I subscribe to a newsletter from Dick Tofel, the head of the investigate journalism outfit ProPublica, and the latest one featured how they have created easy-to-use databases for people researching or navigating the ghastly health care system in the US.
Last week, we updated our tool tracking the performance of more than 4,700 emergency rooms around the country, which we now call ER Inspector. This news app lets you look up emergency room wait times and problems each facility has encountered since 2015. The underlying data is collected by the federal government, but it’s very hard to find or to sift. You can use ER Inspector to show you results from the facilities nearest to you, sort the data by state and rank all of the emergency rooms included on each of these dimensions. It’s an extraordinary collection of information, and it required about six weeks of news apps developer Lena Groeger’s time to update and extend.
ER Inspector is one of several tools our news apps team has built. The most used are Nonprofit Explorer, which offers free access to tax returns filed by nearly 2 million nonprofits over the last six years, and Dollars for Docs, which charts pharmaceutical payments to individual doctors. Another app, Prescriber Checkup, lets you see how your doctor’s drug prescribing compares to peers.
Dollars for Docs was our first major news app, initially published in 2010; an update is coming in the next few weeks, and it will add data from 2017 and 2018. Dollars for Docs has received more than 22 million page views since its launch. Nonprofit Explorer, which made its debut in 2013, has received more than 21.5 million page views, and on many days it is the most popular item on our website.
It is great that ProPublica is creating this easily accessible database. But while this is invaluable for journalists and researchers, ordinary people really should not have to use things like this. It is utterly absurd that in the US sick people have to become researchers so that they do not get ripped off by doctors and the hospital and pharmaceutical industries.
The problem is that even people who are diligent and have the luxury to shop around for the best deal can get shocked. The radio program On Point had a show on September 26th, 2019 on why shopping for health care is nothing like shopping for a car. It interviewed Los Angeles Times reporter Noam Levey who spoke about a couple who were savvy enough to shop around to see what was the best option for the woman to get rid of fetal tissue after she had a miscarriage. They finally chose a hospital that told them that the cost would be $900, similar to some other hospitals in the area. A few weeks after the 20-minute procedure, they got a bill for $5,948.69. It took them ages to get an itemized bill and they found that it had 23 separate items with exorbitant price tags.
When Grimm finally succeeded in getting an itemized bill from the surgical center, she and her husband were floored by the 23 individual charges, including: $65.23 for Lidocaine, an anesthetic; $133.28 for two injections of Ondansetron, a drug to prevent nausea and vomiting; $413 for oxygen; $132.80 for a liter of sterile water.
There were two charges for the surgery itself of $2,380 and $9,782. Grimm’s brief stay in the recovery room cost $720.
“How in the world were we supposed to know how to shop for all that?” she said.
A key element to understanding why the US health system is so outlandish is the billing code system.
Hospitals that can provide a single price for something like a hip replacement typically “bundle” all the services required for the procedure, including the surgeons’ fees, the anesthesia, the use of any medications and the cost of using hospital facilities such as the operating and recovery rooms.
But that’s not the way most medical care in the U.S. is billed. Rather than a single price, hospitals, doctors and other medical providers rely on approximately 10,000 individual billing codes to charge for services. A consumer who wanted to shop would have to price each service separately.
Back in 2009 I wrote a four-part series about my own personal experience with this nightmare of billing codes while shopping for health care for a colonoscopy. I did my homework and spoke to many people (in the doctor’s office, the doctor’s billing office, several insurance company people, and their supervisors) and had detailed discussions for several weeks all before I even saw an actual health professional like a nurse or doctor, just to get an idea of how much it would cost. And after all that, I still got an unexpected bill. In tracking this down, I found out from a low-level insurance company employee (the people who answer the customer-service phones) that it was because the doctor’s office had used a billing code number that was different from the one they should have entered. Even after the doctor’s office sent in the correction, the insurance company would not accept the change and a supervisor whom I spoke to was even annoyed that I knew the billing code numbers and said that I should not have been given this information! Yes, really. After dozens of phone calls, I finally persuaded a lower-level employee to change the number and the charge was dropped.
This is ridiculous. When people get sick, they should go to a hospital and be treated and not worry about getting massive bills. Even many poorer countries have universal coverage, single-payer, free-at-the-point-of-service systems. The US is an extreme outlier in the Byzantine complexity of its system that can shock even the most well-informed consumer with huge surprise bills.