Fell Into a $33,601 Trap,” is an excellent example for any journalist looking to cover the complex world of health insurance plans that do not comply with the requirements of the Affordable Care Act (ACA), otherwise known as Obamacare.
Maya Miller, an engagement reporter with ProPublica’s Local Reporting Network, also contributed.
How to report on the ‘financial toxicity’ even Medicare cancer patients can face
A recent Cancer Today magazine feature I wrote on the financial difficulties faced by many Medicare beneficiaries with cancer, Learning Medicare’s ABCDs, began its life in 2018 as a failed idea for a brief web explainer.
When I started as an editor at Cancer Today, I tended to think of financial toxicity as the province of people under 65 who were not eligible for Medicare. However, the median age for a cancer diagnosis is 66, and by early 2018, I had noticed in the literature and social media exchanges that some cancer patients on Medicare also were reporting financial troubles.
Award-winning journalist shows what European countries can teach the U.S. about containing opioid crisis
She had written about the opioid crisis in North Carolina and found that the drug-related death and disease statistics were grim. Meanwhile, European countries experienced a heroin epidemic a few decades ago and Paris recently opened a drug consumption room (or safe injection site).
Read about how Knopf reported and produced a six-part series called “Lessons from Abroad” on successful harm reduction methods.
For some patients, high health costs and inadequate insurance are financially toxic
As it turns out, the issue has many twists and turns.
How a doctor’s tip and a Facebook algorithm led to an award-winning series
How reporter Cheryl Clark learned about Trina is probably what happens to a lot of journalists who stumble onto a great story. The path might be circuitous and require a lot of patience and curiosity.
Decoding upcoding: Reporter finds manipulation of patient condition severity in ER bills
Here are her tips on how you can obtain bills, and understand facility fees and “upcoding.”
High-profile interview leads to a five-part series on mental health parity
That interview led to a series of stories about mental health parity – treating mental health on par with physical health. She scoured complaint records in North Carolina and was able to interview several patients and providers, though she found that insurance companies were reluctant to speak on the record.
Reporting on surprise medical bills
In this How I Did It essay, Terhune gives many detailed and specific hints on how to identify, verify, and report on these bills.
How Tarbell dug through layers of complexity to explain why drug prices are so high
Reporting on surprise medical bills leads Mississippi hospital to change its ER billing policy
As a result of complaints from patients and Anna Wolfe's reporting for the Jackson, Miss., Clarion Ledger on how these high charges are calculated, the hospital changed its billing policies to make the charges more fair.
Explaining complex world of pharmacy benefit managers led to series for this data journalist
Katie Wedell began looking into drug prices because of a tip about clawbacks – a practice in which pharmacies charge a customer the full copay even if the drug costs much less, and the pharmacy benefit managers “claw back” the rest. Under the contracts pharmacies have with PBMs, neither side can disclose the actual amounts pharmacies pay and PBMs receive.
Using data, reporter shows how for-profit hospitals provide much less charity care than nonprofits
Editor details the challenges of covering genetic testing companies that make dubious claims
It was the first of four articles about Proove that Piller wrote over eight months that questioned the validity of the test and the company’s marketing practices. In this Q&A, Piller explains how he did the stories and how he and Stat reacted to charges that the reporting was inaccurate.
News brief became catalyst for series on mental health, solitary confinement
Here she shares what she learned while reporting a two-part series about one man who embodied the reality of the broken mental health and criminal justice systems.
State budget cuts had adverse effects on patient care, leading to hospital’s decertification
Hart recognized that there was likely more to the story because it's rare for the Centers for Medicare & Medicaid Services to ‘decertify’ a facility or cut payments.
"Therefore, I knew something serious must have happened at Osawatomie State Hospital. The issue was even more important because in eastern Kansas most people who are involuntarily committed are automatically sent to OSH. The only other state psychiatric facility covers the western part of the state, and relatively few private facilities take involuntary patients, even if the person has insurance."
Finance editor reports on how health systems replace fee-for-service with value-based payment
In the health care-industry revolution prompted by the Patient Protection and Affordable Care Act in 2010 and husbanded by the Obama administration, the pioneers face a harrowing ride, with providers and payers playing the role of test pilots for a slew of new business models in the shift away from fee-for-service medicine to value-based care.
Tagging along with the pioneers to chronicle their story can be a bumpy ride, too. Health care innovators are on the cutting edge of change, often with no road map and never with historical trend data in hand. One of the oldest implements in the journalism toolbox becomes essential: finding reliable sources and trend setters who can help guide the reporting of the story through the twists and turns of an evolving marketplace.
