Patients hoping to shop around for costly diagnostic imaging services are being greeted with a wall of confusion and incomplete information.
For instance, out of the top 20 U.S. hospitals, providers offered 19 differing descriptions of a brain MRI with and without contrast. And 90% of those same hospitals failed to include universal CPT codes alongside their services, according to a new analysis, published Feb. 1 in Academic Radiology. Many also included institution-specific procedure codes that do not translate from one institution to the next, and only half were transparent about additional charges related to professional services.
All this is only making it a monumental task to compare apples to apples from one hospital to the next, a team of Massachusetts General Hospital researchers determined.
“Overall, the lack of CPT code inclusion, inconsistent exam descriptions and presence of nonstandardized institution-specific charge codes may make finding and comparing charges for radiology examinations difficult if not impossible for many patients,” wrote radiologist McKinley Glover IV, MD, and colleagues.
To reach their conclusions, the team analyzed publicly available chargemasters and corresponding websites for the top-ranked hospitals in the country, as determined by U.S. News and World Report. Hospitals were required to make such information available last year under the Affordable Care Act, with the goal of helping consumers shop around and limit their out-of-pocket costs.
But Mass General researchers found that the change has mostly just perpetuated price confusion. Homing in on advanced diagnostic imaging using CT and MRI, Glover and colleagues found broad variability among chargemasters. Brain MRI with and without contrast, for instance, landed at a median of $5,375, with a range of $834 to $13,857. And CT exams with contrast of the abdomen/pelvis carried a median charge of $4,307, with a range of $486 to $11,726.
Just 10% of chargemasters included specific CPT codes; 20% offered disclaimers regarding professional fees; and another 20% included estimated out-of-pocket costs for uninsured patients. And the wide range in descriptions of specific tests provides ample opportunity for standardization, the team noted, particularly in this “era where increased attention is being directed towards 'surprise bills.’”
“To conclude, while all top-ranked hospitals had publicly available chargemasters which may be beneficial, hospitals rarely provided transparent information to allow patients to determine out-of-pocket costs for advanced diagnostic imaging services,” the team wrote.
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.