February 18, 2022
For Lumbar Spine MRI, only 50% of Hospitals Are Compliant with Price Transparency Mandate
Reston, VA – A new Harvey L. Neiman Health Policy Institute study found that as of September/October 2021, only 50% of hospitals that offered lumbar spine MRI were compliant with the Center for Medicare and Medicaid Services (CMS) mandate to publish their prices online. The mandate became effective in January 2021. This study published in the Journal of the American College of Radiology used website data from 523 hospitals offering lumbar spine MRI to assess compliance with the price transparency mandate. This mandate applies to 300 common or “shoppable” services. Given that low back pain is estimated to affect up to 85% of people during their lifetime, lumbar spine MRI is one of these shoppable services.
Hospitals were compared using star ratings from the Hospital Consumer Assessment of Healthcare providers and Systems (HCAHPS) 2019 survey and Google reviews. The study found that hospitals with high HCAHPS patient-recommendation star ratings (4-5 stars) were 70% more likely to be compliant with the price transparency mandate than hospitals with low patient star ratings (<4 stars). “Our results suggest that hospitals that are focused on the patient experience are more likely to comply with price transparency, a patient-centered initiative” said first author Richard Lin, BS.
“CMS’ dual intent of the price transparency mandate is to steer patients towards high-value lower-cost care, thus promoting patient choice, while also discouraging price variability, thus promoting competition across health systems” said Richard Duszak, MD, FACR, Neiman Institute Affiliate Senior Research Fellow. However, “our data demonstrate up to 50-fold variability in charges and cash prices for lumber spine MRI.” While such pricing variability is consistent with what other studies have shown, the researchers found that there is no correlation between hospital quality metrics and lumbar spine MRI cash prices or charges. These findings indicate that pricing should not be considered separately from quality of care. According to the authors, “in order to facilitate informed decision making for price-shopping patients, patient-focused quality metrics should be incorporated in transparency tools.”
“While CMS sets an expectation for a user-friendly interface to promote use of hospital price platforms, our experience suggests that may not be the case, particularly for patients with average or low health and/or technology literacy” said Gelareh Sadigh, MD, senior author. Variability in both pricing and posted service name along with poor navigability of institutional websites make it difficult for patients to determine their options and “casts doubt on the accessibility and effectiveness of such platforms.”
CMS recently increased the penalty for non-compliance with the price transparency mandate from $300 to $5,500 per day. “Future studies are necessary to assess whether this higher penalty will facilitate higher compliance” said Gelareh Sadigh, MD.
To obtain a copy of the study or to arrange an interview with a spokesperson, contact Nichole Gay at (703) 648-1665 or ngay@neimanhpi.org.
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About the Harvey L. Neiman Health Policy InstituteThe Harvey L. Neiman Health Policy Institute® is one of the nation’s leading medical imaging socioeconomic research organizations. The Neiman Institute studies the role and value of radiology and radiologists in evolving health care delivery and payment systems and the impact of medical imaging on the cost, quality, safety and efficiency of health care.Visit us at www.neimanhpi.org and follow us on Twitter, LinkedIn and Facebook.