Nationwide median commercial negotiated prices and cash prices for spinal MRI and pelvic CT exams are lower for general acute-care physician-owned hospitals, according to research published June 23 in JAMA Network Open.
A team led by Yang Wang, PhD, from Johns Hopkins University in Baltimore found in a cross-sectional study that these imaging services have lower negotiated and cash prices at physician-owned hospitals than at nonphysician-owned hospitals.
"Understanding how physicians' ownership of hospitals affects patients and payers is an important research area," Wang and co-authors wrote. "To our knowledge, no [prior] research has examined whether physician-owned hospitals have different prices than their competitors."
Previous studies have explored differences in quality between physician-owned hospitals and other hospitals. However, the researchers pointed out a lack of data on whether physician-owned hospitals have different prices than their competitors within the same market.
Wang and co-authors wanted to investigate these trends, initially believing that physician-owned hospitals would have higher prices. Through the Hospital Price Transparency Rule, the team acquired commercial negotiated prices and cash prices as of January 2023.
It also focused on eight shoppable services designated by the U.S. Centers for Medicare & Medicaid Services. These included the following: MRI scans of the lower spinal canal, CT scans of the abdomen and pelvis, spinal injections, physical therapy-therapeutic exercises, comprehensive metabolic panels, blood test-clotting times, and emergency department visits (levels 3 and 4).
The researchers included data from 156 physician-owned hospitals and 1,116 nonphysician-owned hospitals located in 78 hospital referral regions.
The team found that for the same procedure in the same referral region, the median commercial negotiated prices and cash prices among physician-owned hospitals were 33.7% and 32.7% lower than those of nonphysician-owned hospitals, respectively. Additionally, it found that physician-owned hospital status was tied to 17.5% and 46.7% lower negotiated prices and cash prices for the same procedure in the same referral region, respectively.
MRI and CT services were among the procedures that showed the largest differences.
| Comparison between hospitals on median price of imaging services | ||||
| MRI | CT | |||
| Commercial negotiated price | Cash price | Commercial negotiated price | Cash price | |
| Physician-owned hospitals | $989 | $1,113 | $1,265 | $1,628 |
| Nonphysician-owned hospitals | $1,478 | $1,713 | $1,580 | $2,531 |
The researchers also reported that physician-owned hospitals generally were smaller, more profitable, and more likely to be for-profit. Additionally, these hospitals were more likely to be nonteaching, noncritical access, and located in metropolitan areas than private, nonphysician-owned hospitals in the same market.
Finally, the team found that physician-owned hospitals served fewer Medicaid patients and provided less charity care than nonphysician-owned hospitals. This included an average Medicaid discharge proportion and charity care-to-expense ratio of 3% and 1.3% for physician-owned hospitals, respectively, and 7.1% and 3.2% for nonphysician-owned hospitals.
The study authors suggested that serving fewer Medicaid patients and providing less charity care may allow physician-owned hospitals to accept lower commercial prices. They wrote that these factors were controlled for in regression models.
