This year, some Americans can do something they couldn’t before: check the cost of care before going to the hospital.
A new federal rule requires hospitals to post the prices they negotiate with private insurers.
Data is a rich source of new information. We used it to show that some insurers pay two or three times as much as their competitors for basic services – and that paying cash rather than using your coverage can often lead to a lower price.
But most hospitals have yet to release the required data. Even when they have, finding it can take time and effort. Also, you might need a computer programmer to open it.
“Have a coffee and hydrate, because it’s going to take a while,” said Touré McCluskey, co-founder of health start-up Redu Health, which collected some of the data files. “There is information, but it is not consumer friendly. “
To help those who want to give it a try, we interviewed several researchers who spent months collecting the data. They recommended several simple strategies.
What you need to know to get started
Before you start looking for prices, you’ll want to know what type of health insurance you have – both the name of your insurer and also details like whether you chose an HMO plan during open enrollment or if you have. opted for a PPO option.
Insurers often have half a dozen rates within a single hospital. Some are specific to the plan you have chosen and whether you purchased the insurance through the Obamacare Marketplace or a specific employer. Others have to do with the network you signed up for when you signed up for coverage.
Knowing what type of insurance you have will help you better understand the prices shown in the data that apply to you.
Then do a web search
For most hospitals, the data is published on a page called “price transparency”. Many researchers say they start searching for price files by Google searching for that phrase and the name of the hospital.
“This research should lead you to a top notch result that has something to do with billing price estimates or patient information,” said Morgan Henderson, health economist at the University of Maryland-Baltimore. County who worked with The Upshot to collect the price files. used in our recent articles. “Sometimes what you want is at the very bottom of this page, or you have to follow a few links.”
The page should look like this from MedStar Hospital Center, the largest hospital in Washington, DC.
The hospital’s price transparency site will likely have multiple sections and links, and the labeling of the price files is not always clear. You’ll want to look for something like a “complete machine-readable file” or a “negotiated price list”.
It is also worth opening files described as containing “standard charges” or “chargemaster”. Here’s how these look at Indiana University Health:
When you open the files, you see that they also contain the hospital negotiated rates and the cash prices.
This is what you are looking for
The government hasn’t created a standard format for hospitals to report their price data, and each hospital seems to take a slightly different approach.
Some publish their data in Excel or CSV files, which you can open using free software like Google Sheets. But some use JSON files, a data format typically used by computer programmers and professional data scientists that ordinary people may have trouble opening.
“I have a background in health economics and politics, and I work on a machine with a lot of memory space,” said Morgane Mouslim, also a health economist at the University of Maryland-Baltimore County, who has helped The Upshot collect and standardize data files. “If a file is not in Excel, you may need additional software. “
A typical data set lists prices by procedure for each insurer, like this one from the University of Pennsylvania Hospital:
The five-digit digits on the far left of this worksheet are CPT codes, which hospitals use to describe each service they offer. Most files also have brief descriptions for each code, but these can be confusing. The code U0003, for example, is translated as “PR COV 19 AMP PRB HIGH THRUPUT” – a jargonian way of describing a coronavirus test.
To research the cost of a specific service that you plan to get at a hospital, you will likely need to call the facility and ask what CPT codes it will charge for your visit.
You may also see other numeric codes, sometimes labeled procedure codes or income codes, as in the file below from Baptist Medical Center in Little Rock, Ark. You probably don’t need to pay much attention to it and should focus on CPT codes. . (If the CPT codes aren’t labeled, you can usually recognize them as the five-digit ones.)
Usually you should see dollar numbers representing the actual prices. But you might come across files where the price is listed as “variable,” meaning it might be different for two patients with the same insurance who received the same care under different circumstances.
Molly Smith, vice president of public policy at the American Hospital Association, gave the example of a patient who comes to the hospital for a flu shot versus another who receives one during a procedure. surgical.
“In the contract, we usually negotiate the price of the primary service, but if it’s a secondary service, maybe 15% is taken,” she said. “It is not possible to reflect this in these files.”
The files should also include two other prices: the “price” or the “gross price,” which is the sticker price for a given service that hospitals often use as a benchmark for negotiating discounts. There should also be the “spot” price, which is what the hospital charges patients who don’t use insurance. The availability of this price for insured patients varies from hospital to hospital. Some low-income patients may receive even larger discounts based on how little they earn.
Once you find the data point you are looking for, there may be some additional work to figure it out. Most hospitals show prices in dollars, but some show data as a percentage of gross price – which means that patients will have to do calculations to understand their costs.
What if I can’t find anything?
Most hospitals have not published the required data, which can happen often.
For example, on the NYU Langone Price Transparency website, you can only find standard fees and a patient estimation tool, which uses information about your insurance plan to generate a personalized estimate of how much. you will pay for a certain procedure.
These tools provide limited information. The Standard Fee can tell you the maximum amount you could pay for a given service, and the Patient Estimator shows the out-of-pocket costs associated with simple services like mammograms and blood tests. However, when a Times reporter tried to use the NYU site in late July, it generated error messages for all services crawled.
A representative for NYU Langone declined to comment on why the hospital had not released its full data.
With compliance rates still low, the federal government promises to increase enforcement. It has sent nearly 170 warning letters to non-compliant hospitals and plans to increase penalties for non-compliance from $ 109,500 per year to $ 2 million.
If you believe a hospital has not posted the required information, you can file a complaint with the federal government notifying them of the problem.
Soon, third-party sites could help you
Some healthcare experts say large data files will become more useful after third-party data companies clean up and organize the information, so patients can search across multiple hospitals and healthcare facilities.
A data transparency company, Turquoise Health, has already created a free price finder. Others are expected soon.
Do you see anything surprising? Tell us about it.
The Times has so far looked at data sets from 60 hospitals. But there are many more.
If you notice anything surprising about a hospital price file – unusually high prices, for example, or large variations in the cost of a service – we’d love to hear about it. You can email us with what you found.