What’s in our database? Prices, prices and more prices

Filed Under: Costs, Patients, Providers

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We collect and display cash or self-pay prices — what you would pay without insurance — for about 30-35 common, “shoppable” procedures. Why? To show the range of pricing for simple medical items, which can more or less be compared — as apples to apples. If you see that an MRI can cost $300 one place and $6,000 another place, you’ll be better informed about the health care system, and better able to make money decisions relating to health care.

Those procedures include:

Imaging: MRI of the lower back without contrast; MRI of the lower back without and with contrast; MRI of the upper back without contrast; MRI of the upper back without and with contrast; pelvic ultrasound; abdominal ultrasound; screening or preventive mammogram.

Women’s health: Well-woman exam; Pap smear; sexually transmitted disease test; urinary tract infection test; IUD insertion; abortion; Depo-Provera birth control; screening or preventive mammogram.

Men’s health: Sexually transmitted disease test; vasectomy (traditional and non-scalpel).

Blood tests: Comprehensive blood count (CBC) blood test with differential; comprehensive metabolic panel (CMP); thyroid stimulating hormone (TSH); cholesterol (lipids) blood test.

Dental: Basic dental exam; teeth filling; teeth cleaning; teeth whitening.

Other: Walk-in clinic visit; basic eye exam; colonoscopy; cardio stress test; echocardiogram with Doppler; sleep study (polysomnogram; split-night sleep study; multiple sleep latency test).

Cosmetic or discretionary: Lasik, Botox, teeth whitening.

We chose this list because these are fairly common procedures, in which you have some discretion (where do I want to go?) and are fairly comparable (an MRI is, pretty much, an MRI).

You will also find other prices here, shared by community members; our prices are flagged in orange, community members’ in blue, and those from providers are in green.

Our journalists collect prices by phone, using a several-step process designed and then refined to find accredited providers across a range of facilities: hospital, self-standing radiology center, individual physician, clinics, chains and the like, in various locales (city locations, different neighborhoods, suburban towns, etc.).

We identify ourselves as being from a new independent consumer health-care research organization, and asking for a cash or self-pay price for these procedures. We invite detail about discounts, mandatory consultation or referral visits, and other things we might want to know.

Medicare pricing is also included

Our software also displays the price Medicare pays for any procedure in any part of the United States. This price is important because it’s the closest thing to a fixed or benchmark price in the marketplace.

We taught the software to make this calculation based on the formula the government uses, deriving the final figure by using the tables of Professional Practice Relative Value Unit (PPRVU) downloaded from the site of the Centers for Medicare and Medicaid Services, as well as their zip code files by which CMS divides the country by localities.

Our data collection methods

We seek to use a HCPCS (Healthcare Common Procedure Coding System) number when valid. The HCPCS system uses a number of Common Procedural Terminology coding system numbers. Here’s an explanation of the codes, which govern many parts of the billing system for health care.

(Our Medicare pricing is also figured on HCPCS coding.)

We do not seek to be exhaustive or comprehensive — that is, we don’t collect prices from every single provider in a given region. Rather, we work to be representative.

We collect prices only from accredited facilities; in places where there is no accreditation, we use our journalism skills to determine if a provider is responsible. For example, in one city, we once surveyed a place that had an inexpensive STD test, but when we looked at their website, and then talked to them, they said they were a church, and they use inexpensive STD testing as part of their ministry to expand their congregation. We did not include them.

We also use other standardized data-collection methods.

Most places we contacted had a cash or self-pay price easily available that they were able to quote. Those prices we have listed here. Some respondents said they had some provision for need, a sliding scale for example, or “only for qualified patients.” We’ve used that detail in the “notes.”

If they cannot tell us a price, we list it as $0 (our database structure requires a number) and add in the notes: “No prices over the phone” or “Prices over the phone for patients only.”

When a provider has several locations, we usually do not list every location, but instead flag in the “notes” field by saying “Check website for locations.” Some providers with multiple locations use the same price at every location; some providers have different prices for the same procedure at different locations. Yes, it’s confusing.

We have also learned that the wave of mergers and acquisitions sweeping health care means that provider lists are frequently out of date. Even lists of accredited organizations from, say, the American College of Radiology are frequently out of date.

Providers go out of business, and new ones take their place. When hospitals acquire practices, the pricetag tends to go up (here’s a New York Times article about that). Our surveys reflect the best information we are able to get at the time, but the landscape is changing by the second.

None of these prices are guaranteed prices. We collect them in the manner described, but in every case an individual should ask the price: “What will that cost? What will that cost me?” Take notes. Take names. Take numbers.

Surveying the hospitals

We also approach hospitals directly for a number of prices. Hospitals are generally very hard to contact for pricing information: We get transferred around a lot, put on hold, sent to voicemail and the like.

In some cases, the people we spoke with asked us, for example, to send a spreadsheet of the procedures for which we were seeking prices, and then responded with some variation of “My boss says we will not participate.” In such cases, we recorded that as “no prices over the phone” or “prices over the phone for patients only,” depending on the response.

In some cases, the hospitals’ central pricing office declined to give prices over the phone, while a clinic location of the same hospital (urology or cardiology) was happy to give us prices. Cleveland Clinic Cardiology in Florida, for example, gave us prices, but the central office in Ohio said “no prices over the phone.”

When we were unable to establish contact with anyone for a definitive answer, we left them out of the database.

