If you’re trying to decide where to go for dinner, you can easily compare restaurant expensiveness online. Inexpensive restaurants are usually designated with one dollar sign, while expensive restaurants have three or four.
But if you need to choose a primary care doctor (PCP), how can you know which are the most and least affordable? Depending on where you live, you could have a handful or dozens of choices—and until now, there was no way to see who is generally expensive, inexpensive, or average.
Amino users now have access to Amino’s Primary Care Cost Rating. The Primary Care Cost Rating is an easy to understand, symbolic system of dollar signs ranging from one dollar sign denoting “inexpensive” to four dollar signs denoting “expensive.”
When you’re logged into your Amino account and search for PCPs, you can see primary care cost ratings on doctors’ profile pages. The rating is specific to the average cost to your health insurance carrier and the individual provider, and it helps you see how your choice of PCP can determine how much you’ll pay for common primary care services.
You may also see PCPs with a “Smart Match” badge when you search. “Smart Match” options in your PCP search results are in-network, experienced providing preventive care, and have a primary care cost rating of or — meaning they are more cost effective than at least 50% of other PCPs nationwide when it comes to providing primary care for people with your insurance.
Amino’s database includes primary care cost data about 167,000 PCPs and 125 insurance carriers, for a total of 11 million cost observations since the beginning of 2014 from over 1.3 million combinations of PCPs and carriers.
To develop the Primary Care Cost Rating, we measure the costs of common primary care services with individual PCPs and specific insurance carriers. We then rate the expensiveness of each PCP for each insurance carrier and display that rating on the provider profile using a range of dollar signs (from to ) and descriptive text.
To measure the costs of common primary care services, we first define the group of health insurance billing claims codes that represent the services of interest. The group of billing codes we use is based on reference information in the Milbank Memorial Fund report Standardizing the Measurement of Commercial Healthcare Spending: 9920x, 9921x, 9924x, 99339-99345, 99347-99350, 99381-99387, 99391-99397, 99401-99404, 99411, 99412, 99420-99429, 99495, 99496, G0402, G0438, G0439.
Next, we identify all billing NPIs (National Provider Identification numbers) associated with each PCP in our database. This accounts for the fact that a PCP can practice at different locations and use different billing NPIs for claims, and it allows us to count all their primary care activity across all their associated NPIs. We then calculate the expensiveness of each PCP for each associated billing NPI.
Finally, to produce an overall expensiveness rating for the PCP with each carrier, we calculate a frequency-weighted average cost for all associated billing NPIs and primary care service codes.
Using this overall expensiveness rating, we then rank all PCPs by expensiveness for each insurance carrier they accept. Each PCP may have a different rank for each carrier, since costs often vary by carrier. This carrier-specific rank is used to determine the primary care cost dollar sign rating displayed on the provider’s profile when you perform a search on Amino.
For example, a PCP with a rating is more cost effective than 75% of other PCPs for primary care services for your insurance carrier. A PCP with a rating is less cost effective than 75% of other PCPs for primary care services for your insurance carrier. A more precise description of each doctor’s ranking is included in the explanatory text that accompanies the rating (e.g. “Dr. Lee tends to be more cost effective than 60% of other doctors who provide primary care.”)
For more information about our methodology, contact us at firstname.lastname@example.org.