Document management systems can help find the story in thousands of pages
I knew these documents held secrets. I knew they'd help our readers better understand the inner workings of health care. But I didn’t know how to organize them and make sense of hundreds of PDFs, especially without the context lawyers provide in a courtroom explaining their importance. So, the pressing question I faced was this: How would I organize these documents into a relevant story or series of stories and still have a life?
There’s not one reason why co-ops are failing; there are dozens
The interview wasn't much of a "get" by any standard. MCHO was a little-known health plan that sold coverage to customers on Maine's state exchange. But it was exciting to me for one reason: MCHO was a consumer-oriented and operated plan, part of the first generation of nonprofit health insurers created by the Affordable Care Act and funded by taxpayers.
The co-op program, which consisted of 23 startups, offered an alternative to buying coverage from the traditional big insurance companies. The individual co-ops would ideally be more community-focused, friendlier and more accessible to the average consumer, and maybe even cheaper.
Rush to robotic surgery outpaces medical evidence, critics say
After I saw the item, I went to PubMed and found a few studies that reported varied results with robotic surgery, particularly with its growing use in gynecology. I also was aware, from my aforementioned days with the surgeon magazine, that robotic operations cost more than conventional surgery and required quite a learning curve for the surgeon and operating room staff.
When a doctor threatened to sue this California reporter, he did what journalists do best
The editor and publisher of Payers & Providers, a newsletter in Los Angeles, Shinkman got the phone call we dread. On the line that day in March 2012 was Jeannette Martello, M.D., a plastic surgeon Shinkman had covered when the California Department of Managed Health Care enjoined her from balance billing her patients.
The article was a just-the-facts brief based on a report the insurance regulator issued. With some digging, he discovered that Martello had a history of suing her own patients. In fact, Shinkman found Martello had filed 70 lawsuits in Superior and Small Claims courts in Los Angeles County against her patients. By looking through court and lien records, Shinkman uncovered many of Martello’s patients-turned-lawsuit defendants who became sources in a report he wrote for Payers & Providers.
Attempt to ‘crowdfund’ kidney surgery prompts exploration of ethical issues surrounding coverage
As we covered the hospital’s response to the crowdsourcing effort behind her surgery, I worked with Anthony Ronzio, the news and audience director at the BDN, to sort through the medical crowdfunding editorial policy questions inherent in medical crowdfunding. In so doing, we wrestled internally with the role of media coverage in Royles’ ultimately successful search for a donor.
One series leads to another for Georgia journalist looking into Medicaid expansion under the ACA
An estimated 400,000 Georgians fit into this category. They make too much money to qualify for Medicaid but not enough to be eligible for tax subsidies through the federal Health Insurance Marketplace.
How a fellowship helped one journalist cover the business of oncology
What captivated me was this paradox: Private oncology practices are being driven out of business because of Medicare payment policy, but cancer care delivered at hospital-owned practices actually costs the Medicare program more than if the same services were delivered by private practices.
If I were a staff reporter, I would have bugged my editor to give me time to dig into this topic. But, as an independent journalist, I could not justify the time needed for the just-checking-this-out interviews and to wrap my arms around a hazy topic that might not lead to anything worth publishing.
Journalist turns six months of research into eight-part series on hepatitis C epidemic
New drugs had hit the market with reported cure rates of 95 percent or more, but they cost upwards of $90,000 for a full course. The arrival of these new drugs coincides with another trend: millions of baby boomers who contracted the disease decades ago are just now showing up in doctors’ offices and emergency rooms, sick with something most didn’t know they had.
Add to that a wave of new infections, spreading among younger injection drug users – people who got hooked on opioids and then turned to heroin – and you’ve got a unique moment in the history of an epidemic.
In this AHCJ article, she shares what she learned, what sources she used, as well as a list of potential story ideas. As she points out, this epidemic will impact many lives but also state budgets.
Print, radio reporters team up to expose a fraying mental health system in Idaho
Dutton and Saunders found that Idaho's threadbare mental health care system does not serve well the many Idahoans who need quality, timely and appropriate behavioral and mental health care.
Their work could serve as a blueprint for journalists covering this challenging story in any state. Read about how they focused on Idahoans who lack insurance, or can't find adequate services and end up getting care only in crisis. They looked at emergency room visits, involuntary commitments, jails, homeless shelters and emergency response teams of police and social workers.