One hospital gave us several prices over the phone, and then when I called back and asked for a few more, my contact asked me to send a spreadsheet. Then she emailed me back saying her boss said they would be unable to participate. According to our experience, it depends who you talk to: One person might give a price, while another in the same office might refuse.

One big hospital chain, Hospital Corporation of America, has price estimates on its websites for individual hospitals. The central pricing office at HCA in Florida also gave us prices for most of the hospital-based procedures we survey on. They did say the notes field should read: “Estimate only; facility will call to give final price after scheduling. Pricing line: 800-617-7044.”

(There are 32 HCA hospitals in the Miami and Tampa-St. Petersburg areas, and we decided to list data not from all but rather from eight on each coast, based on location, for geographic diversity; size; and other factors like reputation.)

We identified ourselves as researchers

When we found people who misunderstood and thought that we were patients, not journalist-researchers, we sought to dispel that misunderstanding to insure that our methods were uniform.

When I first started doing this kind of phone survey, I called a number of providers in the New York City area in the fall of 2010 while I was researching this business concept, and misrepresented myself by telling them that I was a patient and had not met my deductible, and needed a test (in this case, a colonoscopy) and asked what it would cost if I was paying out of my own pocket (see blog post). This is not our policy now.

It’s worth noting, though, that when I asked this question in this fashion, as a patient, I found extraordinary support and good will: When respondents thought I was paying out of pocket, they uniformly and completely were sympathetic and helpful — up to and including the very nice Manhattan receptionist who added up the numbers and said that this procedure at her doctor’s rates would be well over $3,000, and that I should not go to him, but should rather shop around on the Internet for a better price.

How do I tell what’s crowdsourced?

In this software, prices collected by our journalists are displayed under an orange panel, the base color of the software, with a flag to the top right saying “PriceCheck journalist.”

Prices shared by our community members are in aqua blue, with a flag saying “Community member.”

When providers come to us directly and ask to put their prices in our database, those prices are in green, with a flag saying “Health care provider.”

Clearhealthcosts.com has already partnered with public radio stations in San Francisco, Los Angeles, New York City, the Delaware Valley (Philadelphia), Miami and Tampa-St. Petersburg on similar efforts. Click the links for examples; our news coverage can be seen here, here, here and here.

Bigger-ticket items have their own database

Separately, for bigger-ticket items like childbirth, gall bladder surgery and arthroscopy, we have this database of cash or self-pay prices for more expensive, often hospital-based, procedures.

The source of this information is the hospitals and surgical centers themselves. Hospital Corporation of America, and also other hospitals and surgical centers post online prices, including  Surgery Center of Oklahoma.

The procedures are a mix of in-patient (childbirth, treatment for chest pain) and outpatient (mammogram, MRI, endoscopy). 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.

Why do the hospitals and surgical centers do this?

HCA says on its website: “HCA is pleased to introduce our pricing transparency initiative. To best serve patients and provide a meaningful estimate of out of pocket expenses, our information is specific to each hospital. … This is a groundbreaking healthcare initiative and we hope, through the information found on our site and our toll-free phone line to our Service Representatives, patients can learn more about the financial side of their healthcare needs.”

Surgery Center of Oklahoma says on its website: “It is no secret to anyone that the pricing of surgical services is at the top of the list of problems in our dysfunctional healthcare system. Bureaucracy at the insurance and hospital levels, cost shifting and the absence of free market principles are among the culprits for what has caused surgical care in the United States to be cost prohibitive. …

“Transparent, direct, package pricing means the patient knows exactly what the cost of the service will be upfront.”

We asked Dr. Keith Smith, a co-founder of the center, about his practice.

“We wanted to show that an ambulatory surgical center could do these procedures for one-tenth of the price,” he said in a phone interview.  “We wanted to show that free markets do apply in health care, contrary to what people think. We wanted to start a price war, get some competition. Indeed that’s what’s going on.

“There are a few that are putting prices online. There are a lot that are about to.”

In the notes field for the hospital in question, we’re putting a link to their pricing policy, so you know which conditions apply. This field changes rapidly; some new listings appear regularly, while others disappear.

Some of these providers include doctor and anesthesiologist prices in their listings, and some don’t. Of course, that means it’s hard to compare.

That’s true, but the prices are interesting. Even partial transparency begins the conversation, and lets us hope for more.

Some notes and tips on how to use this database

A couple of notes: 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.

Things to search for: vaginal delivery, C-section, tympanostomy (ear tubes), bunion, MRI, X-ray, colonoscopy, CAT scan, ultrasound, cataract removal, arthroscopy, endoscopy, blood transfusion, 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.

A bug we’re fixing: the search tool doesn’t always re-set to its original state after a search. So if you can’t get a result, try refreshing your browser window to start again.

For reasons having to do with database design, this hospital or big-ticket data is in a database separate from our other database, which has lower-cost items and procedures like walk-in clinic visits, MRI’s, Lasik and teeth cleaning.   So your searches for Lasik (on our front page search tool) must be separate from the searches for big-ticket hospital items like gall bladder operations and childbirth (on the hospital search tool). We’re working on making that better.

Want more information on the hospitals database? Here’s the full blog post.

Want your prices in our database?

Here’s how to do it:

  • Enter prices on our form on the page.
  • Contribute a lot of prices: Download or send your administrator this spreadsheet Download (XLS, 33KB).

Do you have questions about prices listed here? Let us know. Email us at: info (at) clearhealthcosts (dot) com.

Anything else you want to say? Reach us at info (at) clearhealthcosts (dot) com.