‘Imperfect’ Employer-Supported Insurance Distorts CT and MRI Prices: Study

A new study shows that there is more than a 10-fold gap between the highest and lowest contractual price for conventional imaging services provided in the same hospital.

The average maximum contract price between hospitals and insurance companies for the 13 imaging services analyzed was 3.8 times greater than the average minimum contract price in the same hospital, according to an analysis of data from more than 2,000 hospitals published Tuesday in the journal Radiology. Commercial prices for high-value services, such as CT scans and MRI scans, varied the most among “purchasable” services, as defined by the Centers for Medicare and Medicaid Services, which were studied.

In the most extreme cases, the average maximum contract price for a brain CT scan was 17.9 times the minimum price offered in the same hospital.

“Employers are sick and tired of paying too much and being victims of egregious pricing practices by hospitals and professionals, as well as weak negotiations by some health plans,” said Bill Cramer, senior health policy advisor at Buyr Business Group on Health, a coalition large non-hospital employers.

Employers, including coalition members, are increasingly redefining their coverage plans by contracting directly with hospitals and referring patients to facilities that provide high-quality care at affordable prices. However, employers are often hesitant to limit their employee choices and potentially exclude their preferred service provider from their plans.

The data from the Price Transparency for Insurers Act, which went into effect in July, will help create new health plan benefit plans and has already sparked candid conversations among employers, hospitals and insurers, experts say.

“Only with more transparency in the market can sponsors and health plans plan based on this information to ensure both high quality and fair pricing for these critical services,” said Michael Thompson, President and CEO of the National Buyers Coalition Alliance. medical services, which represents employers.

This is the latest study in a series of multi-year analyzes that demonstrates significant differences in prices for commonly used services. Researchers point to the size of hospital and doctor groups and their impact on negotiations compared to insurers, as well as the ability of insurers to negotiate.

Price fluctuations have a cascading effect, says Ge Bai, a professor of accounting, health management and policy at Johns Hopkins University and co-author of the study. study. Not only are patients responsible for the higher out-of-pocket costs associated with the most expensive services, she said, high healthcare costs also lead to higher insurance premiums and lower wages.

“Insurance premiums are expected to increase by six to eight percent next year, which will undermine wage growth,” Bai said. “The most powerful force to drive down prices is employers who can contract directly or designate an expensive imaging center and send patients there. These efforts start off slowly, but in the end, hospitals may feel the need to cut prices if volume drops.”

Insurance companies are increasingly implementing reference pricing, where prices are based on percentages of Medicare rates. The researchers, however, found that some health insurance plans could negotiate prices less effectively than others.

“There are fundamental drawbacks to employer-sponsored plans,” Bai said. “But this is a good opportunity for employers to make healthcare procurement more efficient.”

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