Abstract
This economic evaluation uses national pricing information to compare US hospital cash prices and commercial negotiated prices for 70 high-volume common services specified by the Centers for Medicare and Medicaid Services.
Highlights
The 70 Centers for Medicare and Medicaid Services (CMS)-specified hospital services represent 74 unique Current Procedural Terminology (CPT)/diagnosis related group codes (4 services were represented by 2 codes)
Cash prices and payer-specific negotiated prices for the 70 services were obtained from Turquoise Health, a data service company that specializes in collecting pricing information from hospitals
As evidenced by the negative correlation between the median cash price of a service and the number of hospitals disclosing a price for the service, more expensive services were less likely to be disclosed, which might suggest strategic disclosing decisions
Summary
On January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Price Transparency Final Rule to promote price competition and improve hospital care affordability. Hospitals in the US are required to disclose, among other items, the cash prices and the payerspecific negotiated prices for 70 CMS-specified, high-volume common services; the compliance rate has remained low.1-3Cash prices can affect the cost exposure of 26 million uninsured individuals and concern nearly one-third of US workers enrolled in high-deductible health plans, who are often responsible to pay for medical bills without a third-party contribution and are interested in having access to low cash prices. In contrast with the commercial price negotiated bilaterally between hospitals and insurers providing insurance plans, the cash price is determined unilaterally by the hospital and might be expected to be higher than negotiated prices. Hospitals in the US are required to disclose, among other items, the cash prices and the payerspecific negotiated prices for 70 CMS-specified, high-volume common services; the compliance rate has remained low.. In contrast with the commercial price negotiated bilaterally between hospitals and insurers providing insurance plans, the cash price is determined unilaterally by the hospital and might be expected to be higher than negotiated prices. The relationship between these 2 prices, remains largely unexplored because of a lack of available data. Using decision analytical modeling and recently disclosed pricing information, we conducted a national analysis to compare US hospital cash prices with commercial negotiated prices for 70 CMS-specified services
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