A new study led by researchers at the Johns Hopkins Bloomberg School of Public Health has found that hospitals in the United States charge significantly higher facility fees for colonoscopy procedures covered by private health insurance compared to smaller clinics known as ambulatory surgical centers. The research, published in JAMA Health Forum, highlights the potential financial burden placed on patients and employers due to these price differences.
Colonoscopies, which are commonly used for cancer screening in middle-aged and older individuals, are typically performed at hospitals and ambulatory surgical centers. The study used Transparency in Coverage data, which was mandated as a requirement for insurers to publish their in-network rates for covered items and services starting in July 2022. The analysis found that hospitals billed an average of $1,530 in facility fees for colonoscopies, $1,760 for colonoscopies with biopsy, and $1,761 for colonoscopies with removal of polyps. In comparison, ambulatory surgical centers charged $989, $1,034, and $1,030, respectively, for the same procedures.
The researchers discovered that the facility fees for colonoscopies at hospitals were 54-61% higher than those at ambulatory surgical centers in the same county and contracting with the same insurer. It is important to note that the study did not analyze facility fees charged under Medicaid and Medicare insurance.
Ge Bai, the senior author of the study, believes that these price differences are challenging to justify. While hospitals have higher overhead expenses that could contribute to their increased costs, the study suggests that patients could benefit from site-neutral payment policies that eliminate price variations based on the service site for standard procedures such as colonoscopies. This could potentially lead to more affordable options for patients and reduce financial strain.
The Transparency in Coverage rule, which was implemented in July 2022, aims to promote competition and lower prices by requiring insurers to disclose prices for covered items and services. The researchers analyzed the Transparency in Coverage data for over 13,000 colonoscopy facility fees charged by hospitals and ambulatory surgical centers across the United States. The data included information from four major private health insurers: Cigna, Anthem, Healthcare Service Corp., and UnitedHealthcare.
It is important to note that the results of this study may not be applicable to other procedures or non-major insurers. However, it highlights the need for increased transparency in healthcare pricing and the potential benefits of site-neutral payment policies to ensure equitable access to affordable care.
The study, titled “Facility Fees for Colonoscopy Procedures at Hospitals and Ambulatory Surgical Centers,” was co-authored by Yang Wang, Yuchen Wang, Elizabeth Plummer, Michael Chernew, Gerard Anderson, and Ge Bai.
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1. Source: Coherent Market Insights, Public sources, Desk research
2. We have leveraged AI tools to mine information and compile it