There is little correlation between a patient’s out-of-pocket cost and either the amount insurers pay or the overall price of a procedure at 14 representative Massachusetts hospitals, according to a new study published by Pioneer Institute.
The total price (insurance payment plus patient contribution) of an MRI of the knee without contrast ranged from $476 at St. Vincent’s Hospital in Worcester to $1,423 at Boston Children’s Hospital. Patient out-of-pocket prices ranged from $55 at Mt. Auburn Hospital to $206 at South Shore Hospital. Insurer payments for the procedure were just $352 at New England Baptist Hospital in Boston, but $1,236 at Children’s.
Even though patients paid $55 for an MRI at Mt. Auburn Hospital and $206 at South Shore, the total price of the procedure was very similar at the two hospitals. New England Baptist patients paid about 30 percent of the price of the MRI, while patients at Tufts New England Medical Center and Mt. Auburn paid less than 10 percent of the total.
The study is based on data obtained from the Massachusetts Center for Health Information and Analysis (CHIA) and its all-payer claims database (APCD). It includes all MRIs of the knee without contrast conducted in May 2015 at the 14 facilities, which are geographically diverse and represent both teaching and community hospitals.
The authors also call for opening the APCD to the public and they recommend that state and industry leaders undertake a substantive, ongoing campaign to educate the public on the importance of healthcare price transparency.
- White Paper No. 192: Wildy Varying MRI Prices at Massachusetts Hospitals. Pioneer Institute. (PDF)
- Related news release: https://pioneerinstitute.org/featured/study-finds-patient-cost-for-mri-largely-unrelated-to-overall-price-or-insurer-contribution-at-14-ma-hospitals/