Featured

Three Ugandan soldiers have been charged over the killing last month of civilians at a wedding in Somalia, the African Union says.

by Charles Ornstein

When choosing a doctor who's right for you, you don't have to rely exclusively on a friend's recommendation or a referral. You can check whether your medical provider practices similarly to his or her peers.

ProPublica's  Treatment Tracker tool allows consumers to compare their doctors, physical therapists and other health providers to others based on data on the services they provide in Medicare's Part B program.

The tool may give you, the patient, information to ask important questions about your care. Here's what to look for and ask:

• Does your doctor perform more services and order more tests per patient than others in his or her specialty and state? Along the same lines, is your doctor's cost per patient higher than peers? If your doctor is in the top 10 percent, you'll see a note in red. It may be worth asking questions to ensure you are not being over-treated. More health care does not always equate to better health care.
• Are the most common services and treatments chosen by your doctor similar to others in the same specialty and state? Some doctors may be relying on unconventional or even questionable therapies that their peers do not. You may want to look for large gaps between where a service ranks for your doctor and where it ranks among similar providers. You'll see an orange symbol in our app if one of a doctor's services has been performed by five or fewer providers in his or her specialty and state.
• Are there drawbacks to the tests your doctor orders? Radiation exposure carries risks, and screening tests may turn up false positives or abnormalities that may not actually be health problems, such as a precancerous node that won't develop into cancer. In addition, tests may add unnecessarily to your costs, via your co-pay, and to those of the government. It's worth asking whether medical tests are necessary, especially if you have recently had similar tests.
• If you need a procedure, say a knee replacement or cardiac stent, does your doctor have much experience performing it? While this data only includes Medicare patients, it's one indicator of how practiced a physician might be at performing a procedure. Studies show that doctors with more experience generally have better outcomes.

Your doctors may not know that they are practicing differently than their peers. If nothing else, your questions may prompt them to look at the data or discuss their approach to medicine. Additional research on reputable health websites such as mayoclinic.org may also help.

Other tools may allow you to learn even more about your provider.

• Does your physician accept payments from pharmaceutical companies or medical device makers for promotional work? Checking our  Dollars for Docs app may provide the answer. If your doctor has a relationship with a company whose product he or she is prescribing or using, you may want to ask about whether that affects decisions.
• How do your doctor's drug prescribing patterns compare to peers? With our Prescriber Checkup tool, you can see if your doctor prescribes more narcotics, antipsychotics or risky drugs in Medicare's Part D program than colleagues, or whether he or she favors brand name drugs over generic medications.
• If your doctor is a surgeon, how does his or her complication rate compare to peers? You can use our Surgeon Scorecard to compare differences on eight common elective procedures, including knee and hip replacements.
• Does your health provider have discipline against his or her professional license? Each state has licensing boards that oversee health professionals and sanction providers for misconduct.  Links to medical boards are available on our provider pages. If your provider has faced discipline, it's worth seeking out the details (sometimes they are online, sometimes you have to call or write the board) and determining if the provider is the right match for you.

by Lena Groeger , Ryann Grochowski Jones and Charles Ornstein

Updated: August 2015

The Centers for Medicare and Medicaid Services released data in June 2015 on the treatments performed by, and the payments made to, health care professionals who cared for beneficiaries in Medicare's Part B program in the year 2013. (The agency first released this data, covering the year 2012, in 2014.) The data covers more than 950,000 health care providers who collectively received $90 billion in Medicare payments.

Part B covers the services delivered to seniors and the disabled by doctors, optometrists, physical therapists and other practitioners. The program also covers ambulance mileage, lab tests, outpatient services and drugs administered by doctors.

We created an interactive news application called Treatment Tracker that places this newly released data in context, showing how providers compare to their peers — that is, providers in the same state and specialty — in terms of the services they perform.

Treatment Tracker includes pages for every health professional, state, medical specialty and service billed to Medicare.

It relies primarily on two files provided by CMS:

• A summary table of the total number of patients treated by each provider in Medicare's Part B program in 2013 and the total amount paid, among other things.
• A detailed list of the services performed by each provider in Part B in 2013, including the number of patients treated, the number of times the service was performed, and the number of unique patient visits during which each service was performed (some services, such as drug infusions and skin tag removals, may be billed multiple times during a single visit). The table also differentiates between medical services and drugs. Medicare has published a detailed  methodology online for how it has gathered this data. The data is also available for  download online.

