The analysis of actual payments to hospitals and physicians by private insurers in 13 U.S. cities found that the most-expensive hospitals got rates as much as 60% more than the lowest-priced competitor for inpatient care and prices that were double those of competitors for outpatient care.
The outpatient differences were particularly stark in Indianapolis, Kansas City, Mo., and Toledo, Ohio, where private insurers paid the most expensive hospitals more than four times what Medicare would have allowed for the same services.
The study drew comparisons between private insurance payments to hospitals and primary-care physicians to make its point. While the most expensive hospitals charged prices far exceeding their lower-priced competitors, study authors found that primary-care doctors don't command the same mark-up power. Thus, some family practice doctors actually received lower rates from private insurers than they did from the famously stingy Medicare program, the study found.
Study authors said that was because primary-care doctors tend to work in smaller organizations that can't afford to walk away from the bargaining table with private insurers.
“In terms of negotiating leverage, primary-care practices fall at the bottom of the heap,” authors wrote in the research brief published online last week by the center. “As a result, few, if any, primary-care practices can command prices that significantly exceed their competitors.”
In contrast, specialty physicians tend to have more negotiating clout because they have higher market concentration and work for larger group practices, according to the study. Many specialists were paid at least one-and-a-half times Medicare rates.