Why do costs for medical imaging procedures vary so much between U.S. hospitals? This is one of radiology’s most enduring mysteries, but a new study in JACR shows that variation may be narrowing in the wake of federal transparency rules.
It’s common knowledge that patients (and payors) can be charged differently for the same healthcare procedure based on the facility where it’s conducted.
- Previous studies have found that patients are surprisingly unclear on how much their imaging exams will cost them.
To clear things up, CMS in 2021 rolled out transparency rules for medical procedures that require healthcare providers to share cost information with patients.
- The rules specified 300 “shoppable” services, including 13 imaging procedures like mammography, abdominal ultrasound, and head CT and MRI scans.
But has the rule been effective in reducing cost variation?
- The new study tackles that question head-on, analyzing cost changes from 2023 to 2024 for three common outpatient imaging exams – MRI brain studies with and without contrast, chest radiographs, and nuclear medicine gastric emptying exams.
Researchers tracked prices for the three exams at 26 U.S. pediatric hospitals, finding …
- The variation coefficient for all three procedures declined 19% (from 27% to 21%).
- The greatest decline in variation was for nuclear medicine gastric emptying (-7.2%) while the smallest was for chest radiography (-2.2%).
- Overall prices rose 6.7% for payor-specific negotiated rates even as variation declined.
- Prices increased 7.7% for nuclear medicine gastric emptying, 6.6% for brain MRI, and 2.6% for chest radiography.
Among the five commercial payors tracked (Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealth), BCBS moved from having the second-lowest prices in 2023 to the lowest in 2024, while Humana was the highest-priced insurer in both years.
The Takeaway
The new results are a classic good news/bad news scenario for radiology. While the reduction in price variation is a positive trend, it appears that the growth in healthcare costs is an inexorable force that even the best-intended legislation can’t derail.