Two important caveats: Medicare only released data on services and referral patterns if they applied to at least 11 patients. If a service was performed on 10 or fewer patients, CMS redacted it and excluded it from aggregate totals.

Also, the data does not include Medicare Advantage plans, which are the health plans Medicare beneficiaries can choose in place of the traditional program. Nor does it include services delivered to patients with other coverage, such as private health insurance or Medicaid.

At the top of each provider's page, ProPublica displays summary information, including the total number of patients that provider treated in Part B in 2013, total services/procedures performed, and the total paid by Medicare. In addition, we show the average number of services delivered per patient by the provider and the average Medicare reimbursement per patient, as well as comparisons to peers in his or her specialty and state. If a provider performs more services or spends more per patient than 90 percent of peers, a note will appear in red.

We note situations in which a significant share of a doctor's Medicare payments comes from drugs they administer (because much of the reimbursement is intended to cover the cost of the drugs themselves).

If a provider had more than 100 office visits for established patients (those he or she has seen at least once before), we also have a graphic breakdown comparing those visits to peers. Such visits are coded on a scale of 1 to 5 (actually 99211 to 99215, with 99215 being the most complicated, using procedure codes created by the American Medical Association).

Nationally, a very small percentage of visits are labeled 99215, but Medicare and its inspector general  have raised concerns about upcoding, or billing for higher-level services than are actually delivered, by some providers. Also see  our story and accompanying  methodology on this topic.

Just because a provider has a higher proportion of complex visits than peers is not necessarily an indication of a problem, but it may be worth asking about.

Lower on the page, we show how each service ranks among that provider's services and compare that to its rank among others in his or her specialty and state. We include:

• The code number for the service and a description, as well as whether it was performed in an office or a facility such as a hospital. In most cases, the office-based services are reimbursed differently than those delivered in a facility, and are broken out separately by Medicare.
• Whether the code is for a medical service or a drug. As mentioned above, much of the Medicare reimbursements for drugs is intended to cover the cost of the drugs themselves.
• The services listed come from two places. Services that begin with a letter come from CMS. All other codes and descriptions of the medical procedures are from the Current Procedural Terminology code set, which was created and copyrighted by the American Medical Association and is used here with the AMA's permission. Where practical, we used the AMA's consumer-friendly translation of the CPT descriptor.
• The number of times each service was performed, or units delivered, and the percentage of all of the services provided that represents. Some services, such as drug infusions (e.g., per milligram, per unit, etc.), ambulance trips (per mile) and skin tag removals are meant to be billed multiple times during a single visit.
• This service's frequency rank for this provider and also how it ranks among all those in the same specialty and state. If a service has been performed by fewer than five providers in the specialty and state, you will see an orange symbol. Though this in isolation does not necessarily indicate there's a problem, if your doctor performs a service that so few of his or her peers perform it may be worth asking for additional information about why that's the case.

• The number of the provider's patients who received the service at least once during 2013, and what percentage of all of the provider's Part B patients that number represents.
• The average number of visits that patients made to receive this service. This is calculated by using a field in the data that totals distinct visits on separate days for this service. Since a beneficiary may receive multiple services of the same type (e.g., single vs. multiple cardiac stents) on a single day, "this metric removes double-counting from the line service count to identify whether a unique service occurred," Medicare says.
• We took this figure (which is not shown) and divided it by the number of patients who received the service to arrive at the average number of unique visits per patient. For comparison, we show the average unique visits for this service for all providers in the specialty and state who delivered the service on at least 11 patients.
• The total amount billed to Medicare and the average amount paid by Medicare. These take the average payment per procedure billed and paid, provided by Medicare, and multiply it by the service count. Services performed at a facility appear to cost Medicare less than office-based services because a separate facility fee is not disclosed in this file.

More broadly, we do not include any comparative information when there are fewer than 11 of that kind of specialist in the state. We also do not compare providers if they have moved to a different state between 2013 (the period covered by the data) and 2015. We also do not compare providers to their peers if they have not designated a primary specialty in the National Provider Identifier system.

We used demographic information, including addresses, phone numbers and primary specialties, from the NPI system, as of July 2015.

