Hospital transparency efforts fail to curb rising imaging prices

Hospital transparency efforts are failing to curb rising imaging prices, according to new research published Friday. 

Federal rules since 2021 have required hospitals to publish prices for hundreds of “shoppable” healthcare services such as back X-rays or mammograms. The idea was to help patients select care based on cost and compel hospitals to behave more competitively with their offerings, experts write in JACR. 

An analysis of pricing data from 26 children’s hospitals demonstrates mixed results four years later. Variation in negotiated rates declined by over 19% between 2023 and 2024, and payer-specific negotiated imaging prices climbed 7%. 

“While hospital price transparency intends to decrease both variation and price levels, only variation decreased in this study while prices continue to rise,” Summer Kaplan MD, MS, a radiologist with Children's Hospital of Philadelphia, and co-author Philip Krotenok wrote May 2. “Factors such as inflation, the premium hospitals place on their ranking and quality, and consolidation across both hospital and insurer markets may cause continued price increases. Nevertheless, transparency remains an important policy lever.”

For the study, researchers downloaded machine-readable pricing files directly from each hospital’s website. They focused on three pediatric radiology procedures that represent a range of cost and utilization levels: MRI of the brain with and without contrast, radiographs of the chest with two views, and nuclear medicine gastric emptying. Kaplan et al. only included national insurers—Aetna, Blue Cross Blue Shield (BCBS) plans, Cigna, Humana, and UnitedHealthcare—to reduce geographic variation in pricing. 

The coefficient of variation for payer-specific negotiated rates across all procedures fell from 26.6% to 21%. This represents a 19.2% relative reduction or 5.6% absolute reduction, the authors noted. Nuclear medicine gastric emptying saw the greatest drop in variation with an absolute decrease of 7.2%, and chest radiographs saw the smallest (2.2%). 

“The low complexity, minimal operation costs, and already low and standardized pricing of [chest radiography] may suggest prices are near margin, leaving little room for further reduction in variation,” the authors noted. “It appears that high-cost procedures may be more reactive to transparency efforts. Overall reduction in price variation is a promising sign of hospital price transparency’s impact; however, variation remains relatively high.”

Price levels increased for all three procedures between 2023 and 2024. Gross charges increased by about 6.5%, the discounted cash price climbed 6.1% and the payer-specific negotiated rate 6.7%. Negotiated rates increased by 2.6% for chest X-rays, 6.6% for brain MRI and 7.7% for the nuclear medicine test. In 2024, BCBS had the lowest price position and UnitedHealthcare was second lowest. Humana, meanwhile, consistently ranked as the highest-priced insurer, “indicating limited pricing flexibility within its negotiated rates.”  

The pre-proof study is limited by its small sample size and focus on only three procedures. However, the authors hope their findings indicate that, given more time, hospital price transparency initiatives will further impact patient care. 

“As stakeholders adjust to the availability of pricing data, more substantial effects on both price levels and variation may emerge,” Kaplan and Krotenok wrote. “Transparency promotes accountability, supports value-based care, and enables researchers to analyze pricing patterns and evaluate value. While critics argue that transparency may have limited impact on demand-side behavior—given that the top 5% of healthcare users account for nearly half of healthcare spending—it remains especially relevant in radiology, where out-of-pocket costs have increased significantly.”

Read more in the Journal of the American College of Radiology.