Price transparency rule isn't preventing patients from overpaying thousands for labs & tests


CMS' price transparency rule aims to save Americans money by allowing them to price shop for healthcare services, but it's still common for patients to overpay for their tests and lab work, sometimes by thousands of dollars, according to research released June 8 by pharmacy discount company GoodRx.

The rule, which took effect Jan. 1, requires hospitals to post a machine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a consumer-friendly format. 

Since patients book their tests and lab work ahead of time, these services are some of the most shoppable in healthcare. GoodRx researchers gathered 15 chargemasters from hospitals across the U.S. After ensuring the data was cleaned and standardized, they looked at these services' cash prices, meaning the prices uninsured patients would pay.

The research team found significant price variation across hospitals. For example, X-rays had prices as low as $26 or as high as $1,355. The test with the most drastic price variation among hospitals was an MRI, which ranged from $213 to $12,383.

The report also found price variation within hospitals. For example, Albany (N.Y.) Medical Center listed cash prices of both $3,324 and $2,108 for a brain MRI. Since an internal charge code is the only thing distinguishing those two prices from each other, it is impossible for users viewing the hospital's pricing information online to know which price they will pay.

The GoodRx research team pointed out that the pricing information displayed for hospitals was difficult to understand and analyze, even though they are trained to do so. 

"Pricing data is obscure and requires background knowledge to understand and use," the researchers wrote. "And without proper pricing shopping tools, patients may be unknowingly paying more than they should for a necessary lab or test."

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