PriceCheck FAQ (Frequently Asked Questions)

 

What is this project?

KQED and KPCC/SCPR are teaming up with Clearhealthcosts.com, a health cost transparency company, to collect prices of common health care procedures from you, the members of our communities. This project is funded by the John S. and James L. Knight Foundation’s Prototype Fund.

 

How does it work?

We are building tools to make it easier to share prices and find prices for common procedures.

 

Why are you doing this?

The rising cost of health care is one of the biggest problems we face as a nation. One major issue: it’s often impossible for consumers to easily find out the cost of health care tests, treatments and services. That has to change.

 

What about quality?

Most people don’t want the cheapest appendectomy or the cheapest MRI, so much as high quality at a fair price. But just as there is little transparency in health costs, there are also few good measures in quality. We’re taking this step toward price transparency in the belief that price transparency will lead to a good discussion about quality metrics.

 

What about my privacy?

The health care information you provide to us in this form will be used only anonymously, and will never be paired publicly with your email address. Clearhealthcosts.com and our Price Check partners will preserve your privacy as part of our bond with you, our communities.

The pricing, procedure and location information you provide to us will be shared publicly in the “Find Prices” table on this site and on our Price Check partners’ sites to help you and others compare costs. Your comments may also be posted wherever the table is posted. Except for your email address, the information we collect, including your comments, may also serve as the basis for articles and reports about health costs.

 

We have also provided an opportunity for you to email our reporters (info@clearhealthcosts.com) and a phone number if you wish to provide information.

 

Our Price Check project partners may use your email address to contact you directly to request more information about the data you have submitted; they will not share your email address with any other third parties.

 

Has anyone ever done anything like this before?

Clearhealthcosts did a similar, smaller project in 2013 with WNYC public radio in New York City. The partners asked people for the prices of mammograms, and almost 400 people responded over the course of just two weeks. Here’s a project launch page and here’s one of the blog posts on Clearhealthcosts about the experience, with links to other posts. The information was wildly interesting – take a look.

 

So this is crowdsourced information – why would you believe any of it?

We trust our communities and believe in you. We believe your information will add to the reported information we already have, and we will be comparing the two sets of data about costs of items and procedures.

Why are you asking about the charges and payments for mammograms? Aren’t they all covered under the Affordable Care Act as preventive care?

When ClearHealthCosts.com did a pilot version of this project with WNYC public radio in New York in May-June 2013, we learned that 25-30 percent of the respondents were paying for their mammograms. (You can read about the pilot at this link.) The primary reasons: because they chose an out-of-network provider, or they weren’t insured, or their insurer said they hadn’t met their deductible, or it simply wasn’t covered. ClearHealthCosts did a blog post about “where’s my free mammogram?” that you can read at this link.

Why do you care about charges and payments? Isn’t the price charged what’s usually paid?

Well, no. In the health care marketplace, a procedure or item can have many charges. The charged price (often called the Chargemaster price) is seldom the price that is actually paid; some people believe the Chargemaster price is almost completely irrelevant, as, for example, Paul Levy, a former hospital chief, explains in this blog post.

 

What is actually paid is either set by law and administrative rules, in the case of government payers like Medicare and Medicaid, or governed by contracts, in the case of non-government insurance plans. Those insurance plans negotiate prices with providers; the paid prices, called the negotiated price or contracted price, are usually secret as a result of gag clauses in contracts. It’s these negotiated rates we’re asking for.

 

The range of paid prices for common procedures can be fairly wide, as we know from our reporting with WNYC and elsewhere, such as for example this blog post about insurance companies starting to reveal some disparities. We think if more people knew about the wide range of prices paid, they’d have a different view of the health care marketplace. Some of that information is slowly becoming public, through this effort and other similar ones.

 

Of course, if you’re paying yourself, then you can use the “self-paid” option.

 

Who built this amazing software?

Our partners at Revsquare, a design-build interactive agency in New York City, have been extraordinary.

Let’s pause for a moment for standing ovation for Alex Filatov, Guillaume Pousseo, Elisa Riteau, Chris Lojniewski and Jeff Mignon. They have offices in Montreal, Warsaw, Paris and Singapore, so you’re covered worldwide.

Our partners at KQED in San Francisco and KPCC/SCPR in Los Angeles have been invaluable. Hats off to Lisa Pickoff-White and Joel Withrow on the dev team, and others too numerous to mention.

I am a Kaiser Permanente member. This was completely covered, so I don’t have a bill or an explanation of benefits.

 

We’re interested in knowing what Kaiser Permanente providers charge and get paid, too. If you don’t have a bill, do you have an online statement of services and charges?

 

I’m on Medicare. I didn’t pay anything.

We’re interested in knowing what your provider charged and what Medicare paid.

 

I don’t see my kind of mammogram or the code for my kind of mammogram in your system.

Please pick the best choice from the options offered. We’re trying to standardize the data!

Also, the comment box is a good place for you to explain things that might help make your entry clearer.

 

I had a breast ultrasound. I can’t find it in your system.

That is usually 76645, which in our system comes up as “Us exam breast(s).” The Us stands for UltraSound.

 

Honestly, if they could make this system any more complicated and non-user-friendly, it’s hard to imagine how.

 

Now that you mention it, these numbers are crazy. What is this system again?

We are using the HCPCS code, for Healthcare Common Procedure Coding System. It’s the system used by the Centers for Medicare and Medicaid Services (CMS) to establish the rates it will pay for Medicare services, the closest thing to a fixed price in this marketplace. The HCPCS codes are based on Common Procedural Terminology or CPT codes, a system devised by, and licensed by, the American Medical Association. There’s more information here in a blog post from ClearHealthCosts.com.

