(Illustration: Andy Warner)
(Illustration: Andy Warner)

Since June, KQED has been crowdsourcing health care prices.

Why turn to crowdsourcing? Because health care prices are notoriously opaque. Negotiated rates between insurance companies and providers, both doctors and hospitals, are sealed tight, by contract. We know there’s variation, but comparing what one insurance company pays with another is virtually impossible.

So we asked you, the members of our community, to share what you paid.

Together with our collaborators KPCC in Los Angeles and ClearHealthCosts.com, a New York City startup dedicated to health cost transparency, we created a form to make it easy for people to share what they paid — and easy for consumers to see apples-to-apples comparisons of prices.

First off, thank you! Hundreds of you shared what you paid for common health care procedures, and thousands more have searched our database, looking for concrete prices they can count on.

Today, we are also proud to report recognition from the medical community: the journal JAMA Internal Medicine invited me to write a Viewpoint to inform doctors about PriceCheck findings. It was published Monday.

How PriceCheck Works

In PriceCheck we asked people to share prices for four common medical procedures: mammograms, lower-back MRIs, IUDs and diabetes test strips — although plenty of people shared prices for other procedures, too. Our form can take virtually any share.

I described in JAMA Internal Medicine what happens next:

“First, people enter the ‘charged’ price. Next, people who do not have insurance and pay out of pocket enter the self-pay price. People with insurance can submit both what the insurer paid and their copay amount, if any. All shared costs are automatically fed into the database, which we pre-populated with cash prices for 30 to 35 ‘shoppable’ medical tests and procedures; these prices were collected by ClearHealthCosts.com.”

We started with mammograms, because this test is done more than 38 million times a year across the country. Since screening mammograms are a test that can be scheduled, women can, in theory, call around and select a facility based on price.

We thought we would find variation, and indeed we did.

Looking just at the San Francisco and Los Angeles metropolitan areas, we found that the variation in what insurers paid for screening mammograms ranged from $128 to $694.

Specifically in Los Angeles, our KPCC co-conspirator Rebecca Plevin found one woman whose insurer paid $600 more than the lowest-cost screening mammogram in Los Angeles. “I’m sure every woman who’s had a mammogram had the exact same experience I did,” this woman told Plevin. “It was a friendly technician, but I don’t think that’s worth maybe $600 extra dollars.”

In lower-back MRIs, we found that for CPT code 72148, insurers paid from $467 to $1,567. But when looking beyond commercial insurers, we found even greater variation — from a low of $255 to a self-pay price of $6,221 at an academic medical center.

That $255 MRI was paid by Medicare — and was just a fraction of the $2,450 price the facility charged.

But the variation doesn’t stop there, as I described in JAMA Internal Medicine. Yet another person went to the same facility and was charged $603 for the same procedure, same CPT code. This patient had commercial insurance, but paid the entire amount out of pocket, the patient said in comments on our form, since “I had not yet met my deductible.”

For IUDs, women reported that prices insurers paid ranged from $440 to $1,230 (for both the device and insertion.)

We received very few formal submissions for diabetes test strips. But people shared their prices in comments on Facebook or blog posts. Culling from these informal shares, we found that cash prices for a box of 50 strips ranged from $9 to $88.

In an editorial, JAMA Internal Medicine editor Rita Redberg, a UC San Francisco cardiologist, called PriceCheck “bold” and said that PriceCheck is starting to supply “essential information” about price information for common health care tests and procedures.

Why Price Matters

Until recently, consumers didn’t have much incentive to shop on price in health care. They might have paid only a manageable copay; insurance picked up the rest.

But today, many people have high-deductible health plans. So it might matter to you if the price your insurer negotiated at Facility A is hundreds of dollars more than at Facility B.

People told us in comments on stories we wrote and on Facebook of their frustration (“fury” might be a better word):

  • “High deductible so paid the whole thing and then found out I could have had it done for *HALF* the price only blocks away. My first foray into individual insurance and it s***ed. Need to shop around assuming can even get a price quote.”
  • “I was told the procedure was $1850. I have a $7500 deductible. So I talked to (an employee) who said if I paid upfront and agreed not to report he procedure to Blue Cross, that it would be $580.”
  • “How’s a civilian supposed to make sense of this?”

What About Quality?

We’ve received thoughtful and pointed questions on two fronts. First, many people ask about quality. Should people be shopping for health care procedures in the same way they shop for a computer or look for the best price on canned goods?

This is a reasonable question, but the problem is that cost and quality are unfortunately not connected in health care. There’s no evidence that getting the most expensive treatment or procedure will yield a better outcome. People are starting to wonder why they’re paying dramatically more if that extra money isn’t buying better health.

At PriceCheck, we believe that driving cost transparency helps drive quality discussions, too. A new law in Massachusetts requires insurers to make their prices public, in advance. Patients can look up their own costs, based on their plan. Advocates are encouraging people to shop on price.

We also hear skepticism about the reliability of crowdsourced data. While I noted this important caveat in JAMA Internal Medicine, we are also firmly behind our community and the prices they share with us. Yes, these data are crowdsourced and as such may contain errors, I wrote, then added:

“Yet people should be able to understand their medical bills and explanation of benefits statements. Some people who shared their prices provided contact information; we reached some of them to discuss their bills more fully.”

The PriceCheck form and database are open to you. Please visit and search our database for prices — or share what you paid. Help us make health costs transparent!

Author

Lisa Aliferis

Lisa Aliferis is the founding editor of KQED's State of Health blog. Since 2011, she's been writing and editing stories for the site. Before taking up blogging, she toiled for many years (more than we can count) producing health stories for television, including Dateline NBC and San Francisco's CBS affiliate, KPIX-TV. She also wrote up a handy guide to the Affordable Care Act, especially for Californians. Her work has been honored for many awards. Most recently she was a finalist for "Best Topical Reporting" from the Online News Association. You can follow her on Twitter: @laliferis

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