Hospital Cash Price for Diagnostic Ultrasound 7X Higher in Florida than New Jersey

LOS GATOS, Calif., June 16, 2021 /PRNewswire/ -- Under the new hospital price transparency law, effective 1/1/21, every hospital is required to post cash prices for all items and services it provides within a machine readable file on its website.

Silicon-Valley based Hospital Pricing Specialists identified 2,078 hospitals that had machine-readable files on their websites.  Less than 30% of the machine-readable files included the total bundled charges for outpatient surgeries, as required by the new law.  For example, the price for a colonoscopy procedure should be inclusive of all associated services, such as anesthesia, operating room time, laboratory, and radiology.  Unfortunately, in most machine-readable files, this was not the case.

A common item, occurring over 85% of the time within the machine-readable files, was the cash price for an Ultrasound of the Abdomen (CPT 76700).

Below is average cash price by state for this abdomen ultrasound:

The national average cash price is $745.  Florida has the highest average cash price for an Ultrasound of the Abdomen at $2,295 or 308% higher than the national average.  Conversely, New Jersey as the lowest average cash price at $319 or 57% lower than the national average.

CMS has signaled that forthcoming clarifications will be released on the machine-readable file to ensure consistency in content and file structure layout across all hospitals.  However, until these clarifications are released and implemented, only vendors with access to advanced artificial intelligence software would be able to analyze the existing machine-readable files and make observations such as this wide variation in cash prices for an Ultrasound of the Abdomen.

"Hospital machine-readable pricing files are a black box. Only with advanced artificial intelligence and machine learning were we able to crack open the black boxes and compare data across hospitals."
— Rick Louie, Managing Director of Hospital Pricing Specialists LLC

Another key concern in the current price transparency law is the allowance for "closed system" price estimator tools.  A "closed system" requires the user to already be a member of the insurance plan in order to get an out-of-pocket estimate.  For example, within a "closed system" patient estimator system, a member of Blue Cross would not be able to get an out-of-pocket estimate for Aetna.  This defies the spirit of price transparency which encourages consumers to shop between plans, increase competition, and ultimately lower the cost of healthcare. 

Why is an open system patient cost estimator tool important? In some cases, the cash price may be less than going through one's insurance, depending on the plan's coinsurance rate and annual deductible.  Requiring all patient cost estimator tools to be "open system" would allow patients to compare cash prices to the final out-of-pocket cost among all plans in order to make an informed decision. Additionally, open system estimators better equip consumers who shop for insurance via the marketplace to make the most informed selection of their health plan by allowing them to see the difference in estimated out-of-pocket costs for services they may be utilizing by insurer prior to selecting a plan.

Hospital Pricing Specialists offers a cloud-based "Open System" patient estimator tool called EZCOST (see example installation), which has been commended by Kevin O'Leary "Mr. Wonderful" of Shark Tank (see video) and Apple Co-Founder Steve Wozniak (see video).

Based in the heart of Silicon Valley, California, Hospital Pricing Specialists LLC is the market leader in helping hospitals set market-defensible, transparent pricing and offering state-of-the-art, fully managed and hosted cloud solutions for CMS price transparency requirements.

Rick Louie
Hospital Pricing Specialists LLC
[email protected]
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SOURCE Hospital Pricing Specialists LLC

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