The Transparency in Coverage rule stems from an executive order issued June 2019 by the Trump Administration that went into effect July 1, 2022. The rule is meant to stimulate competition and reduce prices by restoring price transparency; it requires insurers to post prices for covered items and services.
In their study, the researchers analyzed Transparency in Coverage data for 13,287 colonoscopy facility fees charged by 3,582 hospitals and 17,052 ambulatory surgical centers in 50 states and Washington, D.C., as of May 2023. The data came from four major private health insurers: Cigna, Anthem, Healthcare Service Corp., and UnitedHealthcare, and covered three types of colonoscopy procedures: colonoscopy, colonoscopy with biopsy, and colonoscopy with removal of polyps.
Bai notes that while hospitals incur higher costs primarily due to their greater overhead expenses, these pricing differences could be burdensome. The study suggests that patients could benefit from site-neutral payment policies that remove price differences based on the service site for standard services such as colonoscopies.
The authors note in the research letter that results might not be generalizable to other procedures or non-major insurers.
“Facility Fees for Colonoscopy Procedures at Hospitals and Ambulatory Surgical Centers” was co-authored by Yang Wang, Yuchen Wang, Elizabeth Plummer, Michael Chernew, Gerard Anderson, and Ge Bai.
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