 

 

I want to contribute, but I can’t understand my bill.

You’re not alone. Bills and explanations of benefits are really confusing. Do the best you can, and add notes in the “comment” field.

 

I want to contribute other prices.

Please do! The tool accepts prices for many health tests, treatments and procedures.

 

Some of the procedures say “crowdsourced” and some don’t have a label. What’s up with that?

ClearHealthCosts.com collects cash or self-pay prices for a range of 30-35 common procedures in seven U.S. metro areas, as reported by the providers according to the ClearHealthCosts survey methodology. We are putting those ClearHealthCosts reported prices into this database for purposes of comparison with what you report and also to inform you about procedures other than the ones we’re surveying on. We chose these common procedures because they are relatively comparable — and because they’re “shoppable.”

So about these cash or self-pay prices: I work at a place where the prices listed are wrong/I go to a place where the prices listed are wrong/I go to or work at a place where prices are not listed.

ClearHealthCosts.com collects these prices by surveying providers. Their surveys are representative of a metro area, not exhaustive or comprehensive, on their common procedures. That means they’ve not talked to every provider, but to a representative sample.

If you see a price you think or know is wrong, please input it into our “share your prices” tool and/or  let us know at info(at) clearhealthcosts.com.

If you want to list prices and you’re a provider, let us know. We have an easy way for people to report their prices to this project, for uploading into our database; please check out this link. And congratulations on being a transparency supporter!

 

So what is the total universe of prices in your database?

In this database, we have reported prices from the ClearHealthCosts.com team for the San Francisco and Los Angeles areas for seven radiology or imaging procedures, and several women’s health procedures, from a well-woman exam and an IUD insertion to abortion. We are updating our list of shoppable procedures (on the main ClearHealthCosts website, we track 30-35 procedures).

What else is here: your contributions, and also — to be helpful — we have linked this database to the HCPCS data set, for two reasons: 1) to show how the system is governed and coded by this HCPCS set of identifiers, and 2) to try to standardize data or make it comparable.

There are no reported prices in Eureka or Sacramento — or my neighborhood.

This data set is changing all the time. By its very nature it is partial, but it has the potential to be better than anything else out there. It will always be representative data — not comprehensive or exhaustive. But you can help: Contribute your prices, and help us build a better data set!Come back and visit next week to see how we’ve grown!

 

I searched but I can’t find a price for an esophageal endoscopy/bone density test/hysterectomy. What kind of search tool is this, anyhow!?

We don’t have prices for every procedure at every provider – because that, of course, is the problem. Those price lists don’t exist, though we think they should.

The task we’ve set for ourselves is to join hands with you, our communities, to create price lists for a few common procedures. One other thing: the closest thing to a fixed or benchmark price in the marketplace is what Medicare pays. We decided not to build that into this search engine, though we might in the next version. (It’s complicated.) Meanwhile, if you want to know the Medicare price for any procedure nationwide, you can search for it nationwide in the search engine at clearhealthcosts.com.

 

Will you be doing other procedures?

Yes. We’re planning to do mammograms for a month, then move on to other things. Next on our list, tentatively, is MRI prices.

 

I don’t live in California. Can I play too?

We would love to have you contribute. The tool accepts prices from other places, however you cannot find them in the current iteration of the search. To search for national prices, please visit ClearHealthCosts.com

 

If you have anything to say of a non-California nature, please feel free to email info (at) clearhealthcosts.com.

 

 

You are so focused on cost – I want to find a good doctor at a fair price. How can I find out more about quality?

 

There are many resources for measuring quality in health care, and many of them come to very different conclusions. Here are some of them:.

 

  • Hospitalinspections.org, a website run by the Association of Health Care Journalists, collects federal hospital inspection reports.
  • The federal government lists a number of quality tools on this section of healthcare.gov.
  • A state-by-state and category-by-category list has been compiled by consumerhealthratings.com. Another resource: The Informed Patient Institute.
  • Several organizations rank hospitals. They include:

o   The Leapfrog Group

o   Consumer Reports

o   U.S. News and World Report

Why are you doing this again?

 

The health care marketplace is opaque, full of secrets and anomalies in pricing, service, quality metrics and just about everything else. We’re here to help change that.

 

 

About us

  • The Knight Foundation supports transformational ideas that promote quality journalism, advance media innovation, engage communities and foster the arts. The foundation believes that democracy thrives when people and communities are informed and engaged. For more, visit KnightFoundation.org.
  • KQED serves the people of Northern California with a community-supported alternative to commercial media, via its public radio, public television, interactive and educational services divisions. KQED provides citizens with the knowledge they need to make informed decisions; convenes community dialogue; brings the arts to everyone; and engages audiences to share their stories. For more, visit KQED.org.
  • Southern California Public Radio (SCPR) is a member-supported public media network that operates 89.3 KPCC-FM in Los Angeles and Orange County, 89.1 KUOR-FM in the Inland Empire and 90.3 KVLA in the Coachella Valley. SCPR’s mission is to strengthen the civic and cultural bonds that unite Southern California’s diverse communities by providing the highest quality news and information service through radio and other interactive media. For more, visit SCPR.org.
  • RevSquare, an interactive agency based in New York, serves leading Fortune 500 media and retail companies, small and medium companies around the world, as well as start-ups trying to establish a name for themselves. For more: Revsquare.com.
  • Clearhealthcosts.com is a New York City company bringing transparency to the health care marketplace by telling people what stuff costs. Using a combination of shoe-leather journalism, database sourcing and curation, crowdsourcing and partnering, Clearhealthcosts is revealing the secrets of an opaque marketplace, and seeking to help solve one of the biggest problems we face as a nation. For more, visit clearhealthcosts.com.