What “2-D ECHO TTE COMP NO CONTRST” tells you about modern health care.
The Trump administration rang in 2019 by enacting a seemingly great health care policy: requiring all hospitals to list the price of their most common procedures on their websites.
The whole idea was to make the American health care system more transparent, allowing patients to research the cost of care at thousands of hospitals across the country.
“We are just beginning on price transparency,” Medicare Administrator Seema Verma said when she announced the policy last April. “We know that hospitals have this information and we’re asking them to post what they have online.”
Her goal made a lot of sense: It is really hard for patients to research health care prices in our current system. One 2013 study found that nearly all hospitals could give you their parking prices — but barely any could provide an estimate for the cost of their health care services.
The federal government has had this hospital charge data for a while now. I actually wrote about it five years ago, for the Washington Post, when it was first put together.
All in all, it seemed like a common-sense and well-intentioned policy to liberalize health care data. And, on January 1, the policy rolled out into the real world. We’ve quickly seen some big shortcomings in this effort to increase price transparency — ones that tell us a lot about how hard it is to give patients good cost estimates in a health care system rife with secretive prices.
One of the biggest shortcomings? The data that hospitals are posting can be hard to find, and difficult to parse. I looked up the prices at some of my local hospitals in DC.
It usually took me about five to 10 minutes of searching around their websites to locate the price data — not great, but not terrible either. Once I did find it. ... That’s where things got interesting.
I found the price data at George Washington University Hospital pretty easily. But to see it, the hospital required me to check off multiple boxes, acknowledging “price estimates are subject to change” and “charges are not a reflecting of provider or patient responsibility.” Essentially, I had to acknowledge that the prices here might not be the prices that I would face as a hospital patient.
After clicking through the list, I got to the prices themselves. It is a 4,920-row spreadsheet that looks mostly like this:
I couldn’t tell you what a “2-D ECHO TTE COMP NO CONTRST” is, and I’m guessing that most patients couldn’t either.
And even if I knew what a “2-D ECHO TTE COMP NO CONTRST” was, it’s not clear that knowing its price to be $2,283 would help me much either. These are the prices that George Washington Hospital charges for health care, but they are not the prices that insurers pay for health care. Those prices are negotiated in secret, and are not made available in this dataset. Some research has found that the actual prices insurers and patients pay bear little relationship to the published charges.
This isn’t to pick on George Washington University Hospital. This is just what the newly available charge data looks like at lots and lots of hospitals. As Robert Pear writes in today’s New York Times, “the data, posted online in spreadsheets for thousands of procedures, is incomprehensible and unusable by patients — a hodgepodge of numbers and technical medical terms, displayed in formats that vary from hospital to hospital.”
So, how should a patient use this new wealth of charge data? I thought Martin Gaynor at Carnegie Mellon University had the best take on it in a recent interview he gave to Marketplace:
Adams: So what can consumers do with this information to help them make more informed choices about their health care costs?
Gaynor: I would say nothing. I don’t think this is useful information. Now maybe it’s a step in the right direction. Maybe the government is starting here and wants to move in the direction of getting information out there that people actually can use that’s relevant for them and that’s usable, but that’s not what this information is. I don’t think it’s useful and I don’t think consumers should pay attention to it.
I would be a big, big fan of making health care price data more available. That’s the whole point of the ER billing project I’ve been working on for the past year here at Vox. Unfortunately, I have to agree with Gaynor: This new dataset isn’t really one that’s going to do much to help patients. It’s hard to parse, and doesn’t really say much about what you or I would end up paying for our hospital visit.
There are things that the Trump administration could do to make this data set a bit more consumer friendly. They might take a page from how California regulates price transparency. That state requires hospitals to provide the charges for their 25 most common procedures in a consumer-friendly format. All these documents are available on one, state-run website, which means you don’t have to spend time poking around each hospital’s website.
Those sheets are a lot easier to read than the one above from George Washington University Hospital. Here, for example, is part of the charge sheet for one hospital I’ve been writing about lately: Zuckerberg San Francisco General.
What I like about this data is that its written in plain English. You can understand what medical services the different prices actually correspond to.
But, again, even this data runs into significant limitations. This is still just charge data — it doesn’t show the prices that insurance plans negotiate for the patients that they cover.
So unless you’re at a hospital that doesn’t negotiate prices with private insurers — which Zuckerberg does not, but the vast majority of hospitals do — then this charge data still won’t tell you much about your take-home bill for medical services.
Making that data available means doing a lot more than posting charge lists. It means making public the millions of prices that hospitals and insurers currently negotiate in secret. That’s the data patients really need to understand how much their trip to the hospital will cost — but right now, that’s the data that patients still don’t have access to.
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