Over the past decade there has been increasing demand for price transparency in US health care.1,2 A 2014 Government Accountability Office report called on the Centers for Medicare and Medicaid Services to take concrete steps to collect and disseminate pricing information.3 Most US states have legislation requiring hospitals to report price information. A 2012 study identified more than 60 state health care price transparency websites.4 Several private businesses sell price transparency products.5

Interestingly, it is unclear whether increasing interest in price transparency has translated into tangible improvements in the ability of hospitals to provide price information. We examined whether a group of 122 hospitals we originally surveyed in 20116 had improved in their ability to provide price for a total hip arthroplasty (THA) when resurveyed in 2016.

Methods

Beginning with a list of 122 hospitals performing primary THA initially surveyed in 2011, we resurveyed 120 that remained open and independent.6 The original study included 20 top-ranked orthopedic hospitals selected from the 2011-2012 US News and World Report hospital rankings and an additional 102 randomly selected non–top-ranked hospitals (2 from each state plus the District of Columbia).

This study was approved by the University Health Network institutional review board. We used the same protocol used in our prior study, with only minor modifications to our interview script.6 We phoned each hospital from June to August 2016.

We called each hospital posing as a granddaughter seeking information on the price of a primary hip replacement for her 62-year-old grandmother. We specified that we were looking for the lowest “cash” bundled price, which would include all hospital and physician fees. If the hospital was only able to provide the hospital fee, we asked for the name of an orthopedic surgery practice that we could call for the physician fee. Each hospital was contacted up to 5 times. All prices were categorized as hospital price only, the physician price only, or a combined hospital-physician (or “bundled”) price.

We used bivariate methods to compare the percentage of hospitals able to provide us with a bundled, complete (hospital plus physician by calling separately), partial price (hospital or physician only), and no price in 2012 as compared with 2016. The means in 2012 and 2016 were compared with determine whether reported prices had changed. Using paired t test, differences in the maximum and minimum price estimates received in 2012 and 2016 were compared. All analyses were performed using R software (version 3.0.2).3,4

Results

Of the 120 hospitals included in our 2016 survey, we were able to obtain a bundled price from 8 (6.7%), a complete price from 25 (20.8%) by contacting the hospital and physician office separately, a partial price (hospital or physician only) from 34 (28.3%), and no price from 44.2% (Table 1). The percentage of hospitals able to provide a bundled price declined from 15.8% in 2012 to 6.7% in 2016 (odds ratio [OR], 0.2; 95% CI, 0.0-0.8; P = .01) and the percentage able to provide a complete price declined from 47.5% to 20.8% (OR, 0.2; 95% CI, 0.1-0.5; P = .001) (Table 1). The percentage unable to provide any price increased from 14.2% to 44.2% (OR, 4.6; 95% CI, 2.3-10.2; P = .001). The mean bundled/complete price did not change ($44 300 in 2012, $37 900 in 2016; P = .11) (Table 2). Looking exclusively at hospitals, mean hospital price was $33 276.78 in 2012 and $35 105 in 2016 (P = .72) (Table 2).

Discussion

We found no evidence of improvement in hospitals’ ability to provide price estimates or reductions in the estimated price for THA between 2012 and 2016. Our results provide sobering evidence that substantial efforts from government and industry to improve pricing transparency have had little tangible effect on availability of prices.

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Accepted for Publication: March 6, 2018.

Corresponding Author: Safiyyah Mahomed, BSc, Division of General Internal Medicine, Toronto General Hospital, 200 Elizabeth St, Eaton North, 14th Floor, Room 216, Toronto, ON M5G 2C4, Canada (safiyyah.mahomed@mail.utoronto.ca).

Published Online: May 29, 2018. doi:10.1001/jamainternmed.2018.1473

Author Contributions: Dr Mohamed had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Mahomed, Rosenthal, Cram.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Mahomed, Cram.

Critical revision of the manuscript for important intellectual content: Rosenthal, Matelski.

Statistical analysis: Mahomed, Matelski.

Obtained funding: Cram.

Administrative, technical, or material support: Cram.

Study supervision: Cram.

Conflict of Interest Disclosures: None reported.