US Hospital Characteristics Associated With Price Transparency Regulation Compliance

Ji, Yunan; Kong, Edward

doi:10.1001/jamahealthforum.2022.1702

Cited by 8 publications

(21 citation statements)

References 4 publications

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“…Third, we were unable to obtain the trauma activation fees for 3.3% of eligible trauma centers; however, the fact that we were unable to obtain the trauma activation fees for some facilities is itself useful information because all hospitals are supposed to make these data publicly available. As we and several other researchers have noted, hospitals do not universally provide these data. Fourth, we only assessed the trauma activation fees for trauma centers that had been verified by the ACS, so our data may not be applicable to trauma centers only verified by their states.…”

Section: Discussionmentioning

confidence: 78%

Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership

et al. 2023

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ImportanceTrauma centers must be readily equipped to handle a variety of life-threatening injuries and consequently may charge a fee for the activation of their trauma team. Regional and hospital-related variations in trauma activation fees across the US have not been formally assessed.ObjectiveTo evaluate the variability of trauma activation fees from trauma centers across the US and examine whether certain hospital characteristics are associated with higher activation fees.Design, Setting, and ParticipantsThis cross-sectional study used data from the American College of Surgeons website to identify all trauma centers in the US that were listed as verified from inception of the verification database through March 4, 2022 (N = 546). Five military hospitals were excluded, and trauma activation fees could not be found for 18 trauma centers; the remaining 523 hospitals were included in the analysis. Each hospital’s publicly available chargemaster (a comprehensive list of a hospital’s products, procedures, and services) was searched to obtain its trauma activation fees. Two levels of trauma activation fees were recorded: tier 1 (full activation) and tier 2 (partial activation). Hospital-specific data were obtained from the American Hospital Association website. All data were collected between January 2 and March 11, 2022. Linear regression analyses were performed to assess potential associations between hospital characteristics (type of control [for profit, government, church, or other nonprofit], hospital system [owner], number of staffed beds, and academic vs nonacademic status) and trauma activation fees.Main Outcomes and MeasuresMedian and mean trauma activation fees nationally and stratified by location, hospital system, and other hospital characteristics.ResultsOf 523 trauma centers included in the analysis, most were located in the Midwest (180 centers) and West (129 centers). There were 176 adult level I trauma centers and 200 adult level II trauma centers; 69 centers had for-profit status, and 415 were academic. Overall, the median (IQR) tier 1 trauma activation fee was $9500 ($5601-$17 805), and the mean (SD) tier 1 trauma activation fee was $13 349 ($11 034); these fees ranged from $1000 to $61 734. Median (IQR) trauma activation fees were highest in the West ($18 099 [$10 741-$$27 607]), especially in California, where the median (IQR) activation fee was $24 057 ($15 979-$33 618). Trauma activation fees were also higher at for-profit hospitals, most of which were owned by the HCA Healthcare system, which had 43 trauma centers and a median (IQR) tier 1 trauma activation fee of $29 999 ($20 196-$37 589).Conclusions And RelevanceIn this study, trauma activation fees varied widely among hospitals in the US. Regional variation in these fees was substantial, with hospitals in the West charging substantially more than those in other locations. In addition, for-profit hospitals charged more than other types of hospitals. These findings suggest that some patients with serious traumatic injuries will incur disproportionately high trauma activation fees depending on the trauma center to which they are brought. Therefore, standardization of trauma activation fees is warranted.

