Price transparency implementation: Accessibility of hospital chargemasters and variation in hospital pricing after CMS mandate

Lu, Amanda; Chen, Evan M.; Vutam, Emily; Brandt, J.; Sadda, Praneeth

doi:10.1016/j.hjdsi.2020.100443

Cited by 22 publications

(30 citation statements)

References 9 publications

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“…This variability did not significantly associate with any institutional characteristics. Moreover, our data support prior work showing a lack of availability of chargemaster prices from many institutions, with 33.8% not having ECP chargemaster data available 9 …”

Section: Discussionsupporting

confidence: 86%

“…We encountered great variability in chargemaster pricing for ECP procedures, despite use of the same device and kit in all of the reviewed locations. This variability is higher than other procedures with a SD of 49% versus a SD of 28% determined by Lu et al when evaluating identical line‐item prices for 1,273,366 items in 500 US hospital chargemasters 9 . There was a lack of an association with the institutional characteristics we evaluated.…”

Section: Discussioncontrasting

confidence: 52%

“…Chargemaster prices have been shown to be highly variable, with higher charge‐to‐cost ratios associated with hospitals that are: for‐profit, affiliated with a healthcare system, and practice in an urban setting although some groups show conflicting results 8–11 . Limited large‐scale pricing studies exist; however, most demonstrate variability in pricing, restricted access, and an incomplete listing of procedures 8–12 …”

Section: Introductionmentioning

confidence: 99%

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Extracorporeal photopheresis chargemasters show haphazard billing practices

et al. 2021

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Background United States healthcare spending continues to outpace other developed nations although efforts are being made to increase cost‐transparency. Recent legislation requires hospitals to publish a chargemaster, a list of all billable procedure codes together with prices. Chargemaster prices have been shown to be highly variable, if available, and are not typically paid, but contribute to negotiated rates. Extracorporeal photopheresis (ECP) is performed for a limited number of indications and could serve as a marker of this variability. We investigated the availability of chargemaster documentation for ECP procedures and the variability of pricing as assessed by institutional characteristics. Study design and methods A list of centers with photopheresis systems was obtained from the device manufacturer and the institutional websites were analyzed for chargemaster list prices. Multivariate linear regressions were performed to compare impact of facility variables on chargemaster pricing. Results There are 139 locations in the US which are listed as referral centers for ECP; and chargemaster prices were available in 66.2% of these centers. The range was $571.48–183,452.00, maximum price 321 times greater than minimum, and the median price, after outlier exclusion, was $8989.06 (SD = $4361.72). ECP cost did not correlate with hospital size, facility type, ownership, number of hospitals in the referral region, hospital care intensity index, academic status, or region (p ≥ .05). Conclusions Chargemaster costs for ECP procedures are highly variable and nonuniform, and the current data available for patients undergoing these specialized apheresis procedures is insufficient to afford patients the ability to compare prices.

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Section: Discussionsupporting

confidence: 86%

Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

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Extracorporeal photopheresis chargemasters show haphazard billing practices

et al. 2021

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“…Releasing the DRG chargemasters on the internet was met with little resistance from hospitals, as the information did not compromise revealing negotiated hospital pricing strategies vis-à-vis third-party payors or competitors. Although there was little resistance to the first federal regulation, previous literature has shown an abundance of nonprice-transparent and noncompliant hospitals and hospitals with inaccessible pricing information [8][9][10].…”

Section: Introductionmentioning

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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“…Furthermore, inflated chargemaster prices have made a fair price more elusive for many patients. 2 At the same time, an increasing amount of care is being deemed out-of-network, resulting in a surge in surprise medical bills. 3,4 Patients with low income are particularly affected by these billing trends, which may lead to financial hardship, 5 bankruptcy, 6 avoidance of future medical care, 7 and potentially worse health outcomes.…”

Section: Introductionmentioning

confidence: 99%

Trends in Hospital Lawsuits Filed Against Patients for Unpaid Bills Following Published Research About This Activity

et al. 2021

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IMPORTANCE Suing patients and garnishing their wages for unpaid medical bills can be a predatory form of financial activity that may be inconsistent with the mission of a hospital. Many hospitals in the state of Virginia were discovered to be suing patients for unpaid medical bills, as first presented in a 2019 research article that launched 2.5 months of media attention on hospital billing practices and a grassroots public demand for hospitals to stop the practice. OBJECTIVE To evaluate the association of a research publication and subsequent media coverage with the number of hospital lawsuits filed against patients for unpaid medical bills. DESIGN, SETTING, AND PARTICIPANTSThis cross-sectional study of Virginia hospitals that sued patients for unpaid medical bills used an interrupted time series analysis. Data on hospitals suing patients for unpaid medical bills were collected during a preintervention period (

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Price transparency implementation: Accessibility of hospital chargemasters and variation in hospital pricing after CMS mandate

Cited by 22 publications

References 9 publications

Extracorporeal photopheresis chargemasters show haphazard billing practices

Extracorporeal photopheresis chargemasters show haphazard billing practices

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

Trends in Hospital Lawsuits Filed Against Patients for Unpaid Bills Following Published Research About This Activity

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