Unlike almost anything else you buy, it's usually impossible to know how much you're going to pay for a visit to a doctor or hospital until you've already agreed to pay. And depending where you go, the cost can be wildly different: When researchers tried to figure out how much it costs to get your appendix removed in California a few years ago, they found that the price ranged from $1,529 to $182,955.
A new tool is designed to help—either when you're first choosing a doctor, or when you're at an appointment getting a referral to another specialist. Amino, a San Francisco-based consumer health care company, designed a free cost estimate tool that can show price differences on an interactive map.
The cost estimates are also available in the company's "Find a Doctor" app, which allows patients to also look at data about how experienced a doctor is in a particular procedure, or about the quality of their care. If you have a torn ACL and you're considering surgery, the tool can tell you, for example, how likely it is that you might have to have a repeat surgery later, based on the surgeon's past results. Patients can weigh quality versus cost.
"We're excited to see the way people are going to use this information, because no one's ever had it before," says David Vivero, CEO and co-founder of Amino.
In part, that's because the data was incredibly complex to sort through. Amino pulled data from insurance claims, which have been digitized for years, but never used in this way. With 68,000 diagnostic codes, errors are common ("There's a lot of people born in the 1600s because someone typed in the wrong digit," Vivero says). Insurance companies haven't had an incentive to share the data, though a growing number of states are asking for more transparency.
Amino had to develop methods to protect patient privacy in the hundreds of millions of records they compared, clean up the mistakes, and build a model that could accurately predict the cost of a procedure for a particular doctor (taking into account the fact that each procedure might involve multiple steps that are each billed separately).
There's even more need for this data now than there has been in the past. "People's deductible, on average, have grown six times faster than their wages just in the past five years," says Vivero. "That means that you're essentially paying more for your health care every single year."
The health care industry has argued that high deductibles mean that consumers will shop around more carefully for doctors, but that's impossible to do if people don't know in advance what something will cost.
"A lot of people seem to think in the industry that a high deductible plan is, and I'm not kidding, a 'consumer directed health plan,'" says Vivero. "They think that because the plan is more high-risk for the consumer, they're naturally going to have this Adam Smith-like, capitalistic kind of epiphany, and immediately shop based on price."
Some experts argue that if prices are transparent, it will help bring costs down for consumers. Vivero thinks that will take a long time in a $3 trillion industry with complex processes, but if enough people use the tool, it could be influential. "Having open access to information has always been a good thing for the efficiency of industries and being more empathetic towards customers," he says.
So far, the tool includes 49 different procedures, ranging from allergy tests and Pap smears to various vaccines and surgeries. Amino hopes to quickly expand the list. "Our mission is to create the clearest picture of American health care," he says. "We've barely scratched the surface, if you think about that."
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