Why is this report important?
CMS Price Transparency Report 2.0
- The report displays the price disparity for diagnostic imaging (MRI & CT scans) performed at ambulatory surgical centers (ASCs) and hospital outpatient departments (HODs) facilities.
- It is important to note that facilities that are defined as hospital outpatient departments (HODs) can charge significantly higher facility fees, co-payments and deductibles than ambulatory surgical centers (ASCs) for the same services.
Why should you care?
- Price transparency is fundamental to understanding why healthcare services have increased in cost exponentially over the past 10 years and why hospital systems have made a concerted effort to build monopolies in certain markets. High cost of diagnostic and other procedures have a direct impact on insurance premiums and the entire healthcare system.
What can policymakers do to fix it?
- Beyond cost, specifically in Northern Virginia, COPN regulation has given hospital systems, the latitude to create monopolies and thwart competition in communities where they have dominant market presence. COPN regulation has systematically given hospitals the ability to block competition from independent/unaffiliated entities that can provide diagnostic imaging and surgical services at lower costs.
Data Source: Health Systems Agency of Northern Virginia – CT/MRI Reports 2020
Check which hospitals are compliant with the federal hospital price transparency rule under the authority of the Affordable Care Act (ACA).
About COPN:
Purpose:
- The intended purpose of COPN regulation is to control healthcare costs by restricting services based on a set of criteria and community needs. However, it has accomplished quite the opposite. In the Commonwealth, COPN laws have incentivized large hospital systems to monopolize outpatient diagnostic imaging and surgical services by restricting competition among non-hospital/independent providers, particularly in affluent markets, such as Northern Virginia.
Implications:
COPN regulation has failed to reduce unnecessary healthcare spending. Instead, it has increased costs of outpatient diagnostic and surgical services and systematically given large hospitals and health systems the power to eliminate competition by allowing them to oppose projects they view as a threat to their existing services.
Costs:
In Virginia, the application filing fee can cost up to $20,000 without a guarantee of approval.
About Health Insurance Cost
The line graphs displayed below show the average annual premiums per single and family household in Virginia. The rates are based on employer-based health insurance.
The high cost of diagnostic and surgical services at HOCs has a direct impact on insurance deductibles and premiums.
