Hospital’s limited transparency makes it ‘difficult if not impossible’ to estimate out-of-pocket imaging costs

Matt O'Connor | February 03, 2020 | Healthcare Economics & Policy

Many of the top-ranked hospitals in the United States are doing the bare minimum to improve their price transparency, and patient's aren't able to estimate their out-of-pocket costs for advanced imaging exams because of it. 

That’s according to researchers from Massachusetts General Hospital and NYU Langone Health, who analyzed the publicly available chargemasters and corresponding websites for the top-20 ranked academic hospitals. They determined that most institutions are following minimum federal requirements, and few offer the clear and digestible pricing information that patient’s need to inform their decision-making, according to the analysis published Feb. 3 in Academic Radiology.

“Overall, the lack of CPT code inclusion, inconsistent exam descriptions and presence of non-standardized institution-specific charge codes may make finding and comparing charges for radiology examinations difficult if not impossible for many patients,” McKinley Glover IV, MD, with Mass General, and colleagues wrote.

In 2010, the Affordable Care Act included a provision requiring hospitals to publish a copy of their chargemasters each year. CMS was late in enacting regulatory guidance on the matter, however, addressing and enforcing the measure at the beginning of last year. Although this is an “important step” toward informing consumers, there hasn’t been much research to determine if patients are better equipped to compare imaging prices, nor if they are more informed.

In order to get a better idea of how hospitals are publishing their pricing, the researchers looked at several features of the top 20 U.S. News and World Report-ranked hospitals. The group found all institutions made their chargemasters available to the public, with 90% published in Excel spreadsheets. Only 10% of hospitals included CPT codes.

Without coding information, patients can’t compare charges for the same imaging exam across multiple institutions, the authors noted. Between the 20 hospitals, the group found 19 different descriptions for a brain MRI with and without contrast. Most organizations included institution-specific codes, the authors found. These can help patient’s gauge pricing at a certain hospital, but do not help assess costs across multiple locations.

Each hospital offered disclaimers suggesting their charges might not reflect out-of-pocket costs, but only half acknowledged additional professional service costs may be tacked on to a patient’s bill. Hospitals and patients alike may be better off if institutions were more transparent in this area, the authors argued.

“In the era where increased attention is being directed towards ‘surprise bills,’ healthcare institutions may benefit from being explicit regarding how hospital charges for services may not include physician services and that the bill may come from a different provider entity than the hospital,” Glover et al. wrote.

The researchers did acknowledge that hospitals are doing better, noting that 22% of locations could not offer a price for a non-contrast head CT in a 2015 study. But these institutions could be doing a lot more, they wrote.

“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 authors concluded.

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