Provide a brief synopsis of the story or stories, including any significant findings.

Judges’ comments:  This yearlong series from the Pittsburgh Tribune-Review pinpointed billions of dollars of waste in the nation’s health care system. Spanning the nation from Maine to Miami and from New York to California, with in-depth and investigative reporting by Luis Febregas, Andrew Conte; the Tribune-Review highlighted critical spending issues from unnecessary readmissions to billions being spent on new facilities without review or proof of need.

This series utilized poignant humanization… great photography, striking graphics and an extensive interactive web presentation to drive home the points of the investigation.

Within days of their pointing out that Pennsylvania was one of only 14 states nationwide without a Certificate of Need review process for new hospitals and other equipment, Pennsylvania legislators were drafting new legislation to reinstate the process.

The extensive travel, weeks of data analysis and follow-up reporting in this entry made a difference in the nation’s health care spending practices.

Provide names of other  journalists involved.

Multimedia by Jason Lanza; Photography by Justin Merriman, John Schisler, Sidney Davis, Andrew Russell, Keith Hodan, Joe Appel and Gabor Degris (freelancer ); Graphics by Bob Newell, Caroline Hirt, Therese Harpish and Denise Shean

List date(s) this work was published or aired.

March 6, June 5 and 6, Sept. 25, 26 and 28, and Dec. 18, 19 and 23, 2011

See this entry.

Interactive presentation

Medical building boom increasing Americans' health care costs

Provide a brief synopsis of the story or stories, including any significant findings.

Yearlong series pinpoints billions of dollars of waste in four areas of the nation's health care system.

Explain types of documents, data or Internet resources used. Were FOI or public records act requests required? How did this affect the work?

For its report on hospital readmissions, the Tribune-Review analyzed data on readmissions for complication or infection within 30 days that hospitals reported to the Pennsylvania Health Care Cost Containment Council. The data cover the federal fiscal year 2009 (Oct. 1, 2008, to Sept. 30, 2009).

The Trib reviewed more than 100 lawsuits and other court records at Allegheny County Common Pleas Court in order to identify cases in which a hospital readmission contributed to a patient's death.

For the report on end-of-life care, Trib reporters scoured through obituaries on several online resources such as legacy.com and newspaper obituary databases.

To understand how private and public insurers determine costs, the Trib used data supplied by these organizations: Aetna, Anthem, Maine Health Data Organization, Center for Medicare and Medicaid Services, and Castlight Health, a San Francisco agency that works with companies to identify health cost savings.

The Trib reviewed information from Reed Construction LLC of Oak Brook, Ill, which collects and publishes information on hospital construction projects throughout the United States.

The Trib reviewed CRITICAL CARE MEDICINE 2008, VOL. 36, NO. 12, McGraw Hill Construction, "DISCRETIONARY DECISION MAKING BY PRIMARY CARE PHYSICIANS AND THE COST OF U.S. HEALTH CARE," HEALTH AFFAIRS, VOL. 27, NO. 3; Health Services Research; Institute of Medicine of the National Academies; Municipal Securities Rulemaking Board data and information; Pennsylvania Health Care Cost Containment Council, Hospital Performance Report, Federal Fiscal Year 2009 (Oct. 1, 2008-- Sept. 30, 2009); and Thompson Reuters health care services information.

The Trib also used records from the Dartmouth Atlas of Health Care, the Illinois Health Facilities and Services Review Board and the North Carolina certificate of need review.

Explain types of human sources used.

Reporters interviewed hundreds of health care providers, including hospital administrators, doctors, nurses, medical suppliers and so forth; patients and their families; employers; college researchers; federal and state regulators; and residents affected by new hospital proposals in places such Asheville, N.C., and Elgin, Ill. The reporters conducted face-to-face or phone interviews with people from Maine to Miami and from New York to California.

Results (if any).

The Trib created multiple informational databases that can now be used by Congress, state legislators and other government officials looking for information about ways to save health care costs on hospital readmissions and per-patient expenses for a variety of procedures. Within days of the series, Pennsylvania legislators were drafting legislation to reinstitute the certificate of need (CON) review process for new hospitals and other equipment. Reporting in the stories showed Pennsylvania as one of 14 states nationwide and only two east of the Mississippi River that don't have such a process. Several states without a CON review process are among the top 10 spending states on new hospital construction since 2008. UPMC health system officials acknowledged their readmissions were unacceptable and have begun steps to reduce those numbers.

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.

There were several follow-up stories:

• Deaths, safety concerns in VA readmissions study, March 13, 2011 
• High readmissions for some patients to cost federal money, Aug. 2, 2011 
• Costs high, gains few / Report cites little change in percentage of expensive hospital readmissions, Sept. 28, 2011 (included in entry)
• Monroeville hospitals angle for ambulances, Dec. 22, 2011 
• Legislators eye return to reviews as hospitals build, Dec. 23, 2011 (included in entry)
• Forbes' sign may vie with UPMC's, Dec. 30, 2011

The reporters also responded to dozens of private individuals, health care professionals and others applauding the newspaper for its effort. They directed people to online interactive maps/graphics that contained valuable data analysis they sought and spoke with legislators and congressmen from several states. One of the more important follow-ups was the Dec. 23 story, included in the entry, which reported that some legislators unhappy with what they learned from the series intended to introduce legislation that would re-establish the Certificate of Need process to determine the necessity of hospital construction and certain health care spending. The newspaper will follow the progress of that effort and any other related developments in 2012. No corrections or clarifications have resulted from the series. No one has challenged its accuracy.

Advice to other journalists planning a similar story or project.

Be prepared to dedicate an extensive, exhausting amount of time and effort. Discussions about this series began in 2008. Reporting to determine the number of health care cost issues that could be tackled began in December 2010. Two months later, the list of more than three dozen possibilities was whittled down to four major underlying causes. Reporters must have the upfront backing and support of their editors all along the line for a project that would take a year to report. Extensive travel was involved, along with weeks of data analysis and follow-up reporting. Reporters must have the support of other newsroom departments, including photography, graphics, copy desk, designers and multimedia experts who can help package all this together online. Above all, all must share the belief that you can make a difference in the nation's health care spending practices.