Hospitals' infrequently published prices suggest substantial variance in radiology service charges to commercial payers

Despite the threat of daily fines, hospitals have so far been slow to publish their prices online in accordance with a new federal regulation.

Radiology services look to be no exception, with new study data now suggesting roughly two-thirds of U.S. hospitals have not published commercial negotiated prices for at least one of the 13 radiology services designated as a common shoppable service by the Centers for Medicare & Medicaid Services (CMS). Hospitals are required to publish these prices in compliance with CMS' Hospital Price Transparency final rule.

Further, the hospitals that did share their radiology service commercial negotiated prices appear to be all over the map, often setting price tags that varied by hundreds or thousands of dollars for certain imaging services.

The analysis—published in Radiology by Michigan State University and Johns Hopkins researchers—found than a mean 2,053 out of 5,700 hospitals (36%) had reported a price for one of these services as of Sept. 6.

Disclosures were least common for mammography of one breast (1,708; 30%) and highest for computed tomography (CT) of the abdomen and pelvis with contrast material (2,238 hospitals; 39%), the researchers wrote. Hospitals that disclosed the commercial negotiated prices were dispersed throughout the country.

Among those that did post their prices, the researchers found hospitals raising prices highest for CT exams of the head or brain, where the median negotiated price of $813 far outstripped the $137 charged to Medicare.

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Mammography of one breast, both breasts or bilateral screening saw the lowest increases, ranging between $230 and $289 for median commercial negotiated prices versus $101 to $129 for Medicare rates.

Researchers saw the widest variety in the posted commercial negotiated prices for CT examination of the abdomen and pelvis with contrast material, where some hospitals charged thousands of dollars more than the Medicare rate of $431 as well as the the median negotiated price of $1,654.

Commercial negotiated prices were the most consistent for the three mammography services.

“The level and spread of commercial negotiated prices among the disclosing hospitals varied substantially across the 13 services,” the researchers wrote in the journal. “Broad transparency on hospital pricing for shoppable radiology services has the potential to benefit payers interested in shopping for affordable hospital care.”

The researchers conducted their analysis using data gleaned from hospitals’ websites by price transparency startup Turquoise Health, according to the study.

They noted that the pricing results they reviewed could be subject to selection bias, as hospitals that did not disclose the prices for these radiology services could have different approaches to commercial pricing.

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Evidence of such stark variation underscores the need for greater transparency, Howard P. Forman, M.D., professor of diagnostic radiology, public health, economics and management at Yale, wrote in an accompanying commentary.

Hospitals and health systems’ reluctance to comply with CMS’ price transparency requirements “are at once unsurprising and startling,” he wrote, and unfortunately come with numerous burdens for other stakeholders across the system.

“Consumers, increasingly, are being asked to bear cost-sharing (e.g., copays, deductibles and coinsurance) for their medical imaging and may want to use price as a factor in choosing an imaging provider,” he wrote. “Insurance companies and large employers … deserve to consider cost in their decision making about choice and considering options. Outpatient radiology practices can more effectively compete in a marketplace, perhaps opening more centers where there is sufficient demand, when they have clearer price discovery.

“Although it remains to be seen if [price transparency] will help lower healthcare costs, there is reason to believe that it should,” he wrote.

Researchers and firms have released a slew of analyses through 2021 detailing providers’ limited and inconsistent compliance with the CMS rule, which went into effect at the top of the year. The limited price data that been have disclosed so far suggest hospitals are charging patients and payers a broad range of prices for the same basic services.

Hospitals, for their part, have pointed to what they consider to be confusing language in CMS’ rule as a barrier to their good-faith efforts to achieve compliance. CMS has since unveiled a bigger stick, announcing in early November that it would be increasing the penalties for organizations that are noncompliant.