Accessibility and Usability of Hospital Chargemasters in New York State

Introduction

As of January 1, 2019, a CMS mandate required hospitals to make their chargemasters publicly accessible, reasoning that chargemasters would allow consumers to shop for healthcare to decrease costs.¹ Prior investigations demonstrate that a majority of hospitals have posted chargemasters, but this did not necessarily increase price transparency.^2–4 These studies sampled the largest hospitals or specialized centers across the USA.^3–5 We hope to better characterize the accessibility and usability of chargemasters from a consumer’s perspective by focusing on all hospitals in a specific region.

Methods

This was a cross-sectional study of all available chargemasters in New York State (NY) in May–June 2019. A list of hospitals in NY was obtained from the Homeland Infrastructure Foundation database, and hospital characteristics (rural vs urban, number of beds, annual income, and whether it was part of a network) were obtained from the RAND HCRIS database.^5–7 For chargemasters not found through a hospital’s webpage, a Google search was conducted. Veterans Affair Hospitals were excluded as they do not accept private insurance and therefore do not need chargemasters.

To describe the process of finding chargemasters for all hospitals in NY, metrics of accessibility collected included minimum number of clicks from the homepage to download chargemaster and requirements for personal information (as it might discourage a consumer from accessing a chargemaster) and metrics of usability collected included presence of a machine-readable file format, file size, number of rows, and presence of CPT codes. The number of clicks was counted starting from the hospital homepage until the chargemaster link. For standardization, clicks that did not lead to the chargemaster were not counted (i.e., clicking the back key).

Results

One hundred eighty-nine out of 202 hospitals in NY had locatable chargemasters including 183 (90.6%) located by clicking on links from the hospital homepage and six (3.0%) located via Google search. Of the remaining 13 (6.4%), two (1.0%) hospital websites had a number to call to obtain the chargemaster, and 11 (5.4%) were not found.

The majority of hospitals’ chargemasters, 158 (73%), were located in 3 or fewer clicks from the homepage with a mean of 2.4 (± 1.2) clicks (Fig. 1). To download the chargemasters, only 7 (3%) hospital webpages required users to enter personal information such as name and email address.

Figure 1.

Accessibility: locating the chargemasters: number of clicks to locate each hospital chargemaster from the hospital homepage; if the chargemaster was found on the hospital homepage, the click count is 0.

Of the 189 chargemasters located, 183 (97%) were downloadable and 6 (3%) chargemasters were embedded on the website. Of these 183, 6 (3%) were in .pdf format and the remainder (177, 97%) were in .xls or .csv formats. For the 177 (97%) chargemasters downloaded as .xls or .csv files, the number of rows ranged from 493 to 121,283 with a median (1^st quartile and 3^rd quartile) of 11,727 (5090; 15,818) rows per chargemaster. The majority (56%) of chargemasters contained between 1000 and 20,000 rows. The file size ranged from 27 to 4840 KB, median (1^st quartile and 3^rd quartile) of 382 (74,198) KB. Row and file size did not seem to vary with urban vs rural, number of beds, annual income, or if it was part of a network. Most web pages, 178 (82%), listed a warning that chargemaster listings would not necessarily reflect the final bill. Of the 183 chargemasters, 37 (20%) contained CPT codes (Fig. 2).

Figure 2.

Usability: number of rows in each chargemaster.

Discussion

Overall, chargemasters were locatable and accessible, requiring few clicks and rarely requiring personal information. Chargemasters were usable with the majority downloadable and in machine-readable file formats that allow consumers to use a “find” function to search for procedures of interest, an important feature since the chargemasters are large. Size was unrelated to investigated hospital characteristics; we hypothesize it is related to institutional preference.

The lack of CPT codes and unclear, unstandardized procedure descriptions which often contain medical terminology obfuscate shoppability. Examples of procedure descriptions related to an elective heart procedure include “CATH LAB 1 HR,” “RT & LT HEART CATH,” and “PRQCARD STENT/ATH/ANGIO”; one chargemaster contained “Heart Valve, annulplsty Ring Aa through “Ring Z,” so there were 34 entries for the same procedure each at different price points. Consumers might not be able to identify procedures of interest, compare procedures between hospitals, and predict which items contribute to a final bill. Additionally, chargemaster price listings do not take into account consumers’ various insurance companies and negotiated rates or a patient’s out-of-pocket costs or prior expenditure towards the deductible. Further investigation is needed to correlate price with quality.

Declarations

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclosures

The authors have no disclosures to report.