A Radiology-focused Analysis of Transparency and Usability of Top U.S. Hospitals' Chargemasters

Glover, McKinley; Whorms, Debra S.; Singh, Ramandeep; Almeida, Renata R.; Prabhakar, Anand M.; Saini, Sanjay; Rosenkrantz, Andrew B.

doi:10.1016/j.acra.2019.11.021

Cited by 14 publications

(15 citation statements)

References 24 publications

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“…At this juncture, it is important to digress from the first phase of health price transparency regulation and discuss the implications of the second phase briefly to shed some light on other implications of this study in the context of present health care systems and policies. Although hospitals provide chargemaster data, the standard charges rarely provide information for patients to make informed health care decisions [25]. As a large number of patients are insured, they are more interested in cost sharing information and specific insurer-negotiated pricing rather than standard charges for health care services.…”

Section: Xsl • Fomentioning

confidence: 99%

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Patel¹,

Mazurenko²,

Ford³

2021

JMIR Form Res

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Background The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=−.919; P<.001), efficient use of medical imaging (β=−.458; P=.001), and patient recommendation scores (β=−.414; P<.001), were negatively associated with standard charges. Conclusions We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures.

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Section: Xsl • Fomentioning

confidence: 99%

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Patel¹,

Mazurenko²,

Ford³

2021

JMIR Form Res

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“…Since the implementation of the CMS price transparency rule, several studies have attempted to compare chargemaster charges among institutions for fewer items over larger geographic areas. [24][25][26] One study looked at six advanced diagnostic imaging services across the top 20 ranked hospitals in U.S. News and World Report. 25 Another study analyzed lowdose chest CT scans for lung cancer screening across 55 American College of Radiology accredited imaging centers across the United States.…”

Section: Discussionmentioning

confidence: 99%

“…[24][25][26] One study looked at six advanced diagnostic imaging services across the top 20 ranked hospitals in U.S. News and World Report. 25 Another study analyzed lowdose chest CT scans for lung cancer screening across 55 American College of Radiology accredited imaging centers across the United States. 24 A third study compared chargemaster data for four items across all 110 acute care hospitals in North Carolina.…”

Section: Discussionmentioning

confidence: 99%

“…This was seen in a prior study with 19 different descriptions for head CT without contrast across 20 hospitals. 25 When comparing chargemaster items among Dallas County hospitals, we observed markedly heterogeneous descriptions of synonymous tests and services across institutions, which created several limitations.…”

Section: Chargemaster Accessibility and Usabilitymentioning

confidence: 96%

“…Although these specific price variations may not be generalizable to the rest of the United States, previous studies have identified high variation and prices across different items ranging from 56 to 4,916% difference across items and studies. [24][25][26] The study of chargemasters across North Carolina revealed a 358% variation across institutions ($72.00-258.00) for a complete blood count with differential. This price variation was not as extreme as was identified in our local market (1,375% variation, $48-708) for the same laboratory test.…”

Section: Chargemaster Charge Variationsmentioning

confidence: 99%

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Survey of Hospital Chargemaster Transparency

et al. 2021

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Background In January 2019, the Centers for Medicare & Medicaid Services (CMS) required hospitals to list their standard charges (chargemasters) publicly in an effort to increase price transparency in health care. Surveying hospital chargemasters may be informative to assess the implementation of this rule and its utility to consumers. Objective We aimed to compare hospital chargemaster data within a local hospital market where patients would reasonably try to shop or compare services. Methods We identified and aggregated Dallas County hospital chargemasters available in a database compatible format in May 2019. We manually examined a convenience sampling of 10 common laboratory tests, medications, and procedures. Results Thirteen hospital chargemasters were identified. Eleven hospitals had chargemasters available in a database compatible format (xlsx or csv). These 11 chargemasters were aggregated into a single file containing 155,576 chargeable items, prices, and descriptions. We observed heterogeneous names and descriptions of synonymous items across institutions, preventing automated comparisons. The examined items revealed a high variation in charges. The largest charge variation for laboratory tests examined included a 2,606% difference (partial thromboplastin time: $18.70–506.00), for medications an 18,617% difference (5-mg tablet of amlodipine: $0.23–43.05), and for procedures a 2,889% difference (circumcision: $252.00–7,532.10). One institution accounted for 27% of the lowest prices and another accounted for 60% of the highest prices. Conclusion Chargemaster data presentation varied among the hospitals surveyed, making automatic comparison impossible. Chargemaster data are difficult to interpret for health care decisions. Refining the minimum requirements for publishing chargemaster data could increase their utility.

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Health Care Price Transparency in Ophthalmology

et al. 2021

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transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients.OBJECTIVE To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter economic evaluation study, publicly available price transparency web pages from Association of American Medical Colleges affiliate hospitals were parsed for standard charges and usability metrics. Price transparency data were collected from hospital web pages that met the inclusion criteria. Geographic practice cost indices for work, practice expense, and malpractice were sourced from the Centers for Medicare & Medicaid Services. Data were sourced from February 1 to April 30, 2021. Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges.MAIN OUTCOMES AND MEASURES Availability and variability of standard prices for Current Procedural Terminology (CPT) codes 66984 (removal of cataract with insertion of lens) and 66821 (removal of recurring cataract in lens capsule using laser). RESULTSOf 247 hospitals included, 191 (77.3%) provided consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool. For CPT code 66984, 102 hospital (53.4%) provided discount cash pay estimates with a mean (SD) price of $7818.86 ($5407.91). For CPT code 66821, 71 hospital (37.2%) provided discount cash pay estimates with a mean (SD) price of $2041.72 ($2106.44). The top quartile of hospitals, prices wise, listed included prices higher than $10 400 for CPT code 66984 and $2324 for CPT code 66821. Usability issues were noted for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. Multiple regression analysis found minimal explanatory value for geographic practice cost indices for cash discount prices for CPT codes 66984 (adjusted R 2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R 2 = 0.64; 95% CI, 0.51-0.77; P < .001).CONCLUSIONS AND RELEVANCE Despite recent legislature that codified price transparency requirements, some current standard charges remain ambiguous, with substantial interhospital variability not explained by geographic variability in costs. Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices.

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A Radiology-focused Analysis of Transparency and Usability of Top U.S. Hospitals' Chargemasters

Cited by 14 publications

References 24 publications

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Survey of Hospital Chargemaster Transparency

Health Care Price Transparency in Ophthalmology

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