A-208 Price Transparency of Laboratory Tests Across all Licensed Hospitals in Tennessee

Abstract

Abstract Background The Hospital Price Transparency Final Rule federally mandates hospitals to provide gross price, discounted cash, payer-specific negotiated charges, and de-identified minimum and maximum negotiated rates within a machine-readable file and user-friendly display of shoppable services. Since implementation, compliance has been low and price variability has continued. Methods To assess hospital compliance, barriers to pricing information, and price variability in Tennessee, all hospitals websites were queried for gross, cash, and Blue Cross Blue Shield (BCBS) prices for 8 high-frequency laboratory tests in both mandated pricing sources. Barriers including click counts, data availability, and intra-hospital price discrepancies were noted. Results Only 2.8% of the 145 hospitals were compliant with federal law. Sub-analyses of the available machine-readable files, price estimators, and shoppable services files, only 50.4%, 4.9%, and 21.4% were found to be compliant, respectively. Barriers to pricing information included requiring protected health information (55.9%), missing at least 1 pricing source (7.6%), having no pricing sources available (6.2%), and involving more than 3 clicks to access cash price in machine-readable files (54.1%) and price estimators (68.6%.) The median total number of clicks from homepage to cash price in the machine-readable file and price estimator was 4 (range: 1-7) and 10.5 (range: 6-15), respectively. Average intra-hospital discrepancy for Basic Metabolic Panel cash prices across pricing sources was $101.30 (range: $0-1012.40). Price variability across Tennessee is shown in Figure 1. Maximum to minimum price multiples ranged from 29 to 114 for gross price, 57 to 243 for cash price, and 25 to 115 for BCBS price indicating price variability. Gross and cash prices were affected by median household income of the hospital’s county. Conclusions Our study shows low compliance with price transparency mandates, inequitable pricing affected by median household income, inconsistent and inaccessible pricing, and continued price variability in Tennessee.