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21 March, 2021

Price Transparency in Hospitals – Mostly Nonexistent

65% of hospitals “unambiguously noncompliant” with federal price transparency rule: study shows

Does this scenario sound familiar: You have a procedure or service provided by a hospital and weeks later, you receive a handful of bills, totaling up to exorbitant amounts that you had not anticipated and you’re left contemplating which limb to sell in order to pay them!  And if you try to price-compare shop for medical care ahead of a service, it’s not uncommon to be completely rebuked by a hospital billing department. The truth is, we can all relate to both of these situations as this has become the frustrating reality of obtaining healthcare services in a hospital setting.

To help drive down the rising costs of healthcare and to promote price transparency from providers, several measures have been implemented over the last couple of years. An executive order went into effect January 1, 2019 that required hospitals to disclose prices that patients actually pay and also required healthcare providers and insurers to provide patients with information about their out-of-pocket costs before they receive services. In November of 2019, the Centers for Medicaid and Medicare Services (CMS) issued a new rule expanding on this order, widening the categories of price information that hospitals were already required to publicly disclose.

If this is news to you, there’s good reason for that.

A review of publicly available pricing information from a sample of 100 of the nation’s largest hospitals, conducted by the peer-reviewed journal Health Affairs, found that only 22 of these hospitals were in full compliance and 65 were determined to be “unambiguously noncompliant.”

While this review is disappointing, it shouldn’t come as a surprise when you account for the significant pushback these rules initially received from the American Hospital Association (AHA). Additionally, for decades hospitals have been increasingly incentivized to inflate their prices in order to negotiate higher payment from their in-network insurance providers.

Specifically, when it comes to imaging services, those provided in a hospital or hospital-owned outpatient center, can cost up to 5 to 10 times as much as the same services provided in a freestanding imaging center.

It is this significant discrepancy that lead both Anthem and Cigna to officially stop covering most hospital-based MR and CT imaging procedures, advising their members that freestanding imaging centers offer members lower costs for medically necessary, non-emergent imaging procedures.

Dr. Crues, Medical Director and Vice President of RadNet said, “Radnet‘s out-patient imaging centers are far more available and patient friendly than large hospitals, and the charges are far less for the same imaging procedures using state -of-the-art equipment and specialty trained radiologists to interpret the studies.”

Overall, RadNet is a national leader in providing high quality, cost-effective diagnostic imaging services, and we have been doing so for over 35 years. We are dedicated to advancing early detection of disease and to empowering patients to take charge of their health. We provide transparency with costs and we make it easy for you to find results and answers about your health.

When it comes to imaging, you do have a choice.

21 March, 2021

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