Recently, I needed to make a doctor’s appointment, while my usual doctor was out of town. I turned, as I almost always do now, to ZocDoc, to find a specialist in my work or home neighborhood, one who took my insurance, and who had an opening in the next few days.
It turns out, as with many other projects, I could not fulfill all constraints at once. If I needed a doctor’s appointment soon, either I’d have to take time off from work to travel to a doctor who took my insurance, or pay the out-of-network rate for a doctor close by.
But what was that rate? ZocDoc, though an excellent resource, doesn’t list prices. I had to make an appointment and wait for someone from the office to call me back to learn that the consultation would cost $500, twice as much as I’d guessed.
As part of the Affordable Care Act, the Center for Medicaid & Medicare now releases data on hospital charges and Medicare payments for a set of the most common procedures, by state. This is good. Another initiative, the Fair Health Consumer Cost look-up, started in New York State, does the same by zip code. Also good.
Neither of these databases go down to the practice level, though, which is what I needed when I was making my appointment. By looking up what I thought would be the right CPT (Current Procedural Terminology, medical procedure codes) in the Fair Health database, I found that the zip code out-of-pocket average for an uninsured patient was $224.96. So I now knew that the out-of-network doctor I was looking at was significantly above average. The in-network average was $67.49. But what can I do with that information?
One of the Knight News Challenge semi-finalists asks a similar question: How can people make better-informed decisions about their health care, without access to better information?
OkCopay wants to create a “reliable nationwide platform that provides clear pricing information for services…. support a more informed and engaged public who are increasingly making decisions about their health… and create health competition among providers based on cost, patient experience, and health outcomes.”
It’s a great idea, and I’m glad the reviewers are considering it for an award. I’d ask two questions if I were part of the review team. First, is there a technological advance being made here? That is, how is this information going to be gathered and updated? Accuracy and timeliness is paramount for a tool like this to be useful. OkCopay promises a “proactive data gathering process,” but if it relies on people for that, it’s going to be slow and costly. Secondly, if past price-shopping initiatives have been unsuccessful, which OkCopay says they have been, why will they be successful?
Eventually, I think this site will have to exist, whether it’s made by OkCopay, or ZocDoc, or someone else entirely. The Affordable Care Act has started a national conversation around health insurance and care delivery–now that they’re talking, people aren’t going to stop until the answers make sense.