Wide Price Variations Persist for Common Outpatient Imaging
Published March 2022 | JAMA Network Open
In January 2021, the federal Hospital Price Transparency Rule began requiring hospitals to publish chargemaster rates, discounted cash prices, and payer-negotiated prices in a machine-readable file and publish costs for 300 common shoppable medical services in a consumer-friendly format.
However, a year later, only 39% of the 89 children’s hospitals ranked by U.S. News & World Report were fully compliant with the rule, according to research led by first author Shireen Hayatghaibi, PhD, and colleagues. While 98% of the hospitals complied with the shoppable services requirement, only 39% were fully compliant with both requirements. Many did not provide machine-readable files; 53% omitted minimum and maximum negotiated rates, 51% omitted payer-negotiated rates, 40% omitted cash prices, and 9% omitted chargemaster rates. Medical imaging is an especially common shoppable service, but pricing for similar exams still varies widely based on initial charges, discounted cash prices and negotiated rates with insurers. In many cases, cash prices exceed negotiated rates, exposing the least insured families to the highest costs.
Among fully compliant hospitals, the greatest cash price variation was for retroperitoneal ultrasound (CoV: 84%), computed tomography (CT) of the head without contrast (CoV: 82%), and complete abdominal ultrasonography (CoV: 74%). CoV represents standard deviation divided by the mean, higher numbers mean more variation.
“Most hospitals are not compliant with the transparency law. We were also surprised that hospitals were charging our most vulnerable population, those without insurance, more than those with insurance,” Hayatghaibi says. “It may take more time than many patient advocates had hoped to see more equitable pricing.”
Cincinnati Children’s complies with the transparency law, but now staff are using these learnings to work with families to better understand the financial burden associated with imaging.
Charge and Cash Price Variation for 10 Common Outpatient Imaging Examinations
CT indicates computed tomography; MRI, magnetic resonance imaging; PET, positron emission tomography.
