50% of Hospitals Meet Price Transparency Rule for Lumbar Spine MRI

Only 50 percent of hospitals that offered lumbar spine MRI services were compliant with the CMS hospital price transparency rule, according to a study from Harvey L. Neiman Health Policy Institute.

The hospital price transparency rule requires health systems to post a public list of standard charges, payer-negotiated charges, and discounted cash prices for 300 shoppable services that they offer.

In September and October 2021, researchers looked at 523 websites of hospitals that offer lumbar spine MRI to learn if the health systems were complying with the mandate. Lumbar spine MRI is included in the required shoppable services as more than 85 percent of individuals experience lower back pain during their lifetime.

Only half of the hospitals were compliant with the price transparency rule and published prices for lumbar spine MRIs.

In addition to looking at the hospital compliance rates, the researchers looked at hospital star ratings from the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) 2019 survey. The HCAHPS survey measures patient experience and publicly reports the results to create incentives for hospitals to improve their quality of care.

Hospitals that had high HCAHPS star ratings of four or five stars were 70 percent more likely to comply with the price transparency rule compared to hospitals with low star ratings, the study found. These results suggest that hospitals that prioritize the patient experience are more likely to publicly post prices for services, another patient-centered initiative, according to Richard Lin, BS, one author of the study.

The price transparency rule aims to direct patients toward quality, low-cost care while promoting competition across health systems and discouraging price variability.

However, for the hospitals that did comply with the rule, researchers found up to 50-fold variability in prices for lumbar spine MRIs. Additionally, the researchers found no correlation between hospital quality metrics and lumbar spine MRI cash prices or charges.

This suggests that providers should incorporate patient-focused quality metrics into transparency tools to help patients decide where to seek care.

“While CMS sets an expectation for a user-friendly interface to promote the use of hospital price platforms, our experience suggests that may not be the case, particularly for patients with average or low health and/or technology literacy,” Gelareh Sadigh, MD, senior author of the study, said in the press release.

According to Sadigh, variability in the prices and names of the services, combined with poor navigation features, can make it difficult for patients to understand all their available options. A lack of uniform price transparency tools may render the resource inaccessible and ineffective for users, the authors said.

In November 2021, CMS stated that hospitals with less than 30 beds would receive penalties of $300 per day for noncompliance with the rule. Hospitals with 31 or more beds would receive a $10 penalty per bed per day, with a maximum daily penalty of $5,500.

“Future studies are necessary to assess whether this higher penalty will facilitate higher compliance,” Sadigh said.

Since the price transparency rule went into effect on January 1, 2021, compliance among hospitals has been spotty.

A recent report from PatientRightsAdvocate.org found that only 14 percent of hospitals complied with the mandate. The report also noted that noncompliant hospitals have yet to receive any penalties from CMS.

Price estimator tools, the digital front door, and a solid team of workers may help providers comply with the rule and develop strategies that benefit patients.