title: Are chargemaster rates for imaging studies lower in States that cap noneconomic damages (tort reform)?
abstract: OBJECTIVE
  To determine whether chargemaster (a list of prices for common services and procedures set by individual hospitals) rates for diagnostic imaging were lower in states that cap awards for noneconomic damages (NED) than states with unlimited awards for medical negligence.
  
  
  METHODS
  We analyzed 2011 chargemaster data from the Centers for Medicare & Medicaid, pertaining to 6 ambulatory patient classifications specific to imaging. The dataset includes outpatient imaging facilities and hospitals in 49 states and the District of Columbia. The association between caps on NED and chargemaster rates for imaging in a sample of 15,218 data points was analyzed using linear regression and two-sample t tests assuming unequal variances.
  
  
  RESULTS
  In states that cap NED, the chargemaster rates were higher for the following modalities: Level II Echocardiogram without Contrast (mean charges: $2,015.60 versus $1,884.81, P = .0018); Level II Cardiac Imaging ($4,670.25 versus $4,398.58, P = .002); MRI & Magnetic Resonance Angiography without Contrast ($2,654.31 versus $2,526.74, P = .002); and Level III Diagnostic and Screening Ultrasound ($1,073.31 versus $1,027.32, P = .037). High charge-to-payment ratios were associated with states with the highest charges. There was a positive correlation between number of outpatient centers in the state and the average chargemaster rates for the state (mean chargemaster rate = 1727 + 0.79*Number of Outpatient Centers; R-squared = 0.23, P = .0004).
  
  
  CONCLUSIONS
  Chargemaster rates for select imaging services are not lower in states that have capped NED.
authors.affiliation: Temple University School of Medicine, Philadelphia, Pennsylvania. Electronic address: seth.stein@temple.edu.
authors.forename: Seth I
authors.initials: SI
authors.lastname: Stein
authors.affiliation: Temple University School of Medicine, Philadelphia, Pennsylvania.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Barry
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Saurabh
authors.initials: S
authors.lastname: Jha
mesh_terms: D000553:Ambulatory Care / Q000191:economics; D014487:Centers for Medicare and Medicaid Services, U.S.; D035881:Compensation and Redress; D003952:Diagnostic Imaging / Q000191:economics*; D005249:Fees and Charges; D006801:Humans; D016365:Liability, Legal / Q000191:economics*; D008318:Malpractice / Q000191:economics*; D014481:United States
keywords: Tort reform; chargemaster; noneconomic damages; supply–demand