Factors Influencing List Prices for Radiologists' Services.

Abstract

To identify factors associated with list price variation for radiologists' services. The 2014 Medicare Physician and Other Supplier Public Use File was used to identify submitted charges ("list prices") and payments for radiologists' services (ie, not hospital service charges). Charge-to-payment ratios were computed for individual radiologists as a measure of excess charges. Numerous radiologist-level factors identifiable using publicly available data sets were explored. Among 26,715 radiologists nationally, the mean charge-to-payment ratio was 4.2 ± 2.0. A greater charge-to-payment ratio was most strongly predicted for those serving higher-complexity patients (ratio ranging from 3.8 ± 1.8 to 4.1 ± 1.6 for radiologists in the first through third quartiles in terms of patient complexity, compared with a ratio of 4.8 ± 2.8 for radiologists in the highest quartile in terms of patient complexity). A higher charge-to-payment ratio was also observed among those with, rather than without, a teaching institutional affiliation (4.7 ± 2.8 versus 4.0 ± 1.8, respectively) and among subspecialists rather than generalists (4.4 ± 2.5 versus 3.9 ± 1.5, respectively). Among subspecialties, charge-to-payment ratios ranged from 3.3 ± 1.3 (breast imaging) to 5.7 ± 4.1 (interventional radiology). Charge-to-payment ratios showed weak inverse correlations with total service volume (r = -0.13) and total payments (r = -0.11). Distinct from hospital prices and historically considered arbitrary, higher charges for radiologists' services demonstrate consistent patterns of variation and are most strongly seen for those serving higher complexity patients. As price transparency initiatives expand, radiologists should be aware of how and why their list prices compare with local and national benchmarks.