A new JAMA Network Open analysis has unearthed low compliance with new federal transparency initiatives, coupled with high outpatient imaging price variability at pediatric hospitals.
Cincinnati Children’s experts targeted top institutions for their study, as determined by recent US News and World Report rankings. Out of 89 sampled pediatric institutions, only 39% were fully compliant with the Centers for Medicare & Medicaid Services new Hospital Price Transparency Rule.
Lead author Shireen Hayatghaibi, PhD, and colleagues also noted sizable markups when comparing mean negotiated prices versus Medicare reimbursement amounts. An MRI of the brain without contrast, for instance, could run for $1,693, a more than sevenfold difference from Medicare’s $230 rate. Meanwhile, the most common deficiency was failing to offer this information in a format that computers can easily process.
“Although our study is focused on top pediatric hospitals, our results are consistent with prior reports that found most hospitals deficient in the machine-readable file stipulation,” Hayatghaibi, with the Department of Radiology at Cincinnati Children’s, and colleagues wrote March 2. “Additionally, imaging prices did not include the professional component for examination interpretation, which further restricts the effectiveness of the transparency policy.”
About 98% of hospitals in the study met the requirement to publish costs for common shoppable services in a consumer-friendly format. More than half (53%) of hospitals in the study omitted minimum and max negotiated rates; 51% left out payer negotiated prices; and 40% skipped cash prices. Among those who did comply with the transparency rule, cash price variation was greatest for retroperitoneal ultrasound (with a coefficient of variance at 84%), CT of the head without contrast (82%) and complete abdominal ultrasound (74%). Actual charge variation for the three exams, however, was less.
Some of the highest markups when comparing Medicare rates to mean negotiated prices included MRI of the abdomen ($368 vs. $2,381) and knee without contrast ($230 vs. $1,539), along with CT of the head without contrast ($109 vs. $1,028) and abdomen and pelvis with contrast ($368 vs. $2,265).
Read more of their results in the Journal of the American Medical Association here.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.