For the past year, Vox's Sarah Kliff has been reporting on ED charges, spotlighting unexpected fees patients encounter when they seek ED care. Kliff recently sat down with the Columbia Journalism Review's Elizabeth Hewitt to discuss how the Vox team has approached the project and what they've learned.
How a $629 ED bill for a Band-Aid sparked an interest
Kliff's interest in the project was sparked by a $629 Band-Aid, Hewitt reports. Kliff explained that she received "a handful of medical bills every year" from readers, "but this one just kind of jumped out at me."
According to Kliff, a concerned father in Connecticut had taken his one-year-old daughter to the ED after he accidentally cut her finger while clipping her nails and he saw blood gushing out. When he arrived at the ED, the care team put a Band-Aid on his daughter's finger and sent them both home, Kliff explained. The father later received a $629 bill.
The case led Kliff "down the rabbit hole with" ED bills, she said.
When Kliff examined the $629 bill, she discovered most of the charges came from the ED's facility fees—a base fee most hospitals charge patients for seeking ED services. The fees are generally not publicly shared and vary widely by hospital. As a result, most patients do not know an ED's facility fee until they receive a bill.
Kliff said, "That story happened in May 2016, and I kept it in the back of my head. Wouldn't it be cool, I thought, if we could better understand this interaction that happens millions of times a year where people are constantly getting surprise bills?"
Vox launches project to collect ED bills
In October 2017, the publication put out a call for readers to submit their ED bills, with the goal of building a database to shed light on ED prices throughout the country. Vox focused on facility fees, which Vox called "extremely common but little-understood fees."
Data security and privacy were big concerns for Vox, Kliff said. So the news site "buil[t] a secure platform" to "feel comfortable housing private health care data." Vox's news team had to "work pretty closely" with Vox's legal team to ensure Vox collected the data in a manner that did not carry risks, Kliff said. The data also is off limits to reporters outside of Vox because the readers who submit their ED bills only give the publication permission to read the documents, Kliff said.
According to CJR, Vox's database includes more than 1,600 ED bills. The database has documents from every state and the District of Columbia. Kliff said, "That's one of the things that surprised me: the number of bills we've gotten and the number of interviews I've done."
What Kliff has learned
One theme Kliff noticed in the bills was "a lot of people really struggling financially." She added, "I see a lot of folks who are running into one of two situations: Either they have a high deductible, so they're on the hook for a big chunk of their bill, or they ended up with some kind of out of network charge."
Another observation, according to Kliff, is the breadth of price variation for "very similar services." For instance, using the database, Kliff found that the price for a rabies vaccination—which a person must get if they're bitten by, let's say, a raccoon—cost as much as $14,000 for one patient but significantly less—though still thousands of dollars—for another patient.
How the project is inspiring policy change
Kliff noted, "People are really enthusiastic" to talk about their ED bills. She said, "A lot of them are just so frustrated and [feel] like they have no recourse. They're having their bills sent to collection, and they just feel really helpless in this difficult situation. You know, it can be a surprise how high these fees are."
For some patients, the project has led to financial relief. Since the project launched, Kliff said a number of hospitals have reversed ED bills featured in the series. However, Kliff added, "That being said, I don't think it's a great way to run a health care system."
At the policy level, several senators have introduced bills to stop surprise ED bills "for the first time in years," Kliff noted. For example, congressional aides for Sen. Maggie Hassan (D-N.H.) said Kliff's reporting inspired legislation Hassan sponsored.
Kliff said, "If journalists are focusing on this particular area, then it's an area that's also getting more attention from you know the policymakers who have the power to do something about it"(Hewitt, Columbia Journalism Review, 10/23).
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