Newswise — U.S. hospitals charge facility fees for colonoscopy procedures covered by private health insurance that are on average approximately 55 percent higher than facility fees billed by smaller clinics known as ambulatory surgical centers, according to a study led by researchers at the Johns Hopkins Bloomberg School of Public Health.

The findings appear in a peer-reviewed research letter to be published online December 15 in JAMA Health Forum.

Colonoscopies are widely used for cancer screening among people who are middle age and older and/or have a family history of colorectal cancer, with current guidelines recommending colonoscopies starting at age 50. The outpatient procedures are routinely performed at hospitals and ambulatory surgical centers.

Under a Transparency in Coverage requirement that went into effect in July 2022, insurers must publish their in-network rates for covered items and services. The analysis, one of the first to use Transparency in Coverage data, found that hospitals billed an average of $1,530 in facility fees for colonoscopies, $1,760 for colonoscopies with biopsy, and $1,761 for colonoscopies with removal of polyps, compared to $989, $1,034, and $1,030 in facility fees at ambulatory surgical centers.

The researchers determined that colonoscopy facility fees were, respectively, 54, 56, and 61 percent higher for hospitals than ambulatory surgical centers located in the same county and contracting with the same insurer. (The study did not analyze facility fees charged under Medicaid and Medicare insurance.)

“These price differences for the same services are hard to justify,” says study senior author Ge Bai, PhD, CPA, a professor in the Bloomberg School’s Department of Health Policy and Management. “Higher prices mean higher premium payments from patients and higher premium contributions from their employers.”

Bai is also a professor of accounting at Johns Hopkins Carey Business School. The study’s first author was Yang Wang, PhD, assistant research professor in the Bloomberg School’s Department of Health Policy and Management.

Over the past century, health care in the United States has shifted from a simple, individual-based system to a regulated, insurance-based system. That shift has weakened the market forces that, for health care providers, would normally compel price transparency and constrain pricing power. Providers in recent decades have largely not made available their prices to the public, and often charge dramatically different prices for the same service.

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