--- title: "Fee estimator for ambulatory care-accuracy, usability. | Sutter Health" description: "QI study: Fee estimator was easy to use and provided accurate results." url: "https://www.sutterhealth.org/research/publications/fee-estimator-for-ambulatory-care-accuracy-usability-1055312808" --- 1. [Home](https://www.sutterhealth.org/) / 2. [Research](https://www.sutterhealth.org/research) / 3. [Research publications](https://www.sutterhealth.org/research/publications) / 4. Fee estimator for ambulatory care-accuracy, usability. # Assessment of accuracy and usability of a fee estimator for ambulatory care in an integrated health care delivery network. Stults CD, Li J, Frosch DL, Krishnan H, Smith-McCurdy G, Jones VG, & Chan AS. _JAMA Netw Open. 2(12):e1917445. doi: 10.1001/jamanetworkopen.2019.17445._ 2019-12-02 ## Abstract Importance: Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed. Objective: To assess accuracy and initial user experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third-party payers. Design, Setting, and Participants: This quality improvement study included patients aged 18 years and older at an integrated health care system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019. Main Outcomes and Measures: Tool accuracy and user experience and satisfaction. Results: As of April 30, 2019, 4610 estimates (3569 \[77.4%\] via internet; 1041 \[22.6%\] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287 estimates (83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (44.0%) with an income of $100?000 per year or higher. Mean (SD) age was 46.8 (13.1) years. Ninety-nine participants (79.2%) found the tool easy to use, 109 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate. Conclusions and Relevance: This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. Increasing the number of searchable services and sharing best practices with other health care systems who share the same portal platform are the next steps for the tool. [PubMed abstract](https://www.ncbi.nlm.nih.gov/pubmed/31834394) ![Jiang Li, Ph.D., MPH](https://dyn.mktgcdn.com/p/H4OFJqNxBzDqkSWaIqDBiZgqIsHNsHLWdLuMd9IlNx0/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Jiang Li, Ph.D., MPH Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/jiang-li-phd-mph-1049681008) ![Cheryl Stults, Ph.D.](https://dyn.mktgcdn.com/p/3IhveEwq-t5WoqAzSNGeAr-4g4yrj4v7x1QcPGdCX_s/fit=crop,gravity=auto,dpr=2,width=188,height=250,quality=100) Cheryl Stults, Ph.D. Principal investigator [View profile](https://www.sutterhealth.org/research/investigators/cheryl-stults-phd-1049681000) ## Research topics - [Health Policy](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Policy%5C%22%22) - [Health Services](https://www.sutterhealth.org/research-search-results?query=%22%5C%22Health+Services%5C%22%22) ## Related publications [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) - Publication ### [An effort to spread decision aids in five California primary care practices yielded low distribution, highlighting hurdles.](https://www.sutterhealth.org/research/publications/effort-to-spread-decision-aids-in-5-pcp-practices-1055312691) Lin GA, Halley M, Rendle KA, Tietbohl C, May SG, Trujillo L, Frosch DL. Health Aff (Millwood). 32(2):311-20. doi: 10.1377/hlthaff.2012.1070 2013 Feb 01 - Publication ### [Health care for the working poor: from focus groups to state policy.](https://www.sutterhealth.org/research/publications/healthcare-wking-poor-focus-grps-state-policy-1055312329) Tierney WM, Kinney ED, Tai-Seale M, Greene JY, Murray R, Latondress T. J Investig Med. 46(7):279A. 1998 Jul 01 - Publication ### [Public reporting of provider performance at a crossroads in the United States: summary of current barriers and recommendations on how to move forward.](https://www.sutterhealth.org/research/publications/public-reporting-of-provider-performance-barrriers-1055312919) Hussey PS, Luft HS, McNamara P. Med Care Res Rev. 71(5 Suppl):5S-16S. doi: 10.1177/1077558714535980. Epub 2014 May 27. 2014 Oct 01 - Publication ### [Patients report better satisfaction with part-time primary care physicians, despite less continuity of care and access.](https://www.sutterhealth.org/research/publications/patient-satisfaction-with-part-time-pcps-1055312882) Panattoni L, Stone A, Chung S, Tai-Seale M. J Gen Intern Med. \[Epub ahead of print\] 2014 Nov 22 - Publication ### [Does the frequency of pay-for-performance payment matter? Experience from a randomized trial.](https://www.sutterhealth.org/research/publications/frequency-of-pay-for-performance-payments-1055312614) Chung S, Palaniappan L, Wong E, Rubin HR, and Luft HS. Health Serv Res 45(2):553-64. doi: 10.1111/j.1475-6773.2009.01072.x. Epub 2009 Dec 31. 