Just One Breath: Five Tips for Writing about Health Costs
Costs are so rarely a central part of any health story that I was thrilled when the reporters who are part of our Reporting on Health Collaborative started finding great information about the financial impact of valley fever.
We devoted a three-part package with photos and graphics to the costs of the disease this past weekend. We’re also planning more stories that will explore the cost of researching treatments and cures.
The pieces this weekend were not only well-reported and well-told, they also were instructive. As one editor told me, "the reporting that went into this was incredible."
Here are five tips from the Just One Breath exploration of costs.
1. Find out how that PowerPoint was made. In June, Rebecca Plevin and Yesenia Amaro attended a meeting of county health officials where one presenter really blew their minds. She provided a detailed account of how much valley fever costs in California. The tally was nearly $2 billion over 10 years – just for hospital stays. This was for a disease that most people had never heard of. And, even more interesting, all those people who never heard of it were paying for it anyway because most of that bill was covered through taxpayer-funded programs like Medicare and Medicaid.
When Plevin asked the researcher for the numbers, though, she said she had to get approval through the California Department of Public Health. Plevin kept asking and the state eventually provided the numbers, asking only that we acknowledge that the data were preliminary, which we were more than happy to do.
2. Use peer pressure. Plevin had a bigger fight on her hands when it came to workers’ compensation records. That battle played out right up to publication time. She was told by the City of Bakersfield that the amount the city pays for claims related to valley fever was not a public record. This seemed odd to me, of course. We weren’t asking for specific checks written to specific employees, just total amounts over time.
So I asked all the other members of the team to see if they were met with a similar response elsewhere. Amaro, Kellie Schmitt, Joe Goldeen and Tracy Wood all started asking the same question of cities and counties in their areas. In nearly every case, they were able to obtain the numbers in a matter of days. This only provided more ammo for Plevin, who kept at the city until it finally responded to a public records request and provided one of the best details in the story: one workers compensation claim alone was more than $7 million.
3. Look through your readers’ eyes. Plevin and Amaro started looking into how valley fever hits prison inmates harder than the rest of the population. But they knew it was a tough sell for readers. Most people just don’t care what happens to someone who has been convicted of a crime when they are put behind bars. The assumption is that they deserve whatever horrors befall them. But they do care about how what happens in the prisons affects their pocketbook. It’s significant. Check out the great graphic Kent Keuhl at the Californian made to show the impact.
4. Double-check recollections. We have been writing about the faces and voices of valley fever throughout the series, and, in many cases, reporters have been able to get access to people’s medical records to help document their stories. This can make a small difference in a detail, and it can also make a big enough difference to shape the entire piece.
Plevin looked at hospital records, medical bills, prescriptions, text messages, and handwritten notes to document the story of Berenice Parra. She found that, for the most part, Parra’s recollection of events was quite accurate, but she also found areas where how Parra remembered things wasn’t exactly how it happened. And that’s why the documentation can be so valuable.
5. Go back and ask for more. Schmitt tracked down Archie Scott for the series. Scott, a retired police captain, was like a lot of patients who have been through something grueling. He was reluctant to talk about it. Schmitt got as much as she could in an initial interview, and a lot of reporters have an instinct at that point to just stop calling. They don’t want to spook the source and make them want to try to take back everything they said. (I have had this happen numerous times.)
But Schmitt was persistent and polite. She went back to Scott multiple times with targeted questions to help tell the best story. Just days before we went to press, one of those conversations led to one of the best quotes in the series. Scott told her, "Having valley fever is like having an airborne cancer."
And one last bonus tip, in Plevin’s own words:
The one other thing I did, which was new to me, but maybe not to other health reporters, was deal with the (California) Office of Statewide Health Planning and Development. The information about statewide/regional average charge per hospitalization/average length of stay wasn't available anywhere else. But once we obtained it, it became a central piece of our story. I went back and forth with the guys from OSHPD for days, as we determined what ICD-9-CM codes to use to crunch those numbers. I think they got sick of me midway, but at the end, we all agreed that we learned from each other!