Hospital costs vary by up to 16X for the same emergency care, the study found.

Starting in 2021, federal law will require hospitals to publicly post their prices, allowing Americans to more easily estimate costs and shop for affordable care—for any marketed service or product. But hospitals have largely failed to comply with the law.

2023 KFF analysis The data available to hospitals on compliance is messy, inconsistent, and confusing, making it challenging, if not impossible, for patients or researchers to use for their intended purposes. A February 2024 report The nonprofit Patient Rights Advocate found that only 35 percent of 2,000 U.S. hospitals surveyed were in full compliance with the 2021 law.

But while hospitals have dramatically improved their price transparency, it may not help when patients need emergency care. After an unexpected serious injury, people are sent to the nearest hospital and do not want to buy the best price in the back of the ambulance. If they do, however, they may need to be treated for shock.

according to A study published Wednesday in JAMA SurgeryHospitals around the country charge different rates for trauma care. Prices for the same care can vary up to 16 times between hospitals, and cash prices are sometimes much cheaper than the negotiated prices paid by insurance companies.

According to the authors of the study, “the findings show substantial and often irrational differences,” the authors of the study – a team of researchers at Johns Hopkins and the University of California, San Francisco. “Price differences cannot be explained by trauma alone,” they point out.

For the study, they obtained data on trauma activation fees (TAFs) from hospitals across the US. TAFS was created in 2002 Be standard billing codes to help recoup costs for trauma care preparedness. Those overhead costs hospitals pay to maintain their readiness to provide emergency emergency care, including having operating rooms permanently available, as well as adequate staffing, equipment and supplies, such as blood products. The TAFS is divided into four codes corresponding to levels of trauma response (I to IV), which are based on standard injury severity criteria. These fees are in addition to payment for the patient’s actual medical care.

Wide variety

The researchers extracted TAF data from Turquoise Health, a platform that aggregates hospital-reported pricing data. They then found 3,093 unique TAF observations in 761 unique hospitals in 49 states. They break down TAF payments by different levels of trauma response as well as price types: list prices, cash prices often paid by the uninsured, and negotiated prices paid to insurers.

The rates vary dramatically for each level of trauma and type of pricing. For example, for the most severe trauma response stage (stage I), the average TAF list price was $6,607, the average negotiated price was $3,431, and the average cash price was $2,663. For detailed prices, distance between 10^Th Percentage values ​​and 90^Th Percentage prices went from a low of $1,650 to 11 times that: $18,500. Looking at the percentages for negotiated prices, costs ranged from $900 to $11,661, 13 times more. And the monetary value is from 660 to 8,190 dollars, 12 times more.

The largest spread in cash values ​​was observed for injury response Phase II TAFs. There, the average cash price was 2,630 dollars, but the difference between 10^Th And 90^Th The percentage ranged from $768 to $12,140, ​​a 16-fold increase.

Cash prices were often lower than bargain prices in all data. This is good for uninsured patients who may be offered financial value, but not good for the insured. “One could argue that uninsured patients who pay premiums in advance should not pay more than the monetary value,” the authors wrote.

Overall, pricing and lack of transparency is a problem that calls for intervention, the authors concluded. “Unexpected and urgent trauma patients are referred to the nearest hospital and cannot compare their costs with risk and marketed medical services,” the authors wrote. Moreover, the people who suffer the most from these high prices are the uninsured and the most financially vulnerable patients.