Patients checking their local hospital’s website for the cost of medical services may not find the same prices as those who called on the phone, according to a newly published study.
Across 60 U.S. hospitals, researchers found “wide variation” between the vaginal childbirth and brain MRI prices hospitals listed online—a requirement of price transparency regulations implemented in 2021—and the prices given to secret shoppers who called for an estimate.
The prices “often differed by 50% or more” and sometimes more than 100% for both services and regardless of whether the hospital was highly ranked or a safety-net provider, researchers found.
“These results demonstrate hospitals’ continued problems in knowing and communicating their prices for specific services,” researchers wrote in JAMA Internal Medicine. “The findings also highlight the continued challenges for uninsured patients and others who attempt to comparison shop for healthcare.”
To conduct their study, the researchers sampled 20 hospitals given top spots in U.S. News and World Report’s Honor Roll Hospitals listings, 20 other safety-net hospitals in close proximity to the top-ranked hospitals and then another 20 nearby hospitals that were neither top-ranked nor a safety-net facility.
The researchers collected cash prices from each hospital’s public website between August 2022 and October 2022 for the CPT codes relevant to vaginal childbirth and MRI with and without contrast—two common services included on the Centers for Medicare & Medicaid Services’ (CMS') must-include list of shoppable services. These were compared to the prices given to secret shoppers with a script inquiring about the same procedure as a hypothetical uninsured patient.
Off the bat, researchers found “wide variation” in their ability to obtain the online prices between the hospital types. More than half of the 20 vaginal childbirth prices they were able to obtain came from the top-ranked hospitals. Brain MRI prices were more readily available among the top-ranked (85%) and non-safety-net (100%) hospitals than they were at safety-net hospitals (50%).
Among the facilities with both online and telephone prices available, the statistical correlation between the prices “was poor” for both services.
For the 22 hospitals with two vaginal childbirth prices available, the numbers are within 25% of each other for 45% of hospitals but more than 50% different for 41% of the hospitals. For the 47 facilities with both brain MRI prices available, the estimates were within 25% for 66% of the hospitals but more than 50% at 26% of the hospitals.
“More specifically, for vaginal childbirth, there were five hospitals with online prices that were greater than $20,000 but telephone prices of less than $10,000,” researchers wrote. “For brain MRI, two hospitals provided telephone prices of more than $5,000 when their online prices were approximately $2,000.”
Just 14% and 19% of the facilities had matching prices for vaginal birth and brain MRI, respectively, researchers found.
The investigation also revealed several areas of broad concern for the researchers related to pricing and access. They noted that it was generally easier to get a quote over the phone at the top-ranked hospitals (as measured by the duration of their calls) and that a subset of the billing staff at phoned hospitals were unable to provide a price estimate “despite the hospital having a functioning online price estimator tool.”
Prices for vaginal childbirth and brain MRI within a single given hospital had little correlation, “raising further questions about whether hospitals have a cogent pricing strategy akin to other businesses … or whether this lack of correlation simply reflects a chaotic and disorganized pricing structure,” the researchers continued.
Further, as detailed by other recent studies, online prices reviewed by the researchers varied widely from hospital to hospital and in some cases were clear mistakes ranging from a $0 price tag to a nearly $167,000 brain MRI.
“At best, such erroneous prices may be amusing, but at worst, such errors may trigger further public annoyance with and distrust of our healthcare system,” researchers wrote.
The difficulties researchers outlined are of particular concern to the subset of patients who are either uninsured or underinsured, a population the researchers noted could be growing amid redeterminations. The findings are also a practical demonstration of how hospitals’ continued difficulty complying with federal price transparency regulations could harm a healthcare consumer.
CMS’ enforcement during the requirement’s opening years has been rare but picking up within the past three months, during which the agency issued civil monetary penalty notices to 10 noncompliant hospitals. Prior to that, just four hospitals had been notified of a potential fine.