Commercial Negotiated Prices for CMS-specified Shoppable Radiology Services in U.S. Hospitals
2021; Radiological Society of North America; Volume: 302; Issue: 3 Linguagem: Inglês
10.1148/radiol.2021211948
ISSN1527-1315
AutoresJohn Jiang, Martin A. Makary, Ge Bai,
Tópico(s)Radiation Dose and Imaging
ResumoHomeRadiologyVol. 302, No. 3 PreviousNext Original ResearchFree AccessHealth Policy and PracticeCommercial Negotiated Prices for CMS-specified Shoppable Radiology Services in U.S. HospitalsJohn (Xuefeng) Jiang, Martin A. Makary, Ge Bai John (Xuefeng) Jiang, Martin A. Makary, Ge Bai Author AffiliationsFrom the Broad College of Business, Michigan State University, East Lansing, Mich (J.X.J.); Johns Hopkins School of Medicine, Baltimore, Md (M.A.M.); Johns Hopkins Carey Business School, 100 International Drive, Baltimore, MD 21202 (M.A.M., G.B.); and Johns Hopkins Bloomberg School of Public Health (G.B.).Address correspondence to G.B. (e-mail: [email protected]).John (Xuefeng) JiangMartin A. MakaryGe Bai Published Online:Nov 30 2021https://doi.org/10.1148/radiol.2021211948See editorial byHoward P. FormanMoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In AbstractDownload as PowerPointSee also the editorial by Forman in this issue.IntroductionTo promote price competition and reduce health care costs, the U.S. Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Price Transparency final rule, effective January 1, 2021 (1). Among other provisions, the rule requires that hospitals in the United States display the commercial payer–specific negotiated price (ie, for facility fee only) for 70 CMS-specified common shoppable services, which CMS defines as being routinely provided in nonurgent situations that allow patients to shop for prices and to schedule in advance (1). A total of 13 radiology services are included in the 70 services (1). Understanding commercial negotiated prices for shoppable radiology services has important implications for patients, employers, and insurance plans with incentives and the ability to shop for hospital care (2). A national analysis of the level and range of commercial negotiated prices for the 13 shoppable radiology services was conducted based on disclosed data as of September 6, 2021.Materials and MethodsAll of the 13 CMS-specified shoppable radiology services, representing 13 unique Current Procedural Terminology (CPT) codes, are diagnostic radiology services (1). On September 6, 2021, payer-specific negotiated prices of these services for all hospitals that have disclosed such information were obtained from Turquoise Health, a data service company in San Diego, California, that uses standardized and automated searching algorithms to scan hospital websites for price disclosure information (3). A total of 5700 hospitals (94% of all 6090 U.S. hospitals) had been reviewed by Turquoise Health by that date (4). Turquoise Health used Python (Python Software Foundation), PostgreSQL (PostgreSQL Global Development Group), and open-source DBeaver software to perform its review.Consistent with previous research, the median commercial negotiated price across all commercial plans was obtained for each disclosing hospital for each service (2). The number of disclosing hospitals, the states in which they are located, the median number of contracted health plans, and the median, interquartile range, and 10th and 90th percentiles of their median commercial negotiated price were calculated for each service. The median Medicare rate among all hospitals that disclosed their Medicare rates for each service was also reported to provide a reference price level. The Johns Hopkins institutional review board determined that this study did not require approval because no human participants were involved. Analysis was conducted using SAS software (version 9.4, SAS Institute).ResultsAs of September 6, 2021, a mean of 2053 of the 5700 hospitals (36%) reported the commercial negotiated price for one of the 13 CMS-specified shoppable radiology services, with the median number of plans contracted with a hospital ranging from 10 to 12 across the services (Table). The disclosure rate was the lowest for mammography of one breast (CPT code 77065; 1708 hospitals [30%]) and the highest for CT of the abdomen and pelvis with contrast material (CPT code 74177; 2238 hospitals [39%]). Disclosing hospitals are dispersed across the country. Compared with the Medicare rate, CT examination of the