Mining California Data for Amazing Healthcare Stories

We have a guest post today from veteran healthcare journalist Ron Shinkman, editor of Payers and Providers and healthcare finance editor for the digital publisher FierceMarkets.com. Ron has mined publicly available California health data for amazing stories - including one on hospitals who paid their CEOS more than they spent on charity care. If you report on health in California, his tips are a must-read.
- Barbara Feder Ostrov, deputy editor, ReportingonHealth

When I began my career as a journalist in the late 1980s, making a Freedom of Information Act (FOIA) request was not unlike applying to college - a blend of waiting and low-grade anxiety. It was best to mail your request out and try to forget about it. Like a college application, if a big envelope arrived in a month or two, you knew your desire had been fulfilled. A small envelope contained nothing but disappointment.

I recently made my first FOIA request in a very long time. It crystallized all that has changed in journalism over the past 20-plus years. I sent my FOIA via e-mail to the Centers for Medicare and Medicaid Services. It was approved later that day, and I had the documents I asked for by that afternoon.

E-mail has not only speeded such communications dramatically, but the Internet has hugely expanded the options for accessing information. For example, if I need to access the archives of the New York Times and Los Angeles Times, I can do it from my laptop.

Of course, that's a basic option for any reporter. When covering healthcare - a beat filled with minutiae that has now held my fascination for nearly 18 years - finding the resources at hand can be overwhelming. If I have to dig up basic facts about the local hospital, or about a health plan whose business practices are impacting the community, where do I turn?

California's Transparency

California's government is often criticized for being dysfunctional (particularly on budget matters). But in many ways it has been a national leader in healthcare transparency. A variety of state agencies publicly disclose information that often is unobtainable in other states.

Both the Department of Managed Health Care (DMHC) and the Office of Statewide Health Planning and Development (OSHPD) are extraordinary resources for data. The DMHC, which is a regulatory watchdog for HMOs that do business in the state, posts both health plan financial and disciplinary information on its website. OSPHD posts granular-level financial information on nearly 400 hospitals in California.

Both sites have not only been immensely helpful in my everyday reporting, but can also generate scoops. For example, just nosing through the DMHC site last spring led me to a big story: Blue Cross of California had more than four times as many "enforcement actions" levied by the DMHC than any other health plan. Among those was a $2.5 million fine against Blue Cross that never had been publicized. I also annually report on the consumer complaints filed against HMOs - data that again is helpfully aggregated and posted by the DMHC.

The OSHPD's disclosure of individual hospital finances was particularly helpful when I published a white paper last summer analyzing the compensation of more than 100 chief executive officers of hospitals throughout California. A typical OSHPD report for a single hospital runs more than 140 pages. These reports may be downloaded from their website in PDF format, or through an Excel spreadsheet with an extensive "pivot" function. The Excel option makes it much quicker to sift through a hospital's finances.

I used OSHPD data to provide financial benchmarks against the CEO compensation – was someone who earned $1 million actually keeping their hospital in the black? I also compared salaries to levels of charity care provided to indigent patients. It turned out more than a dozen hospitals paid their CEOs more than they spent on charity care.

Such reporting is not without some pushback. The state's leading hospital lobby, the California Hospital Association, grumbled about the white paper. However, since the data was submitted and audited by the hospitals themselves, it did not rise above that. Moreover, dozens of healthcare executives have so far purchased the white paper and the underlying data, suggesting that the demand for such reporting is quite strong.

Tax Returns

About two-thirds of California's hospitals are not-for-profit operations. Under federal law and the Internal Revenue Service code, they are required to make their tax returns – a Form 990 – available for public scrutiny. Not only do 990s report financial information about the hospital, but the compensation of its top executives and board members.

The Internet has again changed the game for obtaining these returns. When tax regulations were revised in the mid-1990s, most not-for-profits only had to have their 990s on their premises for inspection. That was fine, but given I was at the time covering eight western states for a healthcare trade journal, it was all but impossible to collect them for the hospitals and health systems I wrote about.

Of course, those rules have gradually changed to the point where, again, these forms are available at the click of a mouse. Two terrific websites, GuideStar  and Foundation Center, have these 990s available, mostly free of charge. I used GuideStar to compile the CEO salaries white paper.

Aside from financial and salary data, other interesting things can pop up, such as required self-dealing disclosures. That's how I discovered Bruce Christian, the former CEO of South Coast Medical Center in Orange County, had simultaneously headed a patient debt collections agency that contracted with the hospital. Christian is now CEO of Loma Linda University Medical Center's planned hospital in Murrieta - and he's still in the patient debt-collecting business.

My reporting on Christian's unique self-dealing was followed up by the investigative news organization California Watch. Its reporting was picked up by the Riverside Press-Enterprise, which ran a front-page story in July.

Other Places For Digging

These are not the only resources for a journalist looking to get up to speed on healthcare issues. The California Department of Public Health  regulates the day-to-day operation of hospitals. It regularly issues violations to and fines facilities throughout the state, and posts this data on its website. The narratives for these violations are both informative and often graphic in a way guaranteed to grab a reader's attention. The California HealthCare Foundation (), the UCLA Center for Health Policy Research () and Rand Corp. are all reliable sources for healthcare news, demographics and trends, both statewide and on the community level.

Final Thoughts

Obviously, as the nature of reporting on healthcare delivery has changed, so has the depth and volume of the information that is readily available. It's become much deeper, much more voluminous and also far easier to obtain. You are allowed to matriculate into this culture of information, but its endless complexity means you are not permitted to graduate. The education never ends.

Ron Shinkman is the founder and publisher of Payers & Providers, a weekly healthcare business publication that currently covers news in California but will expand nationally in the first quarter of 2011. He also serves as healthcare finance editor for the digital publisher FierceMarkets.com. Ron previously served as Los Angeles bureau chief for Modern Healthcare, a leading healthcare trade publication, and has written for or edited many other publications. He lives in Los Angeles.