Comparison of Hospital Online Price and Telephone Price for Shoppable Services

Abstract

ImportanceUS hospitals are required to publicly post their prices for specified shoppable services online. However, the extent to which a hospital’s prices posted online correlate with the prices they give to a telephone caller is unknown.ObjectiveTo compare hospitals’ online cash prices for vaginal childbirth and brain magnetic resonance imaging (MRI) with prices offered to secret shopper callers requesting price estimates by telephone.Design, Setting, and ParticipantsThis cross-sectional study included cash online prices from each hospital’s website for vaginal childbirth and brain MRI collected from representative US hospitals between August and October 2022. Thereafter, again between August and October 2022, simulated secret shopper patients called each hospital requesting their lowest cash price for these procedures.Main Outcomes and MeasuresWe calculated the difference between each hospital’s online and phone prices for vaginal childbirth and brain MRI, and the Pearson correlation coefficient (r) between the online and phone prices for each procedure, among hospitals able to provide both prices,ResultsA total of 60 representative US hospitals (20 top-ranked, 20 safety-net, and 20 non–top-ranked, non–safety-net hospitals) were included in the analysis. For vaginal childbirth, 63% (12 of 19) of top-ranked hospitals, 30% (6 of 20) of safety-net hospitals, and 21% (4 of 19) of non–top-ranked, non–safety-net hospitals provided both online and telephone prices. For brain MRI, 85% (17 of 20) of top-ranked hospitals, 50% (10 of 20) of safety-net hospitals, and 100% (20 of 20) of non–top-ranked, non–safety-net hospitals provided prices both online and via telephone. Online prices and telephone prices for both procedures varied widely. For example, online prices for vaginal childbirth posted by top-ranked hospitals ranged from $0 to $55 221 (mean, $23 040), from $4361 to $14 377 (mean $10 925) for safety-net hospitals, and from $1183 to $30 299 (mean $15 861) for non–top-ranked, non–safety-net hospitals. Among the 22 hospitals providing prices both online and by telephone for vaginal childbirth, prices were within 25% of each other for 45% (10) of hospitals, while 41% (9) of hospitals had differences of 50% or more (Pearson r = 0.118). Among the 47 hospitals providing both online and phone prices for brain MRI, prices were within 25% of each other for 66% (31) of hospitals), while 26% (n = 12) had differences of 50% or more (Pearson r = −0.169). Among hospitals that provided prices both online and via telephone, there was a complete match between the online and telephone prices for vaginal childbirth in 14% (3 of 22) of hospitals and for brain MRI in 19% (9 of 47) of hospitals.Conclusions and RelevanceFindings of this cross-sectional study suggest that there was poor correlation between hospitals’ self-posted online prices and prices they offered by telephone to secret shoppers. These results demonstrate hospitals’ continued problems in knowing and communicating their prices for specific services. The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for health care.

Episode-Based Cost Sharing to Prospectively Guarantee Patients’ Out-of-Pocket Costs

“…Yet, recent efforts—such as the Hospital Price Transparency or the Transparency in Coverage rules—fell short of their intended goal . Although patients can now obtain out-of-pocket cost estimates for select medical procedures, these quotes are often inaccurate (patients being charged for services not included in quoted prices), and prove incomprehensible to allow informed medical decisions. Because unpredictable out-of-pocket costs create barriers to essential services, and unexpected medical costs increasingly are a source of financial strain, the provision of guaranteed out-of-pocket cost information before care is delivered would mitigate many of these known limitations.…”