Reporting on how, why hospital superusers account for bulk of health-care spending
Your community might not have a federally-funded pilot program to address super-utilizers as Allentown has. But your community has superusers and it has similarities with Allentown that you can explore in your own reporting. Read about how Darragh approached the reporting and key issues he found.
Reporting on why a huge nonprofit with a healthy endowment would sue an uninsured patient
She first heard about Memorial Hermann Hospital's practice of suing uninsured patients when a local lawyer who specializes in health care lawsuits contacted her about a case he was undertaking on behalf of Ignacio Alaniz.
In January 2012, Alaniz was rushed to Memorial Hermann in the Texas Medical Center after he was run over by his own car. He had emergency surgery and was in the hospital for weeks. He also didn’t have health insurance. He'd been vaguely assured by hospital personnel that the hospital would work something out under its charity arm, but his medical bills were more than $400,000 by the time he was released. Then Memorial Hermann, the largest nonprofit medical system in Houston, sued him for failing to pay the bill.
Figuring out the politics of patient harm
“In health care, cooking up answers to what look like simple questions can quickly get complicated,” he writes. Surprisingly, it was difficult just to determine how to define the term “hospital” because there are so many different types of hospitals. Just distinguishing a local hospital’s performance from that of another hospital miles away was challenging because multiple hospitals owned by one system may share a provider billing number, he explains.
In this “How I did it” article, Millenson explains the challenges of collecting and reporting the data needed to compare one congressional district against others.
Hospital consolidation in Yakima, Wash.
Instead, I found that while the numbers do add weight to hospitals’ claims of desperation, the bulk of the story lay elsewhere.
Here’s the gist of it: In Yakima, Wash., the one remaining independent, nonprofit community hospital announced a year ago that it’s looking for someone to partner with to stave off financial uncertainty in the future. It reached out to several larger Seattle organizations, but only one is still engaged in talks.
Journalists have to make big choices when writing about their own health drama
Since the year 2000, I’ve been jilted by a grand total of seven insurance companies. The eighth—the one covering me now—comes courtesy of Obamacare and looks like it might actually stick around for a while. Expensive? Yes. A relief? Absolutely.
My long-running tale of woe, which features several twists and turns and a dose of irony, isn’t that unusual in the grim world of 21st-century health insurance in the United States. What’s unusual is for a journalist who covers health and medicine to be so open about his own experiences.
Undocumented immigrants struggle for access to health care
In fact, undocumented immigrants were ineligible for both of the main provisions of the law meant to extend coverage to 32 million Americans, the Medicaid expansion and the state insurance exchanges. Tammy Worth investigated how the law would affect care for this population as well as the providers who treat them.
Analysis looks at which consumers get better deal in health insurance exchanges
These discrepancies raised two big questions: Do such disparities exist throughout the entire United States? If so, who gets the better deal – consumers in the Twin Cities with low premiums and little chance of getting federal tax credits, or consumers in the higher-cost places who benefit from the subsidies?
Movement away from fee-for-service reimbursements has begun
Despite the challenges, some payers and providers are in fact shifting away from volume-based payments, commonly known as fee for service, and adopting value-based payment methods, as René Letourneau, a senior finance editor with HealthLeaders Media, reported in a recent cover story, Restructuring Reimbursements. Letourneau explained that the risk of not being paid 15 percent of their contracted reimbursement rates if they do not meet certain outcome measures appears to be motivating hospitals to find ways to deliver better care. Here’s Letourneau’s explanation of how she reported this story.
Finding compelling stories about a fraying safety net in a fast-changing insurance marketplace
'Critical access' designation may be in danger for hospitals in your area
When he learned of the report, David Wahlberg, a health/medicine reporter for the Wisconsin State Journal, interviewed administrators at critical access hospitals in Wisconsin and found that the administrators believed closing these hospitals would have a detrimental effect on care for Medicare patients. The issue of payment for these facilities is important in every state, but particularly in Wisconsin, which has 58 critical access hospitals. Wahlberg also found that, while critical access hospitals will not be decertified soon, they could be in the future.
Wahlberg points out some important issues journalists should be looking into that involve patient care, the local economy and screenings and care for more vulnerable populations.
Reporter finds surprising stance on smokers’ surcharge
Poor oversight of Medicaid managed care programs takes toll on patients
She set out to find out how well the states are overseeing and monitoring the quality of care provided by the managed care plans they contract with, and how states compare with each other. In this article for AHCJ, she explains the challenges in doing so. She also reminds us that even policy stories are about people and shows us how problems in one state's managed care program have affected its residents.
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