Tip Sheets

Investigating health care: Essential public records

Michael J. Berens
Chicago Tribune

The nation's health care industry offers rich veins of journalistic ore.

Few beats are more diverse, spanning cradle to grave -and beyond. Here is found the stories of heroics and life-saving sacrifice, and of financial conspiracies and negligent death.

But there are unprecedented hurdles as well. Beyond noble life-saving efforts is found a health care industry where the true circumstances of patient deaths are obscured from even families. Increasingly, the health care industry finds itself riddled by cost-cutting disasters and desperate financial gambits, an industry where kickbacks and conflicts of interest are sometimes embraced as good business and where scant oversight is commonplace.

Here are some key records - certainly not all - that will help you crack open this industry for your own prospecting.

Quick List

1) Federal survey reports - U.S. Department of Health and Human Services
2) Federal complaint investigation reports - (HHS)
3) Federal computer runs of all surveyed and investigated facilities - (HHS)
4) Federal list of fines and penalties assessed - (HHS)
5) Inspector General reports - HHS Inspector General
6) Medicaid Cost Reports - HHS or state finance/revenue agency

1) State professional licensing records and investigations - state licensing agency
2) State nursing home demographic analysis - state public health agency
3) State facility ownership records - state public health agency
4) State fines and penalty - state public health agency

1) National Practitioner Database - HHS
2) Medicaid Exclusions/Sanctions Database -U.S. Inspector General - HHS
3) MAUDE - U.S. Food and Drug Administration
4) Adverse Drug Reporting System -FDA
5) OSCAR database - HHS
6) In-Patient Databases -State agencies

Federal Investigations and Surveys

Source: U.S. Department of Health and Human Services (HHS) - Centers of Medicare and Medicaid (CMS) - (www.cms.hhs.gov)

Type of records: Survey reports and complaint investigations for hospitals and nursing homes.

Description: The federal government conducts broad surveys of hospitals and nursing homes. The government also conducts narrow investigations based on complaints. In most cases, surveys are completed by state health agencies under federal contract. Reports are public.

Surveys chronicle observed deficiencies of safety and health standards. Each deficiency is described through mini-narratives that often provide compelling detail. When requesting copies of survey reports, make sure the "facility response" is included. After the survey is filed, the facility is given an opportunity to dispute or affirm the finding. In most cases a "plan of correction" is filed -another mini-narrative detailing how the problem will be solved. Frequently, the responses are as valuable as the survey findings.

Complaint investigations include narratives of the complaint, which can be filed by a patient, medical professional or anyone. Complaints can encompass anything, from cold food to serious systemic breakdowns. Mine these reports for patient experiences, detail or to track possible patterns. Where: Federal survey and complaint investigations can be obtained through the HHS media affairs office.

Tricks of the trade: Remember, 99 percent of "federal" reports are drafted by states under federal contract. That means the federal report is on file in your state. Illinois initially refused my request for these reports, citing that I needed to seek the record from its authorizing source at HHS. But any record in possession of the state is a public record. Illinois agreed, but denied the request by citing a state law that seals hospital survey reports as confidential -one of the few states that had such a law. But we successfully argued that federal law makes these records public and that federal law supercedes state law on public records (it says that very clearly in federal law). The state coughed up the records.

HHS also has regional enforcement offices. Contact your local office and request a computerized list of all hospitals or nursing homes that have been subjected to surveys or investigations.

Federal Financial Records - Medicaid Cost Reports

Source: State financehevenue agency or U.S. Department of Health and Human Services

Type of records: An annual financial schematic of a hospital or nursing home showing revenue and expenses, including some overall patient data. Descri~tion:Health care facilities, such as hospitals and nursing homes, receiving Medicaid funds are required to annually file a financial and statistical report, which typically goes to the state before forwarded to federal HHS offices.

Reports can span a hundred or more pages and require a small degree of expertise to understand. Recruit a state agency employee to step you through the financial intricacies. Ever wonder how all those commercial healthcare companies compile their rankings or hospital comparison data? Cost reports are the primary tool.

With nursing homes, you can find how much the owners pay themselves - or their families. You can track all the other related businesses and homes. There are many, many bits of information here.

Hospital cost reports enables you to peer inside the finances of a hospital. Which departments are the moneymakers? Many hospitals operate Labor and Delivery departments at a loss. One important analysis is the cost-to-charge ratio. In short, you can track the hospital's mark-up on prescribed drugs. In Illinois, hospitals have packed up to a 1,000 percent profit level (that's not a typo).

Cost reports are a must-have record whenever you profile a nursing home or owner, or analyze the administration of a hospital. Tricks of the trade: Nursing home owners frequently cite how their facility is losing money. This may be true, but in many cases it's a sham. First, the owner is required to list his financial links to all other homes. Some owners simultaneously pay themselves salaries from a dozen or more homes; one Illinois owner paid himself over $1 million annually this way. Another business tactic is for the home to hire business consultants for accounting and payroll services. Frequently, the nursing home owner also operates those businesses; one Illinois owner paid $900,000 for consultant services - to himself.

Adverse Events - Medical Equipment - Manufacturer and User Facility Device Experience Database (MAUDE)

Source: U.S. Food and Drug Administration

Type of records: Computerized data that represents reports of adverse events involving medical devices.

Description: According to the FDA: the data consists of all voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996.

Want to track patients who strangled in their bed rails? Fatal medication overdoses linked to faulty infusion pumps? Defibrillators malfunctioning during emergencies? It's all here plus countless more angles. Tricks of the trade: The equipment tracking database can also be used to track human errors. In many cases, the machine was deemed in good operating condition, but a nurse or doctor admitted to an error.