Our partnership with MedPage Today for price transparency

(This is an expanded version of our launch post over at MedPage Today.)

Health costs are a blazing hot topic for debate in the U.S., as people feel the effects of rising co-insurance and rising deductibles, and the business of medicine goes through a series of wrenching changes.

At Clearhealthcosts.com, we’re a journalism startup bringing transparency to the health care marketplace by telling people what stuff costs. We have noticed increasingly that patients and their providers are allied in the belief that money should not get in the way of treatment.

MedPage Today has investigated the costs issue from just about every angle — from the million dollar baby and million dollar Vice President to sudden insulin price spikes, lofty cancer drug costs, and the $300,000 a year drug, all the way to why transparency is a physician’s friend.

Recently, news coverage by journalists like Elisabeth Rosenthal in the “Paying Till It Hurts” series in The New York Times and Steve Brill in his “Bitter Pill” coverage for Time magazine, have also explored the topic, and offered some possible steps forward.

And so, we here at Clearhealthcosts.com and our partners at MedPage Today devised this partnership, to develop that natural alliance. Joining hands together, we think, there’s a way to solve this problem. Click here to go to the page displaying the form for entering and searching pricing data.

Why should clinicians care?

You might wonder why providers care about prices. We hear a lot about how doctors think their treatment plans are affected by money: a person who can’t afford medications, for example, might go without, or a person who can’t afford a deductible will skip care.

Some of this is documented in articles and studies like this one and this one, and some has probably walked up to many providers in their offices. People are hungry for health cost information, as this study found, and if we can give it to them, that makes their lives easier.

In reporting on this issue, we journalists from Clearhealthcosts.com have already partnered with public radio stations in San Francisco, Los Angeles, New York City and the Delaware Valley (Philadelphia) to build community-created databases of prices, and to do in-depth reporting on this issue. Click the links for examples. Also, here’s some of the coverage of the California partnership, including links to our Harvard Business Review/New England Journal of Medicine coverage, and our JAMA Internal Medicine coverage, as well as NPR and other coverage.

How can we work together with providers to find a fix?

Now we’re coming to you, providers.

We want you to contribute your cash or self-pay prices, and thus help us build out our  database.

We’ve collected a lot of pricing data already from providers, and put that into the database that powers our interactive tool, which you can see by clicking this link where you can both contribute and search the existing database.

So, as you put your prices in, we’re building on an existing dataset of cash or self-pay prices – the price that would be paid by an uninsured patient or one who’s not on your insurance plan.

Who’s represented in this database? The Hospital Corporation of America, the Surgery Center of Oklahoma and others who post cash prices. It’s been a challenge, though: The data is a mess. (Data geek? Take a look at this post about our data issues.)

This is a startuppy project, and we hope to learn from you, our community. We’ll be expanding our reporting depending on what we learn and what you tell us.

What about quality? We’re better than anybody else.

We understand this is not only about the money. No one wants the cheapest appendectomy, or the cheapest cancer care.

So you’re better? We believe you. But there should be some better way than you telling us you’re great.

Quality measurements for health care providers, hospitals, surgical centers and so on are a hot topic.

Everybody’s got a favorite source (Yelp? healthgrades.com? AHRQ? Leapfrog? Consumer Reports? U.S. News and World Report? Your Facebook friends? HEDIS? HCAHPS? your insurance company’s quality rankings?) but the bottom line seems to be this: There’s a cacophony of competing sources of measurement, none of them definitive or over-arching. So we were interested to see this recent study revealing the outcome of the latest government effort to resolve the problem, as described by Alexandra Robbins in The Atlantic.

The Department of Health and Human Services is wrestling with this, and to hear Robbins tell it, they labored mightily and brought forth a mouse. If you have a favorite quality supplier, please tell us — and tell us why they are better than others.

From where we sit, there’s not much that is really actionable by individuals, or accepted and embraced by the clinician world.

We do indeed hope and believe that providers, who should know quality metrics better than anybody, will unite to fix this problem. Because price without quality is incomplete. In our view, bringing price out of the shadows speeds a thoughtful quality discussion: What makes that $6,000 MRI so much better than the $300 one?

My lawyer says this is illegal

To clear up a misunderstanding or two: when we start talking about publicizing prices, invariably someone tells us that talking about price is illegal.

We are journalists, not lawyers. That said, we have investigated the question of posting cash prices, and there’s nothing illegal about it, though there are certain criteria. Here’s a blog post explaining the lay of the land as we see it.

We have heard clinicians say definitively that their practice has no cash or self-pay price, even though we have already collected a cash or self-pay price from their billing office.

We have heard from clinicians who say that they cannot reveal their cash prices, but that they routinely discount for cash customers.

So we judge that perspectives may differ on this.

If you have further details, or if you would like to connect us with your lawyers or with academics or others who have different perspectives, then we welcome that. Please email info@clearhealthcosts.com or e.chu@medpagetoday.com.

Where else can I see pricing?

Glad you asked.

