ProPublica’s investigation “The Prescribers: Inside the Government’s Drug Data” has provoked a swift response from the federal government. Winner of the 2013 Philip Meyer Award, it exposed the Medicare system’s failure to provide oversight for thousands of physicians who have written prescriptions that in some cases put patients at risk, in others cost the federal government far more than necessary, and sometimes were simply fraudulent.
Charles Ornstein, who has specialized in healthcare investigations for years now, was joined on the project by ProPublica’s Tracy Weber, Jennifer LaFleur, Jeff Larson, and Lena Groeger. Nieman Reports spoke by phone with Ornstein as he prepared to travel to Baltimore to accept the award:
NIEMAN REPORTS: Ultimately, your reporting sparked investigations by the HHS inspector general’s office and by law enforcement. It sparked Senate hearings, disciplinary actions, and a move to enable Medicare to ban doctors. Did you anticipate this kind of a response? And how do you measure success with this type of reporting?
ORNSTEIN: I think success is measured in a variety of different ways. One is, are there steps being taken to address the holes that we identified in terms of Medicare’s oversight of the program? And I think by any account you can say the answer to that is yes. Medicare had access to this vast trove of data and had not really looked at it to determine whether seniors were receiving inappropriate treatment or whether there were certain doctors who were only prescribing brand-name drugs, or whether there were clear signals of fraud.
The fact that three reporters could look at this data and find things that were so glaring, I think opened the eyes of lots of people both on Capitol Hill and in the administration that they had to be doing more themselves to look at their own data.
Your team created online tools for readers to look up their own doctors. What’s the impact of those?
We had more than a million page views in the first six or seven months that this was out, and it continues to grow at a really nice pace. I think the traditional paradigm is that you trust your doctor and your doctor is going to do right by you, but I think that there’s a subset of patients who want to be more empowered than that, who want to have more information at their disposal, who want to research their doctors in new ways, and for them, this is a really welcome opportunity.
You make it clear in your reporting that the information that you have in this data set requires complex interpretation; there are different factors to be weighed. How did you ensure that you were fair in analyzing the data on specific doctors?
Any doctor that we mentioned in a story, we made an attempt to reach that doctor and talk to him. Some talked to us; some did not. But we also tried to talk to dozens of additional doctors in order to understand the different constellation of factors that go into prescribing. We took great care over many months to “interview” our data, essentially, and understand its value and its limitations.
What advice do you have for investigative journalists who are embarking on healthcare reporting projects?
Healthcare reporting is obviously incredibly important, but it’s also very difficult. One, our healthcare system is extraordinarily complex. But two, so many stories about healthcare have been written. So the challenge that we face is how do we write these stories in either new ways or write about trends and other things that have not been reported on.
I think in this case we knew that there had been a whole lot of reporting about prescriptions, particularly narcotics and overdoses of narcotics. There had been a fair amount written about anti-psychotics. But they tended to focus on a handful of physicians, those doctors who got in trouble because they had been disciplined by their state medical boards or had been criminally prosecuted.
Our view was wouldn’t it be great if the public could actually relate this to their own life experience. I think what we did with this project, and the major contribution that it made, was in addition to the investigative findings, what we said is, you can actually see what your doctor’s doing.
It definitely helps to have time to pursue this and time for requests to mature. It took a number of months of negotiation to actually get this data. It took a number of months to analyze it and to ask questions of the data, and to talk to people and to not feel under the gun that we had to produce something immediately. That was really important, and I think if we had less time, this project would not have been as good.
Finally I think one of the commitments that we at Pro Publica have made, is we have said this is not a one-off. Meaning when we first came out with the project, we had 2010 data; we’ve updated it to 2011 data. We’re committed to updating it in the future with future years’ data. If you get into something like this, you have to really be willing to stay on top of it and to update it so that it’s not just a single point in time event or story.
This interview has been edited and condensed
Jeremy C. Fox is a correspondent for The Boston Globe and a journalism instructor at Harvard Extension School
Charles Ornstein, who has specialized in healthcare investigations for years now, was joined on the project by ProPublica’s Tracy Weber, Jennifer LaFleur, Jeff Larson, and Lena Groeger. Nieman Reports spoke by phone with Ornstein as he prepared to travel to Baltimore to accept the award:
NIEMAN REPORTS: Ultimately, your reporting sparked investigations by the HHS inspector general’s office and by law enforcement. It sparked Senate hearings, disciplinary actions, and a move to enable Medicare to ban doctors. Did you anticipate this kind of a response? And how do you measure success with this type of reporting?
ORNSTEIN: I think success is measured in a variety of different ways. One is, are there steps being taken to address the holes that we identified in terms of Medicare’s oversight of the program? And I think by any account you can say the answer to that is yes. Medicare had access to this vast trove of data and had not really looked at it to determine whether seniors were receiving inappropriate treatment or whether there were certain doctors who were only prescribing brand-name drugs, or whether there were clear signals of fraud.
The fact that three reporters could look at this data and find things that were so glaring, I think opened the eyes of lots of people both on Capitol Hill and in the administration that they had to be doing more themselves to look at their own data.
Your team created online tools for readers to look up their own doctors. What’s the impact of those?
We had more than a million page views in the first six or seven months that this was out, and it continues to grow at a really nice pace. I think the traditional paradigm is that you trust your doctor and your doctor is going to do right by you, but I think that there’s a subset of patients who want to be more empowered than that, who want to have more information at their disposal, who want to research their doctors in new ways, and for them, this is a really welcome opportunity.
You make it clear in your reporting that the information that you have in this data set requires complex interpretation; there are different factors to be weighed. How did you ensure that you were fair in analyzing the data on specific doctors?
Any doctor that we mentioned in a story, we made an attempt to reach that doctor and talk to him. Some talked to us; some did not. But we also tried to talk to dozens of additional doctors in order to understand the different constellation of factors that go into prescribing. We took great care over many months to “interview” our data, essentially, and understand its value and its limitations.
What advice do you have for investigative journalists who are embarking on healthcare reporting projects?
Healthcare reporting is obviously incredibly important, but it’s also very difficult. One, our healthcare system is extraordinarily complex. But two, so many stories about healthcare have been written. So the challenge that we face is how do we write these stories in either new ways or write about trends and other things that have not been reported on.
I think in this case we knew that there had been a whole lot of reporting about prescriptions, particularly narcotics and overdoses of narcotics. There had been a fair amount written about anti-psychotics. But they tended to focus on a handful of physicians, those doctors who got in trouble because they had been disciplined by their state medical boards or had been criminally prosecuted.
Our view was wouldn’t it be great if the public could actually relate this to their own life experience. I think what we did with this project, and the major contribution that it made, was in addition to the investigative findings, what we said is, you can actually see what your doctor’s doing.
It definitely helps to have time to pursue this and time for requests to mature. It took a number of months of negotiation to actually get this data. It took a number of months to analyze it and to ask questions of the data, and to talk to people and to not feel under the gun that we had to produce something immediately. That was really important, and I think if we had less time, this project would not have been as good.
Finally I think one of the commitments that we at Pro Publica have made, is we have said this is not a one-off. Meaning when we first came out with the project, we had 2010 data; we’ve updated it to 2011 data. We’re committed to updating it in the future with future years’ data. If you get into something like this, you have to really be willing to stay on top of it and to update it so that it’s not just a single point in time event or story.
This interview has been edited and condensed
Jeremy C. Fox is a correspondent for The Boston Globe and a journalism instructor at Harvard Extension School
