A new analysis published in the American Journal of Roentgenology highlights the drastic inconsistencies in prostate MRI charges across the United States.
The analysis revealed instances of up to a 26-fold difference between facility charges for prostate MRI exams—a difference that experts involved in the research caution could widen existing gaps in access to healthcare across the U.S.
"Patients may be responsible for paying for the examination but poorly equipped to compare highly variable charges among facilities," corresponding author of the AJR paper, Aaron Brant, MD, from the Department of Urology at NewYork-Presbyterian Hospital, Weill Cornell Medicine, and co-authors explained. "These concerns compound population disparities in insurance rates."
For their research, the experts utilized information from the Premier Healthcare Database, which houses data on more than 1 billion inpatient and outpatient encounters. A total of 37,073 MRI examinations conducted at 552 facilities across the U.S. between January 2010 to March 2020 were included in the analysis.
The median facility charge per prostate MRI was $4,419. The difference between the lowest and highest median facility charges was substantial, with charges starting at $593 and peaking at $15,150. This trend was consistent among self-pay rates as well, ranging from $550 to $13,815.
The authors reported numerous potential factors that could account for the vast variations, the greatest of them being interfacility variability at 63.9%. Outside of that, 10.3% of pricing variability was attributable to the use of IV contrast, while geographic region accounted for 2%.
“The explanation for the large variation among facilities is unclear. Potentially, absence of incentives to provide competitive prices enables hospitals to set arbitrary prices,” the authors wrote.
Insurance type was not found to correlate with the price variations, and coverage was found to be inconsistent. Just 11% of insurance providers covered prostate MRI exams in biopsy-naïve patients in 2018, and even with coverage many patients were still responsible for significant out-of-pocket expenses related to the exam.
The authors pointed to the recent growth of narrow-network insurance as a potential cause for the wide-ranging charges, as a large portion of the cases studied were completed out-of-network. Additionally, they cited a continued lack of compliance among U.S. hospitals with the CMS mandate of price transparency, which inhibits patients from being able to compare prices.
To achieve greater pricing consistency, the authors suggest “expanded coverage, broadening of narrow networks and stricter enforcement of price transparency regulations” as a solid starting point.
Learn more about the data here.