How NYT’s Rosenthal reported innovative series on U.S. health prices

After the failure of President Clinton’s health reform effort in the 1990s, New York Times reporter Elisabeth Rosenthal was 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” series.

“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 is this 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” where she published a piece called “Price for a New Hip? Many Hospitals Are Stumped,” 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 bill for the routine screening procedure.

“It really changed my view of social media and reader comments,” Rosenthal said, adding that Facebook groups 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.”