Understanding the Cost of Heart Tests and Procedures: A Guide for Patients

When it comes to medical services, it can be challenging to know how much you'll be paying until you receive the bill. Unlike other services, such as home repairs or plane tickets, it's not always possible to shop around for the best price. However, a new federal rule called the Transparency in Coverage rule aims to change this by requiring hospitals to make their prices public and provide consumer-friendly tools for patients to estimate their costs.

The Importance of Price Transparency in Cardiovascular Care

Cardiovascular disease is the most expensive chronic disease in the United States, making it crucial to understand the costs associated with diagnosis and treatment. Researchers at the Richard A. and Susan F. Smith Center for Outcomes Research at Harvard-affiliated Beth Israel Deaconess Medical Center took advantage of the new transparency rule to compare prices for six common heart tests and procedures across 20 top-rated hospitals.

Wide Price Variations Revealed

The study, published in the September 2022 JAMA Internal Medicine, found striking price differences for the same tests and procedures across different hospitals. For example:

• There was a 10-fold difference in the median price of an echocardiogram (heart ultrasound) across the hospitals.

• Price differences were even greater for procedures like implanting a pacemaker or percutaneous coronary interventions (minimally invasive procedures to open clogged heart arteries, such as placing a stent).

• Within a single hospital, the price of a stress test varied fivefold depending on the patient's commercial insurance company.

Factors Influencing Price Variations

These price variations are likely not a reflection of the quality of care, as the study focused on top-rated hospitals. Instead, they are influenced by the negotiating power between hospitals and insurance companies, which is affected by factors such as location, size, and popularity.

The Impact on Patients

Although patients never see the payer-negotiated prices agreed upon by hospitals and insurance companies, high prices can still affect them through co-pays, deductibles, and overall healthcare costs. When insurance companies pay high prices, those costs may trickle down to patients in various ways.

Navigating the Complex World of Medical Costs

While the Transparency in Coverage rule is a step in the right direction, accessing and interpreting the cost data remains challenging for patients. Researchers and policymakers are working to make high-quality price data more easily accessible, which will help tackle important policy issues related to the high cost of cardiovascular care.

As a patient, it's essential to stay informed about your healthcare costs and work with your healthcare provider and insurance company to understand your options. By advocating for greater price transparency and accessibility, we can work towards a more affordable and equitable healthcare system for all.

For more information on the cost of heart tests and procedures, visit:

• The Cost of Cardiovascular Disease - American Heart Association

• Hospital Price Transparency - Centers for Medicare & Medicaid Services

• Price Transparency and Variation in U.S. Health Services - Peterson-KFF Health System Tracker