Even at elite hospitals, the prices make no sense

In the market for healthcare services, one might assume that higher-quality care comes at a higher price. But even among America’s most prestigious hospitals, prices for common tests and services vary considerably, a new study finds.

Under the 2021 hospital price transparency rule, hospitals are supposed to reveal the prices they negotiate with each insurer, as well as the price someone would pay if they used no insurance and just paid cash. This allows researchers to see the actual prices insurers are paying for all tests and procedures, not just what hospitals charge insurers before negotiations take place. The price transparency rule has opened up a wealth of data for researchers to compare prices across hospitals, and within hospitals among different insurers.

In a recent study in JAMA Internal Medicine, researchers at the Center for Outcomes Research in Cardiology at Beth Israel Deaconess Medical Center used hospitals’ newly-revealed price transparency data to compare prices across several common cardiovascular tests and procedures. To compare differences in price among hospitals with similar quality of care, they looked at the 20 hospitals at the top of the US News & World Report ranking for 2021.

Nonsensical prices

This information was not easy to find. Only seven of the 20 hospitals were fully compliant with the price transparency rule, and four hospitals (NYU Langone, Stanford, UCSF, and Vanderbilt) had no payer-specific or self-pay prices available for the cardiac tests and procedures studied.

But the prices they did find were telling. The median price of common tests such as an echocardiogram or stress test ranged from a few hundred dollars to thousands, depending on the hospital. For example, the median insurer-negotiated price of a stress test at the Cleveland Clinic was $463, while UCLA’s was $3,230. The median price of a stent or balloon angioplasty was $657 at the Cleveland Clinic but $25,521 at Cedars-Sinai hospital.

Even within the same hospital, the same patient with different insurance could pay vastly different amounts for a test or procedure. Brigham & Women’s hospital is a good example of variable prices depending on insurance. At the Brigham, most insurer-negotiated prices (from the 25th percentile to 75th percentile) ranged from about $3,000 to $13,000 for a right heart catheterization, from $4000 to $14,000 for a coronary angiogram, and from $8000 to $23,000 for a pacemaker.

Paying for stent overuse

In 2020, hospitals placed more than 45,000 coronary stents in Medicare patients that met criteria for overuse, a recent report from the Lown Institute Hospitals Index finds. Many of the hospitals charging high prices for stents also have high rates of overuse. Mount Sinai hospital and Cedars-Sinai Medical Center both performed more than 300 low-value stents in 2020 and had high rates of overuse compared to the national average. (NYU Langone also had high rates of stent overuse, but they did not make their prices publicly available).

Mount Sinai and Cedars-Sinai also had the highest insurer-negotiated prices for stents, with their median prices over $20,000. Assuming that their rates of overuse in the privately-insured population are similar to their Medicare population, that’s a lot of money spent on putting patients at increased risk of harm.