New research shows that there exists a gap of more than 10 times between the highest and lowest negotiated prices for common imaging services provided at the same hospital.
The average hospital-insurance maximum negotiated price for the 13 radiology services analyzed was 3.8 times higher than the average minimum negotiated price within the same hospital, according to one analysis. The analysis of data from more than 2,000 hospitals was published Tuesday in the journal Radiology. Commercial prices for high-cost services, such as CT scans and MRIs, vary the most among “affordable” services, as defined by the Centers for Medicare and Medicaid Services, studied. assist.
In the most extreme cases, the average maximum deal price for a brain CT scan was 17.9 times higher than the minimum offered in the same hospital.
“Employers are fed up with overpaying and falling victim to stereotypes,” says Bill Kramer, senior advisor for health policy at the Health Buyer Business Group. Severe pricing by hospitals and specialists, alliances of major non-hospital employers.
Employers, including those represented by the union, are increasingly resetting their insurance plans by contracting directly with hospitals and directing patients to providers. High quality care at an affordable price. However, employers are often hesitant to limit employee options and potentially remove preferred providers from their plans.
Data gathered through the pricing transparency law for insurers, which takes effect in July, will spur new health plan benefit designs and has spurred calls, experts say frank conversation between employer, hospital and insurance company.
“Only with greater market-wide transparency can donors and health plans act on the information,” said Michael Thompson, president and CEO of the National Alliance of Healthcare Purchaser. to ensure both high quality and fair prices for these critical services.” represent employers.
The new study is the latest in years of analysis showing significant price differences for widely used services. The researchers blamed the size of hospitals and physician groups and the negotiating leverage involved with insurers as well as the bargaining power of insurers and the reasons for the differences. separate.
Ge Bai, a professor of accounting, health and policy management at Johns Hopkins University and a co-author of the study, says price changes have a cascade effect. Not only are patients responsible for the higher out-of-pocket costs associated with the highest-priced services, she said, high healthcare prices also lead to higher premiums and lower wages.
“Premiums are expected to increase by six to eight percent next year, and that eats into wage growth,” Bai said. “The most powerful force for lowering prices are employers, who can either contract directly or designate a high-value imaging center and direct patients there. These efforts start slowly but gradually – hospitals may feel pressure to lower prices if output falls. “
Insurers increasingly practice reference-based pricing, where prices are based on a percentage of the Medicare rate. However, the researchers found that some health plans can negotiate prices less effectively than others.
“There are fundamental flaws with employer-sponsored plans,” says Bai. “But this is a good opportunity for employers to make healthcare purchases more efficient.”
