Since Jan. 1, 2021, U.S. hospitals are required by law to publicly post their prices online. But for some it has been impossible to find them or confirm their accuracy.
New York City Health + Hospitals is the corporation that manages the city’s 11 public hospitals. For a research project, we set out to find two things that the law demands they post: a file listing all procedures and what they charge each insurer/payer, as well as a discounted cash price, and a separate file or online price calculator that returns cash prices for each of the 300 most common services, sometimes called “shoppable services.” Here’s a link to the government’s explanation of the entire mandate.
Until last year, hospitals were allowed to keep their pricing information – including the fact that they bill different patients wildly different prices for the same exact care – secret. The United States has the most expensive healthcare system in the world, and on top of that, this lack of transparency is one of the fundamental problems of the U.S. healthcare system according to experts.
In this system, nobody knows how much any procedure will cost them. As a result, individuals and their families have no way to financially plan for their future procedures. These new regulations are meant to start to fix that.
Making price data hard to find
But despite the 2021 mandate, most hospitals do not make this data easy to find or use. There is no standard place where users can find the information. Instead, patients and reporters like us have to look all over the website including searching a variety of terms until we find it. And even when we do, we find that it’s frequently in an unusual file format that we can’t open, or is too large to open on our amateur computers.
We went through all that in our effort to research those 11 New York City public hospitals’ price lists as well as those of dozens of other hospitals in the New York City area. We found the Health + Hospitals data particularly interesting. We spent a week cleaning up the data and getting it into spreadsheet form. It seemed like a win for medical cost transparency.
Then, while double checking our data a few days before we planned to publish our analysis, we found a problem that led us to the realization that none of our prices for N.Y.C.H.H. facilities could be trusted.
Spotchecking prices, and finding a mystery
As a spotcheck, we compared prices between the two N.Y.C.H.H. sources – the big price spreadsheet file and their online calculator tool – at each of their 11 hospitals. The two sources should, of course, give the same prices. Using the calculator, I entered the unique procedure identification number — called the CPT code — for a spinal MRI with and without contrast. But the price it returned was different from the one we found in the official spreadsheet.
We looked up the cost for the same MRI at each of the other N.Y.C.H.H. facilities. At each one, we also found two different prices for the same procedure. At Bellevue for example, the spreadsheet listed $531.06 while the price estimator gave $1,002.
Here are screenshot comparisons from our spreadsheet listing and the cost estimator listings at the same hospital.
The more we looked at it, the more we realized: The spreadsheet seemed in at least some cases to include the amount of the discount, not the actual price.
We spot-checked a few more procedures at the 11 hospitals for good measure. At each hospital the spreadsheet gave the same cash price for a pelvic ultrasound code 76856, $747.60. But for each hospital, the cost estimator gave a higher number in the neighborhood of $1,220, and describes $748 (we assume rounding up $747.60), as the amount of the discount.
When we looked up the price for a knee replacement at the hospitals, the spreadsheet told us either $13,947.16 or $15,621.72, depending on the hospital. while .But the estimator gave us $26,857 for each hospital. This time,confusing the situation even further, the price estimator listed another discount amount, $15,083 at both hospitals, instead of what we expected, $13,947 or $15,621.72. But the conundrum remained the same: we do not know how much a knee replacement costs at either hospital.
We did not check every single price — our research found that N.Y.C.H.H. hospitals have around 7,500 prices for each of the 11 hospitals — but a spot check made it clear that either the spreadsheet or the price estimator is wrong. Or perhaps it’s both? And if these charges can’t be trusted, then what about the thousands of other procedures they’ve posted?
It may not seem like a big deal, but disclosing more than one price for each medical code is almost as useless as giving none: In both cases, a patient does not know how much they will be charged. How do they know which one to believe?
Other hospitals not in compliance
To be sure, Health + Hospitals is not the only hospital system that is not in compliance. From the very beginning of the mandate, on Jan. 1, 2021, this has been true – with hospitals and hospital trade groups often saying something like “we’re doing the best we can” or “this is a huge task, do you understand that?” or “there’s a pandemic on, and we’re spending more time on patient care than we are on complying with picayune transparency requirements.”
In the New York City area alone we found the Stony Brook University Medical Center listed the charged price and the discounted price as one and the same. Mount Sinai listed no cash prices on its site. Valley Health System in northern New Jersey and southern New York has lovely spreadsheets with both CPT and DRG (diagnosis-related group) coding, but all the cash price blocks say N/A. In the Trinitas Regional Medical Center file the “self-pay amount” for all CPT codes is listed as “packaged item.” The file does list the apparent negotiated or contract rates for insurers, but there seems to be no self-pay amount. Huntington Hospital had many many entries at $5,776, including removal of an intrauterine device, treatment of miscarriage and nervous system surgery. When we saw numbers that looked that implausible, we took them out — and used only the numbers that seemed plausible. Here’s a separate post with details on these and other examples of hospital compliance with the transparency mandate in the New York City area.
But like many hospital systems, N.Y.C.H.H. appears to be doing the bare minimum to comply with the law but apparently lacking any quality control over the results. This, then, still functionally leaves patients and the public in the dark and powerless.
We reached out to N.Y.C.H.H. by phone and email but we have yet to hear back.