It all started at the dinner table in February, when Joseph Bernstein told his daughter (then in eighth grade!) about a study of how difficult it was for consumers to find out the cost of a hip replacement.
She was intrigued, and not just by the topic. The lead author of that study was a college undergraduate.
So the Bernsteins wondered: Could the research be followed up by someone just a tad younger?
Dad and daughter set to work.
Joseph Bernstein, a clinical professor of orthopedic surgery at the University of Pennsylvania's Perelman School of Medicine, told his daughter that, in fairness to hospitals, it might be hard for them to quote the price of a hip replacement because the cost varies depending on the patient.
They decided that, instead, she should try asking 20 area hospitals for the price of an electrocardiogram (EKG), a generic procedure that should cost about the same regardless of the patient's age and condition. Then, as a point of comparison, she would call them all again to ask for their parking rates.
Care to guess which phone calls went better?
Of the 20 hospitals, which were not identified in the journal, 19 readily told her their parking fees. (One could not because of a construction-related issue.)
Yet just three of the 20 revealed their price for an EKG. And those prices varied widely: $137, $600 and $1,200.
"It was pretty astonishing," the younger Bernstein said.
Jillian, who sounds fairly grown-up on the telephone, followed a precise script. She told each hospital she was an uninsured patient and would like to pay cash.
Sometimes the people answering the phone told her flat out that they could not provide the price of an EKG. Sometimes she was transferred to someone else, who also could not help. In a few cases, she was directed to call back on another day; she and her father counted that as a "no" response.
"We tried to put ourselves in the position of a patient who was really calling for the information," Joseph Bernstein said. "Could they get it or could they not get it?"
The realm of health-care billing has long been a murky one in the United States, but consumers are starting to seek clarity with the rise of high-deductible insurance plans, said Robert Field, a Drexel University professor of law and public health and a blogger for Inquirer.com and philly.com. The more people have to pay out of pocket, the greater scrutiny they are going to give to the fine print.
And companies are starting to offer help. One is San Francisco-based Castlight Health, which provides cost and quality information to more than 15,000 people covered by large, self-insured employers in the Philadelphia metro area.
Another source is clearhealthcosts.com, a website based in New York City, with data on providers in seven metro areas so far. (The site's operators are considering adding Philadelphia to their list.)
Hospital officials said it was not surprising that Jillian had trouble getting a straight answer with one phone call. It is not the kind of thing that most people who answer the phone have been trained to answer, said John D. Cacciamani, chief executive officer of Chestnut Hill Hospital.
"Frankly, most people don't pick up the phone and make that phone call," Cacciamani said. "And it's got to go to the right person."
Indeed, in an Inquirer mini-survey of five hospitals, several e-mails or phone calls were needed to get an EKG cash price for an uninsured patient from most of them.
Chestnut Hill quoted $60. The others: Crozer-Keystone Health System, $38.69; Virtua Health, $65.40; Abington Memorial Hospital, $140.50 (though a spokeswoman said patients needing financial assistance pay nothing); and Thomas Jefferson University Hospital, $192 (again, steep discounts are given to those who can't pay).
Medicare, meanwhile, pays Philadelphia-area hospitals about $35 for an EKG performed in an outpatient setting.
Jillian said she was attracted by the fact that her question had a straightforward yes-or-no answer.
"It was actually a really cool topic," said the clarinet player and member of the Haverford High School varsity tennis team this year. "Either you could find the price of an EKG or you couldn't."
Asked if she was daunted by the idea of submitting her work to a medical journal at such a young age, she said no, because she did not have high expectations.
"It was kind of unrealistic to think it would make it," she said.
And yet, there it is, published online on Dec. 2: "Research Letter" by Jillian R.H. Bernstein and Joseph Bernstein, M.D.
"It was kind of odd to see my name," she said. "Definitely to get your name out there, especially at a young age, is really cool."
Jillian's mother, Kirsten Hickerson, teaches nursing at Penn, with a focus on pediatrics, and is a doctoral student at the Johns Hopkins School of Nursing.
So, is the ninth grader headed for a career in medicine?
"We haven't talked her out of it," her father said.