Starting in 2021, federal law will require hospitals to publish their prices, just as they do for other over-the-counter services and products, so Americans can easily predict costs and shop around for affordable care. Became. However, most hospitals fail miserably to comply with the law.
KFF analysis in 2023 The compliance study found that pricing information provided by hospitals is “so messy, inconsistent, and confusing that it is difficult, if not impossible, for patients and researchers to use it for its intended purpose.” There was found.a February 2024 Report A study by the nonprofit patient advocacy group found that of the 2,000 U.S. hospitals surveyed, only 35 percent were fully compliant with the 2021 rules.
But even if hospitals dramatically improve price transparency, it likely won’t help when patients need emergency trauma care. After an unexpected major injury, people are sent to the nearest hospital, but they rarely shop from the back of an ambulance for the best deals. However, if you do, you may also need treatment for shock.
according to The study was published Wednesday in JAMA Surgery., Hospitals across the country vary widely in trauma treatment fees. Prices for the same treatment can vary by up to 16 times between hospitals, and the cash price can be significantly lower than the negotiated price paid by the insurance company.
According to a group of researchers from Johns Hopkins University and the University of California, San Francisco, the study authors said, “Our findings demonstrate substantial and often irrational variation in the pricing of trauma.” That’s what it means. They suggest that “price variation cannot be explained by injury severity alone.”
For the study, they obtained data on “trauma activation fees” (TAFs) from hospitals across the United States. TAFS was founded in 2002 To become a standardized billing code to help recover trauma care preparation costs. These costs are incurred by hospitals to ensure that they are able to provide emergency trauma care 24 hours a day, including keeping operating rooms ready and having sufficient personnel, equipment, and supplies such as blood products. is what you pay. TAFS charges four codes that correspond to trauma response levels (I to IV) based on standardized criteria for injury severity. These fees are in addition to the patient’s actual medical costs.
wide variety
The researchers extracted TAF data from a platform called Torquise Health, which aggregates pricing data published by hospitals. From there, they obtained 3,093 unique TAF observations across 761 unique hospitals in his 49 states. They categorized TAF fees by different types of trauma response levels and price types: list price, cash price often paid by the uninsured, and negotiated price paid to insurance companies.
Prices varied significantly by level of trauma and type of pricing. For example, for the most severe trauma response level (Level I), the median TAF list price was $6,607, the median negotiated price was $3,431, and the median cash price was $2,663.For list price, span between $10th percentile price and 90th Percentile prices rose from a low of $1,650 to $18,500, an 11-fold increase. Looking across the negotiated price percentiles, costs ranged from $900 to $11,661, or 13 times more. and cash prices ranged from $660 to $8,190, a 12x increase.
The largest spreads were seen in the cash price of trauma-ready Level II TAF.There, the median cash price was $2,630, but the span between $10th and 90th The percentile was $768 to $12,140, a 16x increase.
Across all data, cash prices were often lower than negotiated prices. This is good for uninsured patients who may be offered a cash price, but not so good for insured patients. “Some may argue that insured patients who already pay premiums should not pay more than the cash value,” the authors write.
Overall, the authors conclude that pricing and lack of transparency are issues that require intervention. “Due to the unexpected and immediate nature of trauma, patients are sent to the nearest appropriate hospital and are not able to compare prices as they would for non-emergency or shoppable medical services,” the authors wrote. are writing. They added that the uninsured and most economically vulnerable patients are the ones who are most harmed by these drastic changes in prices.