Below are the limitations on the data CMS has listed on its website:

1. It only describes care delivered to Medicare beneficiaries in the fee-for-service program and, as a result, may not represent a provider's entire practice. Providers may also see patients enrolled in Medicare Advantage, those with Medicaid coverage or private health insurance, or those who are uninsured.
2. It does not provide any information on the quality of care delivered by providers.
3. It does not account for differences in the sickness of patients treated by different providers.
4. Medicare pays differently when services are provided in a physician's office versus a facility (e.g., a hospital outpatient department). For services furnished in an office setting, the full payment is included. However, if a service or procedure was furnished in a facility setting, in most cases, this data only includes the payment to the provider and not the payment to the facility.
5. In general, when a provider administers drugs to a patient, the provider purchases the drug and Medicare pays the provider 106 percent of the average sales price (ASP) for the drug.
6. The way CMS counts services may differ by billing code. For example, if the number of services is 2 this may reflect two separate procedures, two 15 minute increments of a service (e.g., a 30 minute office visit), or the delivery of two units of a drug.

Do you see an error in this data?

If you are a provider and you believe your address is wrong, you can change it on the website of the  National Plan & Provider Enumeration System. If you believe the procedure data is incorrect or have other questions, you can email CMS at MedicareProviderData@cms.hhs.gov. You can also contact us at checkup@propublica.org.

A book which teaches children how to recognise and reject sexual abuse is launched in Uganda's capital, Kampala.

by Marcelo Rochabrun, ProPublica,

David Simon’s new HBO miniseries “Show Me a Hero,” which premiered last Sunday, is the harrowing tale of a hopeless battle. Based on a nonfiction book of the same title – written by former New York Times reporter Lisa Belkin – the show dramatizes the real fight that took place 25 years ago in Yonkers, New York, after a federal judge ordered public housing projects to be built in the wealthier (and whiter) parts of the city.

School Segregation, the Continuing Tragedy of Ferguson

Michael Brown beat the odds by graduating from high school before his death — odds that remain stacked against black students in St. Louis and the rest of the country. Read the story.

In an interview with ProPublica, David Simon discussed the legacy of the Yonkers crisis and what desegregation is all about. The transcript has been edited for clarity and length.

You said that you thought about this show many years ago. How has the project changed over time?

Very little, sadly. We optioned this book shortly after it came out [in 1999], and we were fairly certain that the dynamic of hyper-segregation was a national dynamic, that we were not just writing a story about Yonkers.

What do you mean by hyper-segregation?

White people, by and large, are not very good at sharing physical space or power or many other kinds of social dynamics with significant numbers of people of color. It’s been documented time and time again. There is a great book by Andrew Hacker called “Two Nations.” My God, it’s almost a quarter century old, but it is an incredible primer on just how specific the desire of white America is to remain in a hyper-majority.

The reason we wanted [Lisa Belkin’s] book was that Yonkers was a place where the housing department actually got the housing right. They didn’t overwhelm the neighborhood with a massive project or hundreds of walk-up units. They were trying to do scattered-site housing for the first time, which has been this quiet revolution in public housing. It works, it doesn’t destabilize neighborhoods. But you were dealing with people who were entrenched behind the same fears as previous generations….

This project kept getting bumped a little bit to the back burner but every time we bumped it, in talking about it with the HBO executives, we’d say, “You know what, look, it just happened to Baltimore.” They tried to do the same thing with scattered housing in eastern Baltimore County, and the white folks went batshit, batshit crazy. At every point, there was a new fresh example that the dynamic was still there, that the racial pathology was still intact. And I think it has only become more pronounced. The show was greenlit before Ferguson, before Baltimore, before Charleston.

If you had written the screenplay after these events, would you have changed anything?

No, no. First of all, “Show Me a Hero” is not about police violence. It’s certainly not about a white racist backlash against changing demographics, which is how I would characterize the Charleston or Lafayette shootings. Part of the implied power of the piece is we are taking you back 25 years and nothing has changed!

Lisa Belkin wrote an op-ed in The New York Times a few days ago saying she viewed Yonkers, at the time when she was doing her reporting, as a place of hope. She expected desegregation to happen around the United States as a result. That didn’t happen. The NAACP didn’t pursue the same cases anywhere else.

Nor did the Justice Department because of horrible resources.

Why do you think that happened?

