Only 50% of U.S. hospitals have disclosed pricing for lumbar spine MR exams
Only half of US hospitals disclose pricing for lumbar spine MR exams
March 10, 2022
by John R. Fischer, Senior Reporter
Only 50% of hospitals disclose their prices for lumbar spine MR exams online in accordance with the Centers for Medicare and Medicaid Services mandate.
The price transparency mandate, which became effective in January 2021, applies to 300 common or shoppable services, with 70 required by CMS and the other 230 chosen by the hospital. This includes lumbar spine MR, due to the fact that lower back pain is estimated to affect up to 85% of people in their lifetime.
But as of September and October 2021, researchers at the Harvey L. Neiman Health Policy Institute found that only half were abiding by the rule. “CMS’ dual intent of the price transparency mandate is to steer patients toward high-value lower-cost care, thus promoting patient choice, while also discouraging price variability; thus promoting competition across health systems. Our data demonstrate up to 50-fold variability in charges and cash prices for lumber spine MR,” said Dr. Richard Duszak, FACR, Neiman Institute Affiliate senior research fellow, in a statement.
The authors assessed data from 523 hospitals and compared them using star ratings from the Hospital Consumer Assessment of Healthcare providers and Systems (HCAHPS) 2019 survey and Google reviews. Those with high HCAHPS patient-recommendation star ratings (4-5 stars) were 70% more likely to be transparent about pricing. Those focused on quality patient experiences usually ranked in this category.
No correlation was found between hospital quality metrics and lumbar spine MR cash prices or charges. Despite being consistent with other studies, pricing variability should not be considered without taking into account quality of care, according to the authors. “In order to facilitate informed decision-making for price-shopping patients, patient-focused quality metrics should be incorporated in transparency tools.”
Senior author Dr. Gelareh Sadigh adds that variability in pricing and posted service names along with confusion in being able to easily navigate institutional websites can make it challenging for patients to find the best options for them and “casts doubt” on the accessibility and effectiveness of hospital pricing systems. “While CMS sets an expectation for a user-friendly interface to promote use of hospital price platforms, our experience suggests that may not be the case, particularly for patients with average or low health and/or technology literacy.”
Creating greater transparency in hospital pricing is a priority for President Joe Biden, who passed an executive order last year for HHS to crack down on it along with other unfair anti-competitive practices in healthcare, particularly by large hospitals that have created monopolies through large-scale consolidation.
Another study by PatientsRightsAdvocate.org back in July found that just over 5% of hospitals were complying with the price transparency mandate all together. About 80.6% did not publish payer-specific negotiated charges that detail price plans with third-party payers and plans, and 51.6% failed to publish any negotiated rates at all.
This conflicted with 85% of American consumers who said in a poll with PatientsRightsAdvocate.org that making healthcare prices, quality metrics and outcomes more transparent should be a priority for lawmakers.
Another challenge is the estimated cost of compliance, at $11,898.60 per hospital in year one, with the “minimal burden on hospitals for remaining compliance” going forward. Many hospitals have called this unrealistic, according to Brenna E. Jenny, a partner for law firm Sidley Austin’s Healthcare group. “Hospitals can expect that they will need to aggregate a cross-functional team, comprising operations, network system administrators, revenue cycle management and lawyers. Structural implementation decisions should be made as soon as possible, such as whether to use paid claims or data from contract management systems and which 230 shoppable services to post.”
CMS recently increased the penalty for non-compliance from $300 to $5,500 per day. Future studies will be required to assess if this higher penalty will lead to greater compliance.
The findings were published in the Journal of the American College of Radiology.
The price transparency mandate, which became effective in January 2021, applies to 300 common or shoppable services, with 70 required by CMS and the other 230 chosen by the hospital. This includes lumbar spine MR, due to the fact that lower back pain is estimated to affect up to 85% of people in their lifetime.
But as of September and October 2021, researchers at the Harvey L. Neiman Health Policy Institute found that only half were abiding by the rule. “CMS’ dual intent of the price transparency mandate is to steer patients toward high-value lower-cost care, thus promoting patient choice, while also discouraging price variability; thus promoting competition across health systems. Our data demonstrate up to 50-fold variability in charges and cash prices for lumber spine MR,” said Dr. Richard Duszak, FACR, Neiman Institute Affiliate senior research fellow, in a statement.
The authors assessed data from 523 hospitals and compared them using star ratings from the Hospital Consumer Assessment of Healthcare providers and Systems (HCAHPS) 2019 survey and Google reviews. Those with high HCAHPS patient-recommendation star ratings (4-5 stars) were 70% more likely to be transparent about pricing. Those focused on quality patient experiences usually ranked in this category.
No correlation was found between hospital quality metrics and lumbar spine MR cash prices or charges. Despite being consistent with other studies, pricing variability should not be considered without taking into account quality of care, according to the authors. “In order to facilitate informed decision-making for price-shopping patients, patient-focused quality metrics should be incorporated in transparency tools.”
Senior author Dr. Gelareh Sadigh adds that variability in pricing and posted service names along with confusion in being able to easily navigate institutional websites can make it challenging for patients to find the best options for them and “casts doubt” on the accessibility and effectiveness of hospital pricing systems. “While CMS sets an expectation for a user-friendly interface to promote use of hospital price platforms, our experience suggests that may not be the case, particularly for patients with average or low health and/or technology literacy.”
Creating greater transparency in hospital pricing is a priority for President Joe Biden, who passed an executive order last year for HHS to crack down on it along with other unfair anti-competitive practices in healthcare, particularly by large hospitals that have created monopolies through large-scale consolidation.
Another study by PatientsRightsAdvocate.org back in July found that just over 5% of hospitals were complying with the price transparency mandate all together. About 80.6% did not publish payer-specific negotiated charges that detail price plans with third-party payers and plans, and 51.6% failed to publish any negotiated rates at all.
This conflicted with 85% of American consumers who said in a poll with PatientsRightsAdvocate.org that making healthcare prices, quality metrics and outcomes more transparent should be a priority for lawmakers.
Another challenge is the estimated cost of compliance, at $11,898.60 per hospital in year one, with the “minimal burden on hospitals for remaining compliance” going forward. Many hospitals have called this unrealistic, according to Brenna E. Jenny, a partner for law firm Sidley Austin’s Healthcare group. “Hospitals can expect that they will need to aggregate a cross-functional team, comprising operations, network system administrators, revenue cycle management and lawyers. Structural implementation decisions should be made as soon as possible, such as whether to use paid claims or data from contract management systems and which 230 shoppable services to post.”
CMS recently increased the penalty for non-compliance from $300 to $5,500 per day. Future studies will be required to assess if this higher penalty will lead to greater compliance.
The findings were published in the Journal of the American College of Radiology.