How Vox Used Crowdsourcing to Bring Transparency to Emergency Room Fees

by Kanyakrit Vongkiatkajorn


Each year, Americans make about 141 million trips to the emergency room, and in nearly all those visits, patients are charged a “facility fee” for seeking medical service. However, these fees can vary widely—from $500 to more than $3,000—and customers have no way of knowing these charges until they receive their bill. In October 2017, Vox launched a year-long crowdsourcing project to collect readers’ emergency room bills and bring more transparency to these costs. Vox has collected more than 1,500 bills since launching the project and produced multiple stories.


Project Goals: One of the major goals of the project is to bring transparency to emergency room costs. Many Americans don’t even seem to be aware that these emergency room facility fees exist. “It’s not transparent at all,” says Lauren Katz, Vox’s senior engagement manager. “There’s no way to know, if there’s two hospitals in town, which one you should go to or which one will charge you less.” Vox aims to bring more transparency through reporting out and producing stories about the wide range of fees.

Tools and Technology: Vox worked with a team of designers and engineers to build its own secure form for users to submit their bills. This ensured that the form met the organization’s needs in terms of control on the backend, while also helping users feel secure about submitting sensitive information.

Impact: Since launching, the project has collected more than 1,500 bills from more than 1,000 people, including at least one bill from each state in the US. Vox reporter Sarah Kliff, who began the project, has written seven stories based off reader responses, including one story about how drugs to treat rabies can cost as much as $10,000. A week after the project launched, the American Hospital Association, which represents nearly 5,000 hospitals across the country, warned its members about Kliff’s project and told hospitals to “be prepared” to share information about its billing practices. Multiple ER bills have also been reversed as a result of Kliff’s investigations. One source reported that the hospital reversed her entire balance after Vox started inquiring about the fees. The project is currently a finalist for a digital media award in the Annual Health Care Research and Journalism Awards.

Organization Background: Vox is a national online publication, part of several other sites and brands under Vox Media. It is a commercial company that largely relies on advertising on its sites as well as some investments.

Project Resources: The project required a dedicated reporter (Sarah Kliff), a community engagement manager (Lauren Katz), and a team of designers and engineers who built the database. Katz, Kliff, and members of the Vox visuals team check in once a week about the project, and the workload can vary week-to-week. Kliff focuses on reading the submissions and reporting the stories, while Katz manages the existing community, uploads any new emails from submissions each week to the email list, and helps communicate updates to the community through tweets, Facebook posts, and email updates.

Here’s how it happened

The project began with an idea from Kliff, the reporter on the project. Ever since writing a story about one particularly expensive hospital bill, Kliff had been receiving emails from readers encouraging her to explore emergency room bills. In order to narrow the topic, she decided to focus solely on facility fees. Kliff met with Katz and Director of Audience Blair Hickman, Kliff’s editor, and the visuals team, which would design the database. Building the form and backend from scratch took about a month. Once that was finalized, the team put together a promotion plan and launched the project.

Here’s what worked

1. Working with the in-house visuals team to design a custom form

As Katz notes, the form “allowed for maximum control in the backend and security for people who submit bills.” It also gave the team the ability to iterate based on reporting needs, easily organize, track, and tag submissions, as well as find contact information. The custom backend also tracked when people started a form but did not complete it. This later led to Katz doing user testing to improve the form.

2. Creating an advisory network of experts

This helped Vox engage with experts or others who did not have a bill to submit, but wanted to help in other ways. If Kliff had a specific question about an issue, she could engage with this network for advice.

3. Continually updating the community with findings from the reporting

Katz emails both readers and the advisory network any time Kliff publishes a new story related to the project. This helps maintain interest in the project as well as close the feedback loop for those who have already participated.

Here’s what could work have worked better

1. User testing on the form earlier in the process

Though the majority of people submitted their bills, Katz notes that several hundred did not complete the form. After doing some user testing, Katz says the team made several tweaks, including: breaking up the instructions, letting people know upfront how long the form would take, and making the landing page shorter and more tightly focused on submitting the bill. The original landing page looked more like an article, and users said they were confused by the format.

2. Hiring another reporter to help write stories

Katz says that this would help generate more content from the database.

Here’s what else you should know

  • While Vox promoted the project on social media, the biggest increase in submissions came from a new story about the project: “If you look at when we get submissions, there’s always spikes on days that we publish a story,” says Katz. She has also reached out to five or six newsrooms about sharing the project. One newsroom shared links on social, while Vox is in conversations with another newsroom about a partnership that may help the project reach more diverse
  • Projects like this take a lot of work: Katz emphasizes that it’s important to make sure that the reporter involved is really game to do the project and actually has the time to do it. Katz works with Kliff at least once a week on the project. “It does take a lot of time and energy to run this project. It’s definitely not something you can set up, walk away, and six months later, go, look, we got x number of bills.”

Learn More

To learn more, feel free to reach out to Lauren on Twitter or through the Gather platform.

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