If yes, how to check the prices in your hospital?

This year, some Americans can do something that was previously impossible: research the cost of care before going to the hospital.

A new federal rule requires hospitals to publish prices they negotiate with private insurers.

Data is a rich source of new information. We used this to show that some insurance companies pay two or three times more for essential services than their competitors, and paying cash instead of using your coverage can often result in a lower price.

However, most hospitals have not yet released the necessary data. Even if they do, finding it can take time and legwork. Also, you may need to be a computer programmer to open it.

“Have some coffee and hydrate, because it’s going to take some time,” said Touré McCluskey, co-founder of health organization Redu Health, which collected some of the data files. “There’s information out there, but it’s not consumer friendly.”

To help those who want to try it, we interviewed several researchers who spent months collecting the data. They suggested a few simple strategies.

What you need to know to get started

Before you start looking for prices, you’ll want to know what type of health insurance you have – both the name of your insurer and details such as whether you chose an HMO plan during open enrollment or whether you went with a PPO option.

Insurers often charge half a dozen at the same hospital. Some are specific to which plan you choose and whether you buy the insurance from the Obamacare marketplace or from a specific employer. Others have to do with which network you choose when you sign up for coverage.

Knowing the type of insurance you have will help you best understand which prices in the data apply to you.

Then do a web search

For most hospitals, data is published on a page labeled “price transparency”. Many researchers say they started looking for price files by searching for this phrase and the name of the hospital on Google.

“This search should get you to the best result, which is something to do with price estimate billing or patient information,” said Morgan Henderson, a health economist at the University of Maryland-Baltimore County, who worked with The Upshot to collect price files. used in our recent articles. “Sometimes what you want is at the bottom of that page or you just have to follow a few links.”

The page should be something like this, taken from MedStar Hospital Center, the largest hospital in Washington DC.

The hospital’s price transparency site will likely have multiple sections and links, and the labeling of price files is not always clear. You’ll want to look for something like “comprehensive machine-readable file” or “negotiable price list”.

It’s also worth opening files specified as containing “standard charges” or a “chargemaster”. Here are those who looked at Indiana University Health:

When you open the files, you see that the hospital has bargain rates and cash prices as well.

Here’s what you’re looking for

The government has not established a standard format for hospitals to report price data, and each hospital seems to take a slightly different approach.

Some of their data Excel or CSV files that you can open using free software like Google Sheets. Some, however, use JSON files, a data format commonly used by computer programmers and professional data scientists, and a data format that ordinary people may have trouble opening.

“I have training in health economics and policy, and I’m working on a machine with a lot of memory space,” said Morgane Mouslim, a health economist at the University of Maryland-Baltimore County, who helped collect and standardize The Upshot. data files. “If a file is not in Excel, you may need additional software.”

A typical dataset lists procedural prices for each insurer, like this one from the University of Pennsylvania Hospital:

The five-digit numbers on the far left of this spreadsheet are the CPT codes that hospitals use to identify each service they offer. Most files also have short descriptions for each code, but these can be confusing. For example, the code U0003 translates as “PR COV 19 AMP PRB HIGH THRUPUT”, which is a jargon-free way of describing a coronavirus test.

To find out the cost of a particular service you can expect to receive at a hospital, you will likely need to call the facility and ask what CPT codes they will bill for your visit.

You may also sometimes see other numeric codes, such as procedural codes or income codes labeled, as in the file below from the Baptist Medical Center in Little Rock, Ark. You probably don’t need to pay much attention to these and should focus on the CPT codes. (If CPT codes are not labeled, you can usually recognize them as five-digit codes.)

Usually, you should see dollar figures that represent actual prices. However, you may encounter files where the price is listed as “variable”; this means that it can be different for two patients who have the same insurance and receive the same care under different circumstances.

Molly Smith, vice president of public policy at the American Hospitals Association, gave the example of a patient who came to the hospital for a flu shot and got a vaccine for surgery against him.

“We usually negotiate the price of the primary service in the contract, but maybe 15 percent off if it’s a secondary service,” he said. It is not possible to reflect this in these files,” he said.

The files must also include two other prices: the “fee” or “gross price”, which is the sticker price of a particular service that hospitals often use as a basis for negotiating discounts. It should also be the “cash” price at which the hospital bills patients who do not use insurance. Whether this price is valid for insured patients varies from hospital to hospital. Some low-income patients may qualify for even higher discounts, depending on how little they earn.

Once you find the data point you are looking for, there may be additional work to understand it. Most hospitals list prices in dollars, but some show data as a percentage of gross pay. — so patients will have to do the math to figure out their costs.

What if I can’t find anything?

Most hospitals have not published the required data so this may be too much.

For example, you can find a patient estimator on NYU Langone’s price transparency website that uses only standard fees and information about your insurance plan to create a custom estimate of how much you’ll pay for a particular procedure.

These tools provide limited information. Standard charges can tell you the maximum amount you can pay for a particular service and show the out-of-pocket costs associated with simple services such as a patient estimator, mammograms and blood tests. But when a Times reporter tried to use NYU’s site at the end of July, it produced error messages for all services investigated.

A representative from NYU Langone declined to comment on why the hospital did not release all of its data.

While compliance rates are still low, the federal government promises to increase enforcement. It has sent nearly 170 warning letters to noncompliant hospitals and plans to increase non-compliance penalties from $109,500 to $2 million annually.

If you feel that a hospital has not published the necessary information, have an ax to grind with the federal government reporting the matter to it.

Soon, third-party sites can help

Some healthcare professionals say large data files will become more useful once third-party data companies clean and organize the information so that patients can search across multiple hospitals and healthcare services.

Turkuaz Health, a data transparency company, already has a free price search tool. Others are expected soon.

Did you see anything surprising? Tell us about it.

The Times has reviewed datasets from 60 hospitals so far. But much more is out there.

If you notice something surprising in a hospital price file – for example, extremely high prices or large differences in the cost of a service – we’d love to hear about it. You can do email us with what you find.