We have  collected cash or self-pay prices via a direct provider survey for several years. On the front page of our website, you can see links to our price lists of 30-35 common, “shoppable” procedures in the New York area; we also have pricing from seven other metro areas, which you can access via the search box at the top of the front page. That search tool also gives you the Medicare reimbursement rate for any one of the 8,400 procedures in the government’s Medicare reimbursement data set, in any U.S. locale.

Also, as we mentioned above, in the “find prices” part of our MedPage Today tool, you can find a lot of cash or self-pay pricing.

Things to search for: vaginal delivery, C-section, tympanostomy (ear tubes), bunion, cataract removal, arthroscopy, hernia repair. That should get you started. If you type in a few letters, the search tool will offer you suggestions of what it thinks you’re seeking. If you find an item and it’s not in your state, try “all states,” the first location in the states list.

Where does this data come from? Here’s a blog post with a link to the full Clearhealthcosts.com hospitals database, a collection of cash or self-pay prices posted online by about 120 hospitals and surgical care centers.

Click on the “notes” field in the database to see the pricing policy of the institution in question.

The source of this information is the hospitals and surgical centers themselves: one big for-profit hospital chain, Hospital Corporation of America, and also other hospitals and surgical centers posting online prices, including these and others: Surgery Center of Oklahoma, Regency Healthcare in New York City, Rochester General Hospital in Rochester, N.Y.; Banner Health in Arizona.

Much but not all of this data has been included here in the MedPage Today version. (Data geek? Here’s  a blog post about what data is in the MedPage Today database and what isn’t, and why.)

Also, as you probably know, the retail health sector is booming – Wal-Mart, CVS, Walgreen’s and others have walk-in centers. They post prices online. Here’s an example from CVS,  and here’s one from Walgreen’s. We can point to many others.

Who cares about cash prices?

So why would anyone care about a cash or self-pay price? Now that insurance is extended to many – if not all – under the Affordable Care Act, isn’t everybody paying a slight copay or co-insurance, so the cash price matters not a bit to anyone?

First, not everyone is insured. And not all providers are in network.

Also, with rising deductibles and rising coinsurance, much more of the price is being paid by insured people. If you’ve got 20 percent co-insurance, then knowing if a procedure will cost $300 or $6,000 can be quite important.

We’ve heard of people on a high-deductible plan who routinely ask to pay the cash rate instead of the negotiated rate. Here’s one example: One person who responded to our California PriceCheck survey wrote: “I was told procedure would be 1850. I have a 7500 deductaible[sic]. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”

We even heard of an insurance company that is (quietly) revealing its contract rates via its online pricing tool by explaining the coinsurance for simple procedures: an MRI, for example, in our New York City backyard could cost $42.50 in coinsurance, or $253. Since coinsurance is 10 percent, that also reveals the reimbursement rate by the insurance company. Here’s a blog post about that.

There are a number of other reasons that people might be interested in the cash or self-pay price, including the question of whether their insurance premiums are giving them access to the highest rate, rather than the lowest, until they have met their deductible.

With our work here, we take part in a growing ecosystem of partners who seek transparency. Among the physicians and clinicians we count as like-minded, in no particular order: Dr. Rob Fogerty, author of the leadoff post at MedPage Today, and also of this post on clearhealthcosts.com; Dr. Neel Shah, founder of CostsofCare.org; Dr. Yousuf Zafar, cancer doc and co-author of a paper on the toxicity of cancer; Dr. Geraldine McGinty, an eminent radiologist  and author of this post on clearhealthcosts.com; Dr. David Belk, founder of truecostofhealthcare.org and author of this post on clearhealthcosts.com; Dr. Ken Croen of Scarsdale Medical Group, author of this blog; Dr. Peter Ubel, a practitioner who engages these topics and others at Duke University at this blog; Dr. Stephen Rakower, who found us via our California PriceCheck project and authored this post on clearhealthcosts.com; Dr. Ryan Neuhofel, tweeting about direct primary care over at NeuCare; and, of course, the membership of the Society for Participatory Medicine.

Standardbearers from the patient side: e-Patient Dave deBronkart, who beat kidney cancer and later issued an RFP for his skin cancer; Peggy Zuckerman, who also beat kidney cancer and wrote this post on clearhealthcosts.com; and Casey Quinlan, price transparency Valkyrie who beat breast cancer.

O.K., so what do you want me to do?

If you have lots of prices to contribute, you can download or send your administrator this spreadsheet Download (XLS, 33KB)

To contribute individual prices or to search our PriceCheck database, click here to go to the page displaying the form for entering and searching the data.

Here’s our Frequently Asked Questions (FAQ), and here’s a link to our post about what data is in the database.

Have a suggestion/question/comment that isn’t addressed here?

Email us at info@clearhealthcosts.com or e.chu@medpagetoday.com.

Jeanne Pinder is founder and CEO of Clearhealthcosts.com, a New York City startup bringing transparency to the health care marketplace by telling people what stuff costs.