By Jeanne Pinder, C.E.O., ClearHealthCosts.com

So where’s this data from?

In our partnerships with news organizations, we begin by collecting cash or self-pay prices from a range of area providers to put into our database of about 30 common, “shoppable” health care procedures — for example, several MRI’s and ultrasounds, a well-woman exam, Lasik eye surgery, a vasectomy and teeth cleaning.

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.

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.

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 another state, 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.”

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 in conducting our surveys 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 out of date; a hospital might have just bought a practice, for example, or a clinic may be merging with another practice. 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?”

Surveying the hospitals

With our previous survey experience and knowledge at hand, we also took the opportunity to approach hospitals directly for a number of prices, seeking a central pricing location. 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, for example, gave us prices, but the central office in Ohio said “no prices over the phone.”

Generally, my hospital notes are full of things like “Left message” “left message” “left message” “started again from the beginning” “on hold for 10 minutes” and so on.

When they told us they did not want to participate, or did not give prices over the phone, we registered them in the database as “$0” with a note explaining; our database requires that we apply an integer in that field, so we cannot use something like “N/A” or a blank space. We think it’s important to include those non-answers in the database.

When we were unable to establish contact with anyone for a definitive answer, we left them out of the database. We are working on a better way to represent the cases in which we could not establish contact and thus receive a definitive answer (“no prices over the phone”).

In several cases, the hospitals did not perform the services we inquired about, or performed them at a separate facility (this is common for sleep studies).

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.

One big hospital chain, Hospital Corporation of America, has price estimates on its websites for individual hospitals. The central pricing office at HCA 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 do ////whatever we decided to do/// with their data.)

According to our experience, it depends who you talk to: One person might give a price, while another in the same office might refuse.

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 and the Delaware Valley (Philadelphia) on similar efforts. Click the links for examples; our news coverage can be seen here and here.

Want your prices in our database?

Here’s how to do it:

  • Contribute a lot of prices: Download or send your administrator this spreadsheet Download (XLS, 33KB).
  • Contribute individual prices in the form on the page (link to home form).
  • Questions? Email us at: info (at) clearhealthcosts (dot) com.

Check out our full coverage here (link to project page)

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.