In spite of a new price transparency rule that requires all USA hospitals to publish the prices of common health services, comparing prices across hospitals remains challenging due to limited compliance with the law and a lack of standardisation in the available data, according to findings from the Kaiser Family Foundation.
The federal rule, which went into effect on January 1 this year, aims to lift the veil on how much health plans pay hospitals for health services.
To be compliant, hospitals must post payer-specific negotiated rates for medical services and products in two formats on their websites: in a machine-readable file that insurers, employers, healthcare providers, and other stakeholders can use to compare prices across providers; and in a consumer-friendly tool that allows patients to shop for lower-priced care.
However, anyone attempting to make comparisons across hospitals in the USA using the data should exercise caution.
Using data collected from large hospitals across all 50 states and the District of Columbia, the Kaiser analysis found limited compliance with the new federal rule. Only 35 of the 102 hospitals included in the analysis provided some payer-negotiated rates accessible to the public in a machine-readable file; only three provided payer-negotiated rates via consumer tools.
Even when hospitals are compliant, the lack of data standardisation makes it difficult to compare prices across facilities. Many of the hospitals included in the analysis define and describe prices differently. For example, some hospitals include professional fees (e.g. for physician services) in the posted prices, while other hospitals do not and still others do not specify either way. Many hospital machine-readable files are inconsistently formatted and leave out key information, including the full range of payers and plans in a given region.
While the new price transparency data does not yet support price comparison across hospitals, it could in some cases enable analysis of price variation within a hospital. Using payer-negotiated rates from ten U.S. hospitals, the research found significant variation in the price of common services. For example, the price of a lower back MRI at a hospital in New Mexico ranged from US$221 to US$2,142 depending on the payer.
The price transparency rule was intended to enable consumers to comparison shop for certain healthcare services. Hospitals lobbied against the idea, and the analysis suggests that they are now undermining the project by refusing to provide full information or making it too vague to be comparable.
Another reason it is still difficult to do a comparison between one provider and another is that few hospitals distinguish the price difference between inpatient and outpatient care.
The rule does require facilities to name the price and main service alongside any ancillary services and professional fees, but Kaiser found such ancillary services were rarely listed.
These results from implementation, the researcher say, demonstrate a wide range in interpretation and compliance with the hospital rule that requires hospitals to post charges for at least 300 shoppable services on their website in an accessible way.