Covering Medicare Spending, Part 2: Tips from The Wall Street Journal's Secrets of the System

The Wall Street Journal's series on Medicare costs, "Secrets of the System," sets the mind spinning with possibilities for future health investigations. I culled five tips from the on Wednesday. Here are five more. Next week, I will offer a few story ideas that could grow out of the Journal's efforts to crack open the Medicare claims database for everyone.

1. Narrow your scope. Stories that talk about "the health system" or "the staggering costs of health care" can leave readers feeling defeated before they even get past the lead. The Journal did something very smart with this series. They chose specific types of care – radiation therapy, spine surgery and physical therapy – and used those areas to explain the broader problems with the Medicare system:

Physical therapy, which cost Medicare almost $3.5 billion in 2008, offers a case study in how Medicare polices its payments. Even when Medicare identified providers whose physical-therapy billing raised red flags, it kept paying thousands or even millions of dollars, sometimes for years, The Wall Street Journal found.

2. Look for hot zones. The Dartmouth Atlas made the mapping of health spending a regular part of the health care discussion, and Atul Gawande helped explain that mapping in a groundbreaking piece for The New Yorker in June 2009. (And Gawande did something similar last month with his piece, "The Hot Spotters.") The Journal takes this type of analysis one layer deeper by identifying hot zones for a particular type of care and then describing the specific practices of the doctors who are racking up the most charges.

Here's what the Journal had to say about one doctor in Florida, a physical therapy hot zone:

Dr. Wayne took in more than $1.2 million from Medicare in 2008, according to a person familiar with the matter, a large portion of it from physical therapy. That's more than 24 times the Medicare income of the average family doctor, according to a Wall Street Journal analysis of Medicare-claims data.

3. Find out who has two masters. In its piece on spine surgeries, the Journal explored how spine surgeons reap millions in payments from surgical device manufacturers while also performing huge numbers of spine surgeries using surgical devices. As with the other hot zones it identified, the Journal focused on one area, Louisville, Ky., and, in this case, one medical center: Norton Hospital. It showed how five surgeons there were big recipients of payments from Medtronic:

From 2004 to 2008, Norton performed the third-most spinal fusions on Medicare patients in the country. The five surgeons are also among the largest recipients nationwide of payments from medical-device giant Medtronic Inc. In the first nine months of this year alone, the surgeons-Steven Glassman, Mitchell Campbell, John Johnson, John Dimar and Rolando Puno-received more than $7 million from the Fridley, Minn., company.

4. Then find the wobblers. The comeback from some of these spine surgeons was that every surgery they performed was legitimate and that they weren't paid royalties on the specific devices that they put into patients, only on those that were put into other patients by other surgeons. The Journal looked to see how many of those surgeries were, indeed, legit:

The most hotly debated use of spinal fusion surgery centers on patients who merely suffer from aging disks, a condition known as degenerative disk disease.  One health insurer, the nonprofit Blue Cross and Blue Shield of North Carolina, announced in September that it would stop paying for spine fusions performed on such patients beginning on Jan. 1. The insurer said that the procedures are ‘considered not medically necessary.'

What percentage of the patients who underwent spinal fusion at Norton Hospital was in this "hotly debated" gray area?

At Norton, spinal fusions on patients who only suffered from aging disks accounted for 24% of the 2,475 fusions the hospital performed for Medicare between 2004 and 2008, compared with 17% nationally. This placed it 11th in percentage terms out of 60 hospitals that performed 1,000 or more spine fusions in those years, and fourth in raw count.

5. Share your scribbles. As more reporters over the past two decades have become sophisticated number crunchers, they also have become better at explaining to readers how they arrived at their conclusions. The Journal does a great job breaking down its methodology in simple terms. They do this in nearly every story in the series, and they also provided a nice sidebar about their work on radiation and physical therapy. Journal reporter Maurice Tamman also has been generous with his time and skills, walking reporters through his analysis at the 2010 Computer-Assisted Reporting Conference in Phoenix in March and sharing tips through the National Center for Business Journalism.

Related Posts:

Covering Medicare Spending, Part 1: Tips from The Wall Street Journal's Secrets of the System