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Section: Discussionmentioning

confidence: 78%

Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership

et al. 2023

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“…5,7 Our own work has highlighted financial motivations such as market competition as a factor associated with compliance. 11 Our current study adds to this literature by reporting, to our knowledge, the largest academic assessment of hospital price transparency compliance for both 2021 and 2022. Our data are unique in that they have the highest degree of completeness (ie, the share of hospitals for which we locate price data), with compliance for each hospital in each year assessed multiple times by different researchers.…”

Section: Discussionmentioning

confidence: 79%

“…Other articles have examined hospital characteristics that correlate with compliance at a given time point . Our own work has highlighted financial motivations such as market competition as a factor associated with compliance …”

Section: Discussionmentioning

confidence: 99%

“…We report novel compliance data over 2 years (2021 and 2022) from almost all acute care hospitals in the US and assess whether increased financial penalties were useful for increasing hospital compliance with the CMS Price Transparency Rule. We report new compliance rates and evaluate why compliance estimates vary widely in the literature . Leveraging our large sample size and an instrumental variable research design with negative controls (sometimes referred to as placebo tests ), we asked whether increases in compliance were associated with increases in penalties across hospitals.…”

Section: Introductionmentioning

confidence: 99%

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Provision of Hospital Price Information After Increases in Financial Penalties for Failure to Comply With a US Federal Hospital Price Transparency Rule

Kong

2023

JAMA Netw Open

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ImportancePrice transparency regulations aim to help patients make informed decisions about medical care, but enforcing these rules is a policy challenge. There may be an association between financial penalties and hospital compliance for enforcing price transparency regulations.ObjectiveTo evaluate the association between financial penalties and acute care hospital compliance with the 2021 Centers for Medicare &amp; Medicaid Services (CMS) Price Transparency Rule.Design, Setting, and ParticipantsThis cohort study uses an instrumental variable design to evaluate the responses of 4377 acute care hospitals in the US operating in 2021 and 2022 to changes in financial penalties in the context of a federal rule requiring hospitals to disclose privately negotiated prices.ExposureChanges in noncompliance penalties between 2021 and 2022 based on a nonlinear function of bed counts.Main Outcomes and MeasuresWhether hospitals publicly posted a machine-readable file with private, payer-specific negotiated prices at the service-code level. Negative controls were used to address confounding.ResultsThe final sample included 4377 hospitals. Compliance increased from 70.4% (n = 3082) in 2021 to 87.7% (n = 3841) in 2022, with 90.2% of hospitals (n = 3948) reporting prices in at least 1 year. Noncompliance penalties increased from $109 500/y in 2021 to a mean (SD) of $510 976 ($534 149)/y in 2022. Penalties in 2022 were substantial, averaging 0.49% of total hospital revenue, 0.53% of total hospital costs, and 1.3% of total employee wages. Compliance increases were significantly positively correlated with penalty increases: a $500 000 increase in penalty was associated with a 2.9–percentage point (95% CI, 1.7-4.2 percentage points; P &lt; .001) increase in compliance. Results were robust to controlling for observable hospital characteristics. No associations were found for preperiod (2021) compliance or ranges of bed counts where penalties do not vary.Conclusions and RelevanceIn this cohort study of 4377 hospitals, compliance with the CMS Price Transparency Rule was associated with increased financial penalties. These findings are relevant for the enforcement of other regulations designed to promote transparency in health care.

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“…Empirical studies have found gradual increases in the proportion of hospitals complying with the new CMS requirements. 2,3 Other studies have found between-hospital variation in posted prices (eg, 20%-50% price differences) for the same service, suggesting potential opportunities for savings if patients were to select lower-cost facilities 4,5 ; such savings are particularly important for the 10% of individuals in the US who are uninsured, but also for other populations, such as those enrolled in high-deductible health plans. 6,7 However, the extent to which a hospital's prices posted online correlate with the prices they give to a telephone caller is unknown.…”

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confidence: 99%

Comparison of Hospital Online Price and Telephone Price for Shoppable Services

Thomas,

Flaherty,

Wang

et al. 2023

JAMA Intern Med

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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.

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US Hospital Characteristics Associated With Price Transparency Regulation Compliance

Abstract: had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Cited by 8 publications

References 4 publications

Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership

Assessment of Trauma Team Activation Fees by US Region and Hospital Ownership

Provision of Hospital Price Information After Increases in Financial Penalties for Failure to Comply With a US Federal Hospital Price Transparency Rule

Comparison of Hospital Online Price and Telephone Price for Shoppable Services

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