Our MedPage Today database: What’s in here anyway?

About our MedPage Today data partnership: what data is in this database?

We built this database so people can contribute prices to it and also search for others’ prices, as part of our partnership with MedPage Today to build a database of cash or self-pay prices supplied by providers (our launch post explaining the project is here; the page with the form to search and share prices is here).

What’s here: This is what these providers say is their cash or self-pay price, subject to certain conditions. You can see the conditions in the notes field, with a link to the web site where available.

We collected this information both from providers’ web sites and from the providers themselves, using our handy form to make sure the data structures match. We put all of it in this database, which we describe in this blog post and this blog post.

Then we excerpted that data to import into this MedPage Today database. We wanted to take all of it, but it didn’t fit, because of data structure.

Data wonk alert! Detail about the data.

In our hospitals database, there are generally two kinds of data:Screen shot 2015-04-06 at 3.36.52 PM

  1. Some providers listed a procedure as “diagnostic MRI” or “ultrasound” or “X-ray” and gave a price, without a common procedural terminology (CPT) code or Healthcare Common Procedure Coding System (HCPCS) code, among the primary tools for standardizing billing and payment in U.S. health care. This made us twitchy, because for most providers, the price charged or paid for a diagnostic MRI depends on the body part (brain is different from knee) and because a diagnostic MRI can be made without contrast or dye, and also with contrast or dye (again, the prices differ). The CPT codes add a great deal of clarity. We could not with any certainty assign a CPT code to such a mooshy category as “diagnostic MRI,” because that would suggest that we knew what was actually being performed. Also, our other data work has proved to us that we need to look — if at all possible — for a CPT code, and that’s the way we built our database. So a search or a contribution of prices with a similar description but no CPT code invited skepticism and confusion (see screenshot).
  2. Some providers gave a price for an episode of care, described also by natural language with no CPT code: Childbirth, say, or gall bladder removal. These episodes of care come without CPT codes, as do some of our other data categories, partly because there are a number of procedures wrapped up into that one episode of care.

So we removed the confusing ones (so long, diagnostic MRI!) and included the less-confusing ones (hello, tympanostomy with tubes!).

We also omitted some episodes of care that were confusing for other reasons. A urinary tract infection that cost in the thousands of dollars at a hospital seemed to us to be puzzling in the context of our other data, which includes garden-variety urinary tract infections. We surmised that the extremely expensive ones required hospitalizations and extensive treatment, and that putting them in the same database with more trivial treatments was going to confuse issues.

The hospitals use different terminology to describe their services in some places. Because we didn’t know for sure that “Normal Vaginal Delivery of a Newborn – Mother’s Stay,” at H.C.A., is the same as “Vaginal delivery w/o complicating diagnoses,” at Banner Health, we left the hospitals’ original terminology. It’s confusing, but so is our health-care system.

Although there is no CPT code, we left “diagnostic X-ray (bone, joint),” “diagnostic X-ray (chest)” and “diagnostic X-ray (tissue, organ, other),” partly because X-rays are so common, partly because there is a named body part, and partly to demonstrate just how complicated this problem is.

We left “mammography routine screening,” “screening mammogram” and “screening mammography” also to show how terminology messes up the categories, and encourages us to collect data only with CPT codes. (Note: When you send us prices, please use a CPT or HCPCS code. Our database thanks you.)

We left all the CT scan and computed tomography, if a body part was named. We removed “Diagnostic CT scan” because it was confusing. But you can see how the different categorization systems of different providers make the data confusing.

Things to search for: vaginal delivery, newborn, C-section, tympanostomy (ear tubes), bunion, cataract removal, arthroscopy, endoscopy, 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, leave out the zip code and you’ll get nationwide listings.

O.K., so who are the providers here?

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.

There are around 120 hospitals and surgical centers here; this is a small fraction of the hospitals in the United States, which the American Hospital Association says number 5,686.

Different hospitals and surgical centers do different procedures, of course. Many states are represented, some with one provider and some with many.

The pricing comes with conditions or caveats. Surgery Center of Oklahoma posts its prices online, and describes its prices as binding and guaranteed. HCA posts prices online and describes them as estimates only. Each of the other sources of pricing has its own conditions and stipulations; Rochester General, for example, is clear to say that doctor and anesthesiologist will charge separately.

Details of pricing policies are listed in “notes” both in the “contribute prices” form and in the “find prices” results.

If you know of other sources that are not listed here, let us know at info@clearhealthcosts.com or e.chu@medpagetoday.com.

What we are not interested in: Chargemaster prices, as posted by providers in California, Ohio and other states. We are interested in cash or self-pay prices.

Clearhealthcosts.com has already partnered with public radio stations in San Francisco, Los Angeles, New York City and the Delaware Valley (Philadelphia) on similar efforts. These prices come from the provider survey our journalists conduct according to our survey methodology. We ask providers for their cash or self-pay prices for a range of common, “shoppable” procedures, like MRI’s, IUD’s, a well-woman exam, Lasik and a range of other procedures.

What you can do

What we’d like you to contribute: data that has a CPT code, if available, or something that matches this kind of “episode of care” methodology.

We want the cash or self-pay price, for an uninsured patient or one who’s not on your insurance plan.

We are most interested in the “all-in” price: Ideally, use the total prices charged, then specify a breakdown of other charges in the notes. That would be the best way for us to build a useful data set. A link to your pricing policy is very helpful.

If you’re not sure we want it, here’s your answer: yes, we want it. Detail is good!

How you can contribute

Go here: you’ll see our spreadsheet, which you can download. Fill in the blanks, then send it to info@clearhealthcosts.com.

Questions? Same email.

If you want to enter your own individual prices, use the simple tool.

Did something not work right? Here’s what to do.

First, if your data is not accepted by our database (it has happened before: the database likes existing procedures or procedures with CPT or HCPCS codes), we will be able to enter your data manually.

And second, can you help us figure out what went wrong? A small number of the shares are not working properly.

On the first point:  If you return this to us, we’ll put it in for you!

  • Provider (as specific as possible, with address, city, zip, phone, website)
  • Name of procedure
  • CPT or HCPCS code
  • Cash or self-pay price charged
  • (If you’re sending in personal information, not practice information, tell us what insurance paid and what you paid)
  • Comments
  • Email address

On the second point, here’s how we like to hear reports of malfunctions:

Bug (mandatory) or feature (optional)?

(bug is if it doesn’t work, feature is if I wish it would do something that was not in our design, like search by insurance company or by provider, instead of procedure)

  • What it does—be as explicit as possible.
  • What you would like it to do–be as explicit as possible.
  • Tell us what device, operating system, browser–be explicit (MacBook Air, OS X 10.6.8, Chrome build 40.0.2214.93 64-bit or iPhone 5S, IOS 7, Safari).
  • Pictures are great, so if you can attach screenshots, documents and so on, that’s ideal. Arrows are helpful.
  • Email to info@clearhealthcosts.com with “PriceCheck bug report” in subject line.

Do you have other questions? Here’s the interactive form where you can share and search pricesHere’s our FAQ. And here’s the full launch blog post. Here’s our other coverage (link to project page). Questions? Suggestions? Email us at info@clearhealthcosts.com or e.chu@medpagetoday.com.