This year, some Americans may do something that was previously impossible: raise the price of nursing care before going to the hospital.
A new federal rule requires hospitals to post the prices they negotiate with private insurance companies.
The data is a rich source of new information. We used it to show it Some insurance companies pay twice or three times as much as their competitors for basic services – and that paying cash rather than using your cover can often lead to a lower price.
However, most hospitals have not yet published the necessary data. Even when they have, it can take time and effort to find it. You may also need to be a computer programmer to open it.
“Get some coffee and moisture, because it’s going to be a while,” said Touré McCluskey, one of the founders of health startup Redu Health, which has compiled some of the data files. “There’s information out there, but it’s not consumer friendly.”
To help those who want to try, we interviewed several researchers who have spent months collecting data. They recommended several simple strategies.
You need to know that to get started
Before you start looking for prices, you want to know what kind of health insurance you have – both the name of your insurance company and also details such as whether you chose an HMO plan during open enrollment or went with a PPO option.
Insurance companies often have a dozen rates at the same hospital. Some are specific to which plan you chose and whether you purchased the insurance through the Obamacare marketplace or a specific employer. Others have to do with which network you chose when you signed up for coverage.
Knowing the type of insurance you have will help you get the most out of the prices in the data that apply to you.
Then do a web search
For most hospitals, the data is published on a page labeled “price transparency”. Many researchers say they start looking for price files through a Google search for that phrase and the name of the hospital.
“This search should lead you to a top result that has something to do with price estimates, or patient information,” said Morgan Henderson, a health economist at the University of Maryland-Baltimore County who worked with The Upshot to collect the price files used in our recent Articles. “Sometimes what you want is at the bottom of the page, or you need to follow a few links.”
The site should look like this one from MedStar Hospital Center, the largest hospital in Washington, DC
The hospital’s price transparency site is likely to have more sections and links, and the labeling of the price files is not always clear. You want to look for something like a “comprehensive machine readable file” or “negotiated price list”.
It is also worth opening files that are described as containing “standard charges” or “chargemaster”. This is how they view Indiana University Health:
When you open the files, you see that it actually also has the hospital’s negotiated rates and cash prices.
Here’s what you’re looking for
The government has not set up a standard format for hospitals to report their price data, and each hospital seems to have a slightly different approach.
Some submit their data Excel or CSV files that you can open using free software like Google Sheets. However, some use JSON files, a data format typically used by computer programmers and professional computer scientists that ordinary people might struggle to access.
“I have a degree in health economics and politics, and I work on a machine with a lot of memory space,” said Morgane Mouslim, also a health economist at the University of Maryland-Baltimore County who helped The Upshot collect and standardize data files. “If a file is not in Excel, you may need additional software.”
A typical data set shows prices by procedure for each insurance company, such as this one from the Hospital of the University of Pennsylvania:
The five-digit numbers to the left of this spreadsheet are CPT codes that hospitals use to describe each service they offer. Most files also have short descriptions for each code, but they can be confusing. For example, code U0003 translates to “PR COV 19 AMP PRB HIGH THRUPUT” – a jargon way of describing a coronavirus test.
To look up the cost of a particular service you expect to receive at a hospital, you will most likely need to call the facility and ask what CPT codes it will bill for your visit.
You can also see other numeric codes, sometimes labeled procedure codes or revenue codes, as in the file below from Baptist Medical Center in Little Rock, Ark. You probably do not need to pay much attention to them and should focus on the CPT codes. (If the CPT codes are not tagged, you can generally recognize them as the five digits.)
Usually you should see dollar numbers that represent real prices. However, you can run across files where the price is listed as “variable”, meaning it may vary for two patients with the same insurance who received the same care under different circumstances.
Molly Smith, vice president of public policy at the American Hospital Association, gave the example of a patient coming to the hospital for a flu shot against someone who happens to get one while he is there for surgery.
“In the contract, we generally negotiate the price of the primary service, but if it is a secondary service, maybe 15 percent is taken off,” she said. “It is not possible to reflect it in these files.”
The files should also include two other prices: “fee” or “gross price”, which is the label price for a given service that hospitals often use as a basis for negotiating discounts. There should also be the “cash” price, which is what the hospital charges patients who do not use insurance. Whether this price is available for patients with insurance varies from hospital to hospital. Some low-income patients may qualify for even steeper discounts based on how little they earn.
Once you have found the data point you are looking for, there may be additional work to understand it. Most hospitals indicate prices as dollar figures, but some show the data as a percentage of gross amount – which means that patients will have to do math to understand their costs.
What if I can not find anything?
Most hospitals have not published the necessary data, so a lot can happen.
For example, on NYU Langone’s price transparency website, you can only find standard fees and a patient estimator tool that uses information about your insurance plan to generate a customized estimate of how much you will pay for a particular procedure.
These tools provide limited information. The standard fees can tell you the maximum you can pay for a given service, and the patient estimator shows the out-of-pocket costs associated with simple services like mammography and blood tests. However, when a Times reporter tried to use the NYU website in late July, it generated error messages for all services explored.
A NYU Langone representative declined to comment on why the hospital had not released its full data.
With compliance rates still low, the federal government promises to increase enforcement. It has sent nearly 170 warning letters to incompatible hospitals and plans to increase non-compliance penalties from $ 109,500 annually to as much as $ 2 million.
If you believe a hospital has not provided the necessary information, you can do so submit a complaint with the Federal Government notifying it of the problem.
Soon, third-party sites may help
Some health experts say the big data files will become more useful after third-party data companies clean and organize the information so patients can search across multiple hospitals and health services.
A data transparency company, Turquoise Health, has already set up one free price lookup tool. Others are expected soon.
Can you see anything surprising? Tell us about it.
The Times has examined data sets from 60 hospitals so far. But there are many more out there.
If you notice something surprising in a hospital price file – e.g. Unusually high prices or large variations in what a service costs – we would love to hear about it. You can send us an email with what you found.
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