Rationale and Objectives
In 2019, Centers for Medicare and Medicaid Services enforced regulation from the Affordable
Care Act, requiring all U.S. hospitals to publish standard hospital charges annually.
This study assesses top U.S academic hospitals’ chargemasters for selected advanced
diagnostic imaging services and the usability of publicly available information to
allow consumers to determine out-of-pocket costs.
Materials and Methods
Publicly available chargemasters and associated websites for the top 20 ranked hospitals
in U.S. News and World Report were assessed for several features including: file format,
inclusion of CPT codes, disclaimers on charges versus costs and professional fees,
and tools allowing determination of actual out-of-pocket costs for selected advanced
diagnostic imaging examinations.
Results
All hospitals had publicly available chargemasters, 90% of which were in Microsoft
Excel format. Ten percent of chargemasters included CPT codes. All chargemaster websites
had disclaimers regarding differences between charges versus patient costs; 20% had
disclaimers regarding professional fees. 20% of hospitals provided out-of-pocket costs
for uninsured patients or tools allowing out-of-pocket cost determination. Median
(range) MR exam charges were: brain with and without contrast: $5375 ($834–$13,857),
noncontrast knee: $3402 (4530–$6924); noncontrast lumbar spine: $ 3449 ($473–$7367).
Median (range) CT exam charges were: noncontrast head: $1923 ($165–$4974), noncontrast
chest: $1947 ($282–$2991); contrast abdomen/pelvis: $4307 ($486–$11,726).
Conclusion
While all top-ranked hospitals had publicly available chargemasters, they rarely provided
transparent information to allow patients to determine out-of-pocket costs for advanced
diagnostic imaging services.
Key Words
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REFERENCES
- Price transparency in primary care: can patients learn about costs when scheduling an appointment?.J Gen Intern Med. 2017; 32: 815-821
- The challenge of understanding health care costs and charges.AMA J Ethics. 2015; 17: 1046-1052
- Physician awareness of diagnostic and nondrug therapeutic costs: a systematic review.Int J Technol Assess Health Care. 2008; 24: 158-165
- First, do no (financial) harm.JAMA. 2013; 310: 577-578
- Knowledge of the costs of diagnostic imaging: a survey of physician trainees at a large academic medical center.J Am Coll Radiol. 2016; 13: 1304-1310
- Association between availability of a price transparency tool and outpatient spending.JAMA. 2016; 315: 1874-1881
- Association between availability of health service prices and payments for these services.JAMA. 2014; 312: 1670-1676
- CASE STUDIES IN PRICE TRANSPARENCY. Leading hospitals and health systems recognize that enhancing their patient financial communications can boost consumer satisfaction, loyalty and even the bottom line.Healthc Exec. 2015; 30 (36, 38): 30-34
- Americans support price shopping for health care, but few actually seek out price information.Health Aff (Millwood). 2017; 36: 1392-1400
- Considerations for exchanging and sharing medical images for improved collaboration and patient care: HIMSS-SIIM collaborative white paper.J Digit Imaging. 2016; 29: 547-558
- Awareness, utilization, and education of the ACR appropriateness criteria: a review and future directions.J Am Coll Radiol. 2016; 13: 131-136
- Health care spending in the United States and other high-income countries.JAMA. 2018; 319: 1024-1039
- Out-of-pocket costs for advanced imaging across the US private insurance marketplace.J Am Coll Radiol. 2018; 15 (e1): 607-614
- Health care price transparency and communication: implications for radiologists and patients in an era of expanding shared decision making.AJR Am J Roentgenol. 2017; 209: 959-964
- A randomized trial of displaying paid price information on imaging study and procedure ordering rates.J Gen Intern Med. 2017; 32: 434-448
- How primary care physicians integrate price information into clinical decision-making.J Gen Intern Med. 2017; 32: 81-87
- Patient-physician communication about out-of-pocket costs.JAMA. 2003; 290: 953-958
- Full disclosure—out-of-pocket costs as side effects.N Engl J Med. 2013; 369: 1484-1486
Timbie JW, HP, Burgette L, Wagner NS, Medicare Imaging Demonstration Evaluation Report for the Report to Congress. 2014.
- How much is that head CT? Price transparency and variability in Radiology.J Am Coll Radiol. 2015; 12: 453-457
- The role of states in improving price transparency in health care.JAMA Intern Med. 2015; 175: 886-887
- Medical bankruptcy in the United States, 2007: results of a national study.Am J Med. 2009; 122: 741-746
- US health policy-2020 and beyond: introducing a new JAMA series.JAMA. 2019; 321: 1670-1672
- Mystery of the chargemaster: examining the role of hospital list prices in what patients actually pay.Health Aff (Millwood). 2017; 36: 689-696
- Factors influencing list prices for radiologists' services.J Am Coll Radiol. 2017; 14: 1396-1402
- Consumers' responses to surprise medical bills in elective situations.Health Aff (Millwood). 2019; 38: 425-430
Article info
Publication history
Published online: January 31, 2020
Accepted:
November 27,
2019
Received in revised form:
November 27,
2019
Received:
October 22,
2019
Identification
Copyright
© 2019 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.
