Abstract 4136705: Complexity and Inconsistency of Echocardiogram Prices at Top-Rated Hospitals in the United States

Background: Recent U.S. policies require hospitals and health insurers to post payer-specific negotiated prices for services. Few studies, if any, have thoroughly investigated the accuracy of these payer-specific prices for individual hospitals. Hypothesis: Top-rated medical centers charge consistent prices for echocardiograms, which are reflected in price transparency files. Aim: To evaluate the concordance of prices of echocardiograms using three datasets: 1) hospital price transparency, 2) payer price transparency data, and 3) Electronic Remittance Advice (ERA) claims data, reflecting actual payments. Methods: We extracted prices for transthoracic echocardiograms (CPT 93306) at 22 top-rated hospitals by US News&World Report from 1/1/2022 to 12/31/2022. We used price transparency data aggregated by Turquoise Health and compared with ERA claims data. This analysis included 9,171 insurance claims, matched to either payer or hospital-reported prices. For each claim, concordance between datasets was determined by evaluating whether each claim payment fell within a $10 margin of a publicly reported payer-specific price. Findings: In the payer and hospital price transparency files, reported prices ranged from $1.3 to $34,424. In the ERA claims data, the median payment for the professional fee was $203 (Q1 = $116, Q3 = $245), and the median payment for the facility fee was $2682 (Q1 = 1829, Q3 = $4531). There was a ten-fold difference in median price between the cheapest and most expensive facility. Only 27.4% of claim payments had a concordant price in the payer price transparency dataset, and 11.9% in the hospital dataset. Conclusion: Deriving accurate price estimates for patients requires precise matching of the insurance plan, place of service, and fee type. This process highlights the complexity of insurance contracting, and it is not surprising that there is some disagreement in prices. Regardless, we are hopeful that highlighting variation and complexity in prices is a step towards a better system of healthcare payments in the United States.