head or brain (CPT code 70450) had the highest median negotiated price ($813 vs $137), and mammography (CPT codes 77065, 77066, and 77067) had the lowest median negotiated prices ($230 vs $101; $289 vs $129; and $235 vs $104, respectively).Commercial Negotiated Prices for CMS-specified 13 Shoppable Radiology Services, as of September 6, 2021The spread of commercial negotiated price was widest for CT examination of the abdomen and pelvis with contrast material (CPT code 74177). The interquartile range was 1.3 times the median, and the 90th percentile to 10th percentile range was 2.3 times the median. On the other hand, the spread was narrowest for mammography (CPT codes 77065, 77066, and 77067). The interquartile and 90th percentile to 10th percentile ranges for mammography were 0.7–0.8 times and 1.3–1.4 times their medians.DiscussionExtending early evidence on hospital compliance with the Hospital Price Transparency rule (2,5), we found that 8 months after the rule went into effect, only approximately one-third of U.S. hospitals disclosed their commercial negotiated prices for one of the 13 U.S. Centers for Medicare and Medicaid Services–specified shoppable radiology services. The level and spread of commercial negotiated prices among the disclosing hospitals varied substantially across the 13 services. Broad transparency on hospital pricing for shoppable radiology services has the potential to benefit payers interested in shopping for affordable hospital care (6).The results of this study are subject to potential selection bias because nondisclosing hospitals might differ from disclosing hospitals in pricing behavior. The cross-plan price variation within the same hospital and the cross-hospital variation within the same plan are beyond the scope of this study. These topics remain promising areas for future research.Disclosures of Conflicts of Interest: J.X.J. No relevant relationships. M.A.M. No relevant relationships. G.B. No relevant relationships.Author ContributionsAuthor contributions: Guarantor of integrity of entire study, J.X.J.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; approval of final version of submitted manuscript, all authors; agrees to ensure any questions related to the work are appropriately resolved, all authors; literature research, M.A.M., G.B.; statistical analysis, J.X.J., G.B.; and manuscript editing, all authorsReferences1. Department of Health and Human Services. Medicare and Medicaid Programs: CY 2020 hospital outpatient PPS policy changes and payment rates and ambulatory surgical center payment system policy changes and payment rates. Price transparency requirements for hospitals to make standard charges public. https://www.federalregister.gov/documents/2019/11/27/2019-24931/medicare-and-medicaid-programs-cy-2020-hospital-outpatient-pps-policy-changes-and-payment-rates-and#p-531. Published November 27, 2019. Accessed July 15, 2021. Google Scholar2. Xiao R, Rathi VK, Gross CP, Ross JS, Sethi RKV. Payer-negotiated prices in the diagnosis and management of thyroid cancer in 2021. JAMA 2021;326(2):184–185. Crossref, Google Scholar3. Users of Turquoise's price transparency data include the National Public Radio, the New York Times, and the Wall Street Journal. A random check of some large hospitals did not reveal any inaccuracy of the data. https://turquoise.health Accessed September 6, 2021. Google Scholar4. American Hospital Association. Fast facts on U.S. hospitals. 2021.https://www.aha.org/statistics/fast-facts-us-hospitals. Published 2021. Accessed July 15, 2021. Google Scholar5. Gondi S, Beckman AL, Ofoje AA, Hinkes P, McWilliams JM. Early hospital compliance with federal requirements for price transparency. JAMA Intern Med 2021;181(10):1396–1397. Crossref, Medline, Google Scholar6. Sachdev G, White C, Bai G. Self-insured employers are using price transparency to improve contracting with health care providers: the Indiana experience. Health Affairs Blog. https://www.healthaffairs.org/do/10.1377/hblog20191003.778513. Published October 7, 2019. Accessed July 15, 2021. Google ScholarArticle HistoryReceived: Aug 1 2021Revision requested: Aug 27 2021Revision received: Sept 10 2021Accepted: Sept 28 2021Published online: Nov 30 2021Published in print: Mar 2022 FiguresReferencesRelatedDetailsCited ByPrice Variability for Common Radiology Services within U.S. HospitalsJohn (Xuefeng) Jiang, Howard P. 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