2010 Apr 01 [View all publications](https://www.sutterhealth.org/research-search-results?verticalKey=research_publication) ```json {"@context":"https://schema.org","@type":"MedicalOrganization","name":"Sutter Health","@id":"https://www.sutterhealth.org/#medicalorganization","url":"https://www.sutterhealth.org","logo":"https://www.sutterhealth.org/static/images/sutter-health-logo.svg","address":{"@type":"PostalAddress","streetAddress":"2200 River Plaza Drive","addressLocality":"Sacramento","addressRegion":"CA","postalCode":"95833","addressCountry":"US"},"areaServed":{"@type":"AdministrativeArea","name":"California"},"sameAs":["https://www.facebook.com/SutterHealth","https://www.instagram.com/sutterhealth/","https://x.com/SutterHealth","https://www.youtube.com/sutterhealth","https://www.linkedin.com/company/sutter-health","https://en.wikipedia.org/wiki/Sutter_Health"]} ``` ```json {"@context":"https://schema.org","@type":"BreadcrumbList","@id":"https://www.sutterhealth.org/research/publications/fee-estimator-for-ambulatory-care-accuracy-usability-1055312808#breadcrumblist","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https://www.sutterhealth.org/"},{"@type":"ListItem","position":2,"name":"Research","item":"https://www.sutterhealth.org/research"},{"@type":"ListItem","position":3,"name":"Research publications","item":"https://www.sutterhealth.org/research/publications"},{"@type":"ListItem","position":4,"name":"Fee estimator for ambulatory care-accuracy, usability."}]} ``` ```json {"@context":"https://schema.org","@type":"MedicalScholarlyArticle","@id":"https://www.sutterhealth.org/research/publications/fee-estimator-for-ambulatory-care-accuracy-usability-1055312808#medicalscholarlyarticle","name":"Assessment of accuracy and usability of a fee estimator for ambulatory care in an integrated health care delivery network.","headline":"Fee estimator for ambulatory care-accuracy, usability.","abstract":"Importance: Given increased enrollment in high-deductible health insurance plans and mandates from the Patient Protection and Affordable Care Act, individualized price transparency tools are needed. Objective: To assess accuracy and initial user experience of a cost estimation tool for ambulatory procedures delivered via an online patient portal and informed by real-time data feeds from third-party payers. Design, Setting, and Participants: This quality improvement study included patients aged 18 years and older at an integrated health care system in Northern California. Data from patients who used the cost estimator tool from August 21, 2018, to April 9, 2019, and who had matching explanation of benefits statements were used to assess accuracy of the tool. User experience was assessed with a brief survey completed online or via postal mail. Data were analyzed from April 15, 2019, to October 11, 2019. Main Outcomes and Measures: Tool accuracy and user experience and satisfaction. Results: As of April 30, 2019, 4610 estimates (3569 [77.4%] via internet; 1041 [22.6%] via telephone) were produced using the cost estimator tool. Among 342 individuals who had an estimate and a matching explanation of benefits statement, 287 estimates (83.9%) were accurate. All 342 individuals with an estimate and an explanation of benefits statement were invited to participate in a user survey, and 125 individuals completed the survey (36.5% response rate). Survey respondents included 92 (73.6%) women, 72 (57.6%) non-Hispanic white participants , 91 participants (72.8%) with a college degree or higher, and 55 participants (44.0%) with an income of $100?000 per year or higher. Mean (SD) age was 46.8 (13.1) years. Ninety-nine participants (79.2%) found the tool easy to use, 109 participants (87.2%) would use it again, and 100 participants (80.0%) would recommend it to others. Seven participants (5.6%) reported contacting a clinician about the estimate, and 12 participants (9.6%) changed their decision based on the estimate. Conclusions and Relevance: This quality improvement study is the first report of an online cost estimator in an integrated health care delivery network. The findings suggest that the tool, informed by real-time data feeds from third-party payers, was easy to use and provided accurate results. 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