[Ip-health] How NYT’s Rosenthal reported innovative series on U.S. health prices

Elizabeth Rajasingh elizabeth.rajasingh at keionline.org
Tue Jul 15 17:02:14 PDT 2014


After the failure of President Clinton’s health reform effort in the 1990s,
New York Times reporter Elisabeth Rosenthal
frustrated with American health care to the point where she moved to China
to serve a six-year stint as a correspondent in the paper’s Beijing bureau.

When Rosenthal, an M.D. who converted to full-time journalism, returned to
the U.S. in 2007, she was startled by the rise in health pricing. “I
started experiencing cognitive dissonance when I saw U.S. health care
prices,” Rosenthal said while delivering the Sunday keynote to this year’s 2014
National Health Journalism Fellowship

When Rosenthal broke a small bone in her hand while jogging in Sweden, she
was treated in full by “the best orthopedist in Stockholm” for $400. When
she fell and broke the same bone in her other hand – she pleads guilty to
clumsy jogging – back in the U.S., the total cost was about $13,000.

So when the Times’ then-managing editor Dean Baquet asked Rosenthal to
cover the Affordable Care Act during the 2012 election, she said the one
topic capable of luring her back to health care reporting would be a series
investigating health care costs. And so began Rosenthal’s widely
acclaimed “Paying
Till It Hurts

“I wanted to focus on what makes those ordinary procedures so expensive,”
Rosenthal said. “Where is the money going? Could this all be legal?”

While she plumbed Medline for relevant studies on health prices, she found
most studies relied on aggregate numbers from insurance claims and big
databases. “To me that’s where journalists come in – the academics can do
those umbrella studies, but it’s our job to ask how this is working for
patients?” Rosenthal said.

But how to do you find patients with harrowing stories of health costs run
amuck? Patients referred by NGOs are often “highly processed,” and flagging
down patients in parking lots can be tough sledding. Rosenthal decided
she’d try something different. She remembered a tactic formerly employed by
Jane Fritsch at the Times’ investigative desk. The “open-for-business
story” was a short story buried deep in the paper that announced a reporter
was interested in a topic, and in so doing, generated enough responses and
leads from readers to launch a fuller investigation.

“How could we do an open-for-business story for the digital age?” Rosenthal
asked herself at the time. “Because what I really needed was patients.”

She turned to the Times’ health blog “Well <http://well.blogs.nytimes.com/>”
where she published a piece called “Price for a New Hip? Many Hospitals Are
a post about a college thesis project devoted to tracking down the prices
for hip replacement surgery. But crucially, the post had a small insert box
that asked readers: “Have you had a hip replacement or other procedure?
Tell us about your costs and bills. Join the discussion.”

The prompt generated more than 500 reader responses in a couple hours. “My
series was off and running,” Rosenthal said.

One of those respondents, Renée Martin, would eventually lead Rosenthal’s
June 2013 story called “American Way of Birth, Costliest in the World
and she was also featured in a video
Deirdre Yapalater, another respondent, was featured in “Colonoscopies
Explain Why U.S. Leads the World in Health Expenditures
after she received a $6,385 for the routine screening procedure.

“It really changed my view of social media and reader comments,” Rosenthal
said, adding that Facebook groups <https://t.co/Uwd6K5A6KI> and Twitter
prompts can be used in the same way to generate sources and stories.

One of the journalistic gold-mines that turned up in Rosenthal’s comment
stream was a man named Michael Shopenn
an extremely resourceful health consumer who’d been in need of a hip
replacement. Even after Shopenn had found a connection who would sell him a
hip implant at wholesale cost, he was looking at hospital fees in excess of
$65,000. Shopenn instead traveled to a well-regarded private hospital in
Belgium, where the total price came to $13,360. Rosenthal used the contrast
to highlight some of the key differences between the U.S. health system and
its European counterparts.

Shopenn’s story included a telling moment: Upon glimpsing the shabby
exterior of the Belgium hospital where his surgery was scheduled, he nearly
told his driver to take him back to the airport. “Part of journalism is
reeducating patients about what matters,” Rosenthal said. Costly amenities
and cushy perks should matter far less than infection rates and patient
outcome measures. Nonetheless, some U.S. hospitals are now
indistinguishable from luxury hotels, as Rosenthal and her graphics team
cleverly illustrated last year in an online quiz called “Is This a Hospital
or a Hotel?

(Another smart online interactive shows “What $250 of Prescription Drugs
Looks Like
in the U.S. compared to other countries.)

On a broader level, Rosenthal hopes her reporting will make people realize
that such exorbitant costs for care are neither inevitable – other
countries have been far more successful in containing costs – nor are they
necessarily correlated with the quality of care.

“The bills are so far our proportion to any kind of realistic payment that
it’s fiction,” she said. “There needs to be some sort of pressure for
realistic pricing.”
Elizabeth Rajasingh
Perl Fellow, Knowledge Ecology International
1621 Connecticut Ave. NW, Suite 500
Washington, DC 20009
*elizabeth.rajasingh at keionline.org <elizabeth.rajasingh at keionline.org>* |

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