Some payers leaving 'money on the table' for radiology services: Study

Payer-negotiated prices for radiology services can vary widely, even within the same hospital, a study published Oct. 18 in Radiology found. 

The study, authored by researchers from East Lansing-based Michigan State University, New Haven, Conn.-based Yale University and Baltimore-based Johns Hopkins University, used price transparency data to compare the highest and lowest negotiated payment rates for 13 shoppable radiation services. 

Across all radiology services, the highest negotiated price was 3.8 times higher than the lowest price. 

For CT scans, the highest negotiated price was, on average, 5.2 times higher than the lowest. At some hospitals, this was as much as 17.9 times higher. 

The authors wrote that their results suggest some plans are negotiating prices more efficiently than others. 

"Higher  prices  (relative  to  Medicare) for highest-cost services imply higher hospital profitability,  which  can  potentially  motivate  hospitals  to  direct  investments  away  from  low-cost  to  high-cost  imaging,  regardless of incremental clinical value, and lead to inefficient spending for patients and payers," the authors wrote. 

Ge Bai, PhD, a professor of health policy and accounting at Johns Hopkins University and a co-author of the study, told MarketWatch the study's results indicate payers are leaving money on the table when negotiating. 

This can result in higher copays for patients and higher premium costs for insurance plans, Dr. Bai said. 

Read the full study here.

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