Prices disclosed by hospitals for 13 “shoppable” imaging services may serve little use to patients, as they fail to include charges for independent radiologists not employed by the institution.
That’s according to new research out of Emory University, published Monday in JAMA Network Open. The Centers for Medicare & Medicaid Services started requiring hospitals to share these payer-specific negotiated rates for care on Jan. 1, hoping to steer individuals toward a more cost-conscious selection of providers to drive down spending.
But health policy experts believe these numbers are of little benefit if they do not incorporate total costs. Analyzing more than 4.5 million hospital encounters for shoppable services, researchers found that episodes frequently involved independent providers who account for a substantial portion of costs but were not included in that initial upfront estimate.
In radiology, between 65% to 87% of services included an independent radiologist, adding anywhere from $26 to $210 in additional reimbursement, dependent on the exam type.
“In some encounters, such as most laboratory and pathology services, the undisclosed reimbursements of independent practitioners were relatively low; thus, the disclosed hospital prices could be beneficial to consumers,” Michal Horný, PhD, with Emory University School of Medicine’s Department of Radiology and Imaging Sciences, and co-authors concluded. “In other encounters, such as some evaluation and management services, radiology services, and most medicine and surgery services, the reimbursement of independent practitioners was often nontrivial and could create a substantial financial burden for patients who may not expect to receive additional bills beyond those from the hospital.”
For their study, Horný and co-authors utilized 2018 information from IBM’s MarketScan Commercial Database, offering a large collection of commercial claims. Alongside the technical payment for an imaging exam many also included the added professional component for an independent rad to read the scan, often not included in the initial estimate. That ranged anywhere from $26 for lower back radiography to $210 for brain MRI. Abdominal ultrasound of a pregnant uterus included more than one additional component not delivered by the hospital about 65% of the time, while mammography screening had one 87% of the time.
In a corresponding editorial, University of Pennsylvania experts argued that patients need better information to make informed decisions. Reference pricing—where payers set a maximum for hospital charges, with all above that the consumer’s responsibility—is one option. “Inclusive shared savings” is another, offering patients a positive incentive to select cheaper facilities.
“Patients would receive financial rewards for selecting less costly treatments, say a $50 bonus card if they selected a lower-cost imaging facility for magnetic resonance imaging or an ambulatory surgical center rather than a hospital for a colonoscopy,” Ezekiel Emanuel, MD, PhD, and Amaya Diana, with the Perelman School of Medicine’s Department of Medical Ethics and Health Policy, wrote Dec. 13. “If we want the information provided on costs to be of any use, we need to properly incentivize the people making care decisions to choose high-quality, lower-cost options.”
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.