Because of how blistering Yonkers was, how insanely volatile and irrational Yonkers was. You have to remember that this case was brought at the end of the Carter administration. There wasn’t a single civil rights action filed by the Justice Department from 1980 to 1988 that mattered. Reagan effectively shut down the civil rights division of the DOJ. Then you had Clinton, who was doing everything he could during the Gingrich years to maneuver to the center. The reason you didn’t have aggressive use of this legal precedent under Clinton is the same reason you have those omnibus crime bills that filled up prisons as fast as we can construct them. Bill Clinton’s triangulation with the political center made things like fair housing prohibitive for his political priorities.

We haven’t seen any movement on this in any presidential administration until the last two years of Obama. They sort of opened the books on all their data to basically encourage the use of the Fair Housing Act to do precisely what they did in Yonkers. But notice that this is coming in the last two years of the administration, and it’s coming as an administrative act.

In the show, no one really wants the housing either. The NAACP is already tired of the whole ordeal before any units were built.

You have to remember, they filed the case in [‘80]. It was litigated. They are now in 1987, and they can’t get the goddamn city to name a geographic site to build house No. 1...

But the truth is, the 200 units were built. They are still there, and there has been no increase in crime in those neighborhoods as a result of it. There has been no substantive decrease in the housing values in Yonkers. There was a brief dip as there was some fundamental white flight, mostly surrounding the school desegregation portion of the civil rights suit, which is a whole other can of worms.

The population in Yonkers is now probably about 56 percent white, 44 percent people of color, heavily Latino. A lot of people, with a certain amount of unknowing racial malevolence, say “oh, look, it was 80–20 white, now it’s almost 50 percent people of color. See what happens? Look at all that white flight.” But in 25 years, the population of the New York metropolitan area has been transformed.

What desegregation is about is not about keeping Yonkers 80–20 or 75–25. This is about the browning of America. We are becoming a less white country. The trick is, can we become more brown without destabilizing ourselves and without having gated white communities and ghettos?

Did you hear from current residents as you were filming?

We talked to all the people in the book, some of whom are still living in those townhouses. I mean, did I go take a poll of random people in Yonkers? No. But every time we set up and started filming, people would come over, and we talked to people who were unrelenting in their belief that what was done was illegal and that the judge had no right to do this and that it was an affront to their freedom and their liberty. They would come and tell us that, and we’d say “well, okay…”

Did anyone object to you filming at, for example, the actual city hall of Yonkers? Or that this could reopen wounds?

No, the mayor appeared with us in Yonkers. I’m sure there are people who didn’t want to see the story made at all. But, you know, I’m not used to making shows that everyone agrees with, so I wouldn’t know what that would feel like anyway.

With two episodes down, is there anything that viewers should remember, have in mind, when they watch the next two on Sunday?

I certainly don’t want to tell people what to watch until they watch it. Just that we were very true to the history. This is all predicated upon a 40-year history of American government at the federal, state and local level using public money to purposefully hyper-segregate our society. Poor people didn’t end up all packed into housing projects in one square mile of Yonkers by accident. It was a plan. It was a plan in Chicago, in Baltimore, in Dallas and everywhere that took federal housing money since the 1930s.

The records, the history of it is in plain sight. I have nothing but contempt for anybody who says that [the racial integration of Yonkers] was social engineering by this judge. Really? You want to parse it that way? What bullshit. The social engineering begins in the 1930s, with FHA mortgages and with the first public housing monies in the New Deal. Republicans and Democrats are both complicit.

The idea that the social engineering starts at the moment that somebody might want to restore somebody to their full civil rights, 40 years into the rigged game. And that’s when you object? Sorry, that’s racist to begin your argument there.

After being almost destroyed in Mozambique's civil war, the country's Gorongosa National Park is once again becoming a draw for tourists thanks to a dedicated investment programme.

In South Africa, big game hunting is big business. The whole sector is worth more than $2bn (£1.3bn) a year to the country's economy, and animals can change hands at auctions for millions.

Congolese militia leader Thomas Lubanga wants to be released from prison early to study the causes of ethnic conflict, he tells the International Criminal Court (ICC).

One of Nelson Mandela's grandsons, who cannot be named for legal reasons, is charged with raping a 15-year-old girl in South Africa.

East Africa's most popular international music festival, Sauti za Busara in Zanzibar, is cancelled next year because of a lack of funding.