The hospital price transparency rule went into effect this past January, but a new dive into the numbers revealed low compliance rates, as well as "startling" variations between commercial and Medicare rates for diagnostic radiology exams.
The research paper, published Tuesday in Radiology, unveiled a slew of curious figures for imaging services. In some situations, a private payer rate came in 10 times higher than a Medicare rate for an exam with the exact same CPT code. This, in addition to hospital compliance, or lack thereof, was cause for concern for Howard P. Forman, MD, MBA, with Yale University's School of Medicine.
“The results are at once unsurprising and startling. Price transparency has always been a challenge for healthcare. However, one would expect that the force of federal law would induce compliance,” Forman wrote in an editorial published alongside the analysis.
Experts examined the 13 CMS-specified shoppable diagnostic radiology services included under the federal law, along with disclosed negotiated prices for these exams across 5,700 hospitals (94% of all U.S. hospitals).
Researchers discovered that the vast majority of U.S. hospitals are not in compliance with price transparency stipulations, with only 36% adhering. Just as concerning, Forman noted, is that median negotiated prices for commercial versus Medicare rates often differed substantially for the exact same exam.
CT scans of the brain or head, for example, had the highest median negotiated price range for Medicare at $813 versus $137, while mammography had the lowest variance. On the commercial side, contrast-enhanced CT scans of the abdomen and pelvis had the greatest range.
“Why should performance, not the interpretation, of a single brain CT examination vary by 10-fold between the lowest and highest negotiated rates?” Forman questioned. “If there is more value in one imaging study than another identical one, then ask yourself why.”
As hospitals eventually begin to comply with transparency laws, the authors caution that patients will be armed with the freedom to choose where to spend their money. This, they noted, may negatively impact some markets, particularly academic practices.
“This will not stop at price discovery. We will likely be required to report on quality, too. We would do well to be prepared,” Forman warned.
You can read the full paper and editorial in Radiology.
In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She joined Innovate Healthcare in 2021 and has since put her unique expertise to use in her editorial role with Health Imaging.