Hospital Prices Online Are Not Aligned With Prices Offered via Telephone

Hospital prices posted online for vaginal childbirth and brain magnetic resonance imaging (MRI) did not match the prices offered to a secret shopper via telephone, indicating poor price transparency.

The Hospital Price Transparency Rule requires hospitals to publish a machine-readable file with prices for all services and a consumer-friendly tool with prices for 300 shoppable services. The regulation aims to improve transparency and allow consumers to compare prices across hospitals.

The study published in JAMA Internal Medicine focused on whether hospitals’ prices posted online correlated with the prices they gave over the phone.

Researchers looked at self-posted online cash prices for vaginal childbirth and brain MRI at 20 top-ranked hospitals, 20 safety-net hospitals, and 20 non-top-ranked, non-safety-net hospitals in 2022. They then contacted the hospitals via telephone using a secret shopper approach to request the lowest cash price for each service.

The ability to provide prices for vaginal childbirth and brain MRI varied among the three hospital cohorts. For vaginal childbirth, 63 percent of top-ranked hospitals, 30 percent of safety-net hospitals, and 21 percent of non-top-ranked, non-safety-net hospitals provided both online and phone prices. For brain MRI, 85 percent of top-ranked hospitals, 50 percent of safety-net hospitals, and 100 percent of non-top-ranked, non-safety-net hospitals provided online and phone prices.

For both services, safety-net hospitals had lower online prices than the other two cohorts, but telephone prices were similar for all three groups.

Additionally, there was significant variation between the lowest-priced and highest-priced hospitals for vaginal childbirth and brain MRI across the three hospital groups. Among non-top-ranked, non-safety-net hospitals, the lowest online price for brain MRI was $457, while the highest was $166,994. Meanwhile, among safety-net hospitals, the lowest phone price for vaginal childbirth was $3,882, while the highest was $100,000.

The correlation between online and telephone prices for the services was poor, researchers found. Non-top-ranked, non-safety-net hospitals had the highest correlation between prices for vaginal childbirth, while safety-net hospitals had the highest price correlation for brain MRI. Top-ranked hospitals had the poorest correlation between prices for both services.

Among the 22 hospitals that provided both online and phone prices for vaginal childbirth, the two prices were within 25 percent of each other for ten hospitals, while the price difference was 50 percent or more for nine hospitals.

Among the 47 hospitals that provided both prices for brain MRI, the difference between prices was within 25 percent for 31 hospitals and 50 percent or more for 12 hospitals.

Nearly 20 percent of hospitals had online and phone prices that matched for brain MRI, while 14 percent had prices that matched for vaginal childbirth.

Five hospitals had online prices for vaginal childbirth that exceeded 20,000 but had telephone prices of less than $10,000. For brain MRI, two hospitals had telephone prices of more than $5,000 but had online prices of around $2,000.

“The findings provide evidence of hospitals’ continuing problems in communicating their own prices to patients,” researchers wrote. “These results illustrate the promise of and substantial barriers to translating newly available hospital price data into actionable information that ultimately facilitates comparison shopping.”

Ensuring that consumer-facing price transparency tools are accurate can benefit all patients but can particularly help those who are uninsured or underinsured. Hospitals should prioritize integrating online pricing data with frontline staff to ensure consumers receive proper price information through online tools and by contacting the facility via telephone.