How should reporters cover healthcare when the Affordable Care Act is no longer a hot political story? It’s an essential question, touched on recently in a Wall Street Journal column by Drew Altman, head of the Kaiser Family Foundation and founder of Kaiser Health News. “As the ACA’s political story diminishes and implementation proceeds across the US,” he wrote, “disentangling the complex story of the healthcare law’s impact becomes both more important and more challenging.” These points resonated a few days later when I read the obituary of Dr. Rashi Fein, an influential economist who laid the intellectual groundwork for Medicare in the early 1960s. Writing in The New England Journal of Medicine in 1982 Fein warned:
A new language is infecting the culture of American medicine. It’s the
language of the marketplace, of the tradesman, and of the cost accountant. It is a language that depersonalizes both patients and physicians and describes medical care as just another commodity. It is a language that is dangerous.
Fein’s comments back then point to fertile ground for health reporting today: the blossoming of the medical marketplace. Healthcare is the fastest growing sector in the economy. Marketplace stories (by which I mean reporting on the businesses that sell healthcare and their relationship to the public) are local and political–and, told in the context of the ACA, they are essential to the public’s understanding of their healthcare system and how they will experience it. Some good examples of marketplace reporting in the last few weeks show what can be done to move healthcare reporting beyond Washington’s legislative horse race and endless speculation about whether Obamacare will be a big factor in the mid-term elections.
For-profit hospitals on the march. The Tampa Bay Times, which has distinguished itself investigating trauma fees charged by Florida’s hospitals, particularly those operating on a for-profit model, recently carried the story a step further. Reporters Kris Hundley and Alexandra Zayas found serious serious consequences arising from the recent expansion of Florida’s trauma system. Five years ago, the state approved six new trauma centers owned by the (for-profit) Hospital Corporation of America (HCA) that compete with existing centers. After analyzing thousands of records, reporters found that paramedics are taking kids to some of these new centers, which may be the closest available but are not equipped to treat them. By the time kids are transferred to centers designed for pediatric emergencies, it’s sometimes too late. “In areas closer to pediatric centers,” the reporters found, “few children wound up at adult centers until HCA entered the market.” Sifting through the billing records, reporters found hospitals billed the families– as much as $33,000 for just showing up–even if their children were transferred to another trauma center. The paper’s revelations should make every parent take notice. Why do such practices flourish? “State officials have done little to make sure young trauma patients wind up at the right hospital,” the reporters wrote. The state Department of Health does not investigate what happens to kids when they end up at the wrong hospital.
Lindy Washburn, a health writer at The Record of Bergen County, NJ, who has carved out a niche covering hospital billing practices, offered a three-part series a few weeks ago that should prompt other journos to take a similar look in their own backyards. Like reporters in Tampa, Washburn concluded that for-profit takeovers of local hospitals may not always be best for patients, but “could define New Jersey’s healthcare landscape for decades.” What’s more, she wrote, “with this remarkable transformation comes a host of unanswered questions that get at the heart of the mission of healthcare.” Among them: Should states exert greater oversight over for-profits? Can business people, some with no hospital experience, be trusted to focus on the needs of patients as well as the bottom line? Washburn shows how the new for-profit facilities bill insurance companies high rates for the services they provide. “The major change we see when there’s a conversion to for-profit healthcare is an increase in charges,” Bradford Gray, a senior fellow at the Urban Institute, told the paper. Doesn’t that run counter to the goals of the Affordable Care Act? Probably, yet, Washburn writes, “the drumbeat of acquisitions continues.” One of her pieces is an indictment of the state’s regulatory oversight of for-profit hospitals (there isn’t much). Washburn’s stories blend business, health policy, and government reporting, giving readers a comprehensive picture of the state’s newly-fashioned hospital system.
Padding bills for medical services. Not every marketplace story has to involve months of combing through documents and reams of government data. As I’ve noted before, some of the best stories spring from personal encounters with the health system. Mary Jane Skala, health reporter for the Kearney Hub–a daily paper in in Kearney, Nebraska–devoted a recent column to the experience of her 93-year-old mother after a hospital stay for a suspected stroke. A day after after all the tests came back negative, Skala’s mother was whisked to a rehab facility for what officials said would be a four- to eight-week stay. Such centers are a booming business these days because of generous Medicare reimbursements. Although her mother was fine, Skala said, the facility refused to let her walk, studied what she ate, washed and dressed her even though she was capable of doing those tasks herself, and tried to force her to take nausea pills even though she hadn’t been nauseated for three days. “I got a free front-row seat to modern American healthcare,” Skala wrote, “now playing at a theater near you.” Skala told me she began to suspect the facility was building a record of her mother’s condition to document a case for Medicare reimbursement. After ten days, the center let her go home. “I smell a rat with this rehab place,” she said. “No doubt some people need rehab, but everyone at her place seemed to be sent there after hospitalizations for any reason.”
All of these stories I’ve cited dig into what is rich terrain for reporters. There are many things happening in our healthcare system that fly in the face of what the ACA was supposed to do–improve the quality of care and lower the national healthcare tab. Reporters on the ACA beat have been so focused on the exchanges, the rate increases–not to mention the political horse race, as Altman noted–that they’ve often neglected to explore how the trend towards for-profit healthcare can conflict with the goals of the ACA.
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Trudy Lieberman is a longtime contributing editor to the Columbia Journalism Review. She is the lead writer for CJR's Covering the Health Care Fight. She also blogs for Health News Review and the Center for Health Journalism. Follow her on Twitter @Trudy_Lieberman.