A Review of Price Transparency Policy and Evaluation of Hospital Compliance in Orthopedic Sports Medicine

Abstract

Background: In 2019, the Centers for Medicare and Medicaid Services (CMS) announced that beginning January 1, 2021, hospitals would be required to post pricing information in a usable format for patients via diagnosis-related group (DRG) or charge description master (CDM) sheets. Purpose/Questions: We hypothesized the new price transparency rule would pose challenges for many health care facilities. We therefore sought to find out how much pricing information was available before the rule took effect and how usable it was for patients receiving sports medicine care. Methods: In late 2019, we randomly selected 100 general hospitals (GH) from the CMS hospital list and an additional 21 orthopedic hospitals (OH). The DRG and/or CDM sheets were obtained from hospital websites. Pricing information for 6 sports medicine procedures (rotator cuff repair, shoulder arthroscopy, knee arthroscopy, anterior cruciate ligament reconstruction, meniscal repair, and steroid injection) was evaluated in qualitative and quantitative form. Results: Pricing information was provided by 74% of GH and 86% of OH. The price of steroid injections was frequently reported in usable form, with 80% by GH and 78% by OH. The remaining procedures were reported by less than 27% of GH and 40% of OH. For each procedure, component pricing was provided by at least 60% of GH and 78% of OH. No facility provided a pricing calculator or payer-type specific rates. Conclusions: Prior to the enactment of the new price transparency rule in January 2021, most facilities provided some pricing information to patients. However, reporting rates in sports medicine were low and the available data were of little use to patients.

Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs

“…Procedure-specific information was also highly variable. Schultz et al, 15 investigating six common orthopedic sports medicine procedures, found that while 74%–86% of hospitals provided pricing information, only one of the six chosen procedures had pricing information available at 80% of hospitals, with the rest being reported by less than 27%–40% of hospitals.…”

Association Between Cancer Center Accreditation and Compliance With Price Disclosure of Common Oncologic Surgical Procedures

“…18 Assessment of compliance to the price transparency rule is not straightforward, given that previous studies have assessed it differently. [11][12][13]16,20 To that end, we sought to use an inclusive definition, where hospitals that disclosed at least one price (and not necessarily prices of all commercial payers, Medicare Advantage, Medicaid, and cash prices along with de-identified minimum and maximum prices) were considered "compliant." Hospitals were considered to have disclosed prices if at least one negotiated payment was identified for the CPT codes and/or Medicare Severity Diagnosis Related Group (MS-DRG) codes encompassing mastectomy, lobectomy, WLE for cutaneous melanoma, partial colectomy, and prostatectomy in the Turquoise Health research dataset (supplemental eAppendix 1, available online at JNCCN.org).…”

“…10 Despite this, compliance with this price transparency rule has been low, ranging from 40% to 50%. [11][12][13][14] Prior cross-sectional investigations have shown that the majority of for-profit hospitals were noncompliant with at least one of the rule's requirements by failing to provide a chargemaster. 11,12,15,16 However, the impact of these studies on the care trajectories of patients with cancer in particular remains unclear.…”

Playing by the Rules? Tracking U.S. Hospitals' Responses to Federal Price Transparency Regulation

“…Numerous studies have assessed compliance among subsets of hospitals, including the 100 largest hospitals in terms of beds (Henderson & Mouslim, 2021) and gross revenue (Gondi et al, 2021), as well as select orthopedic hospitals (D'Amore et al, 2022; Schultz et al, 2021), hospitals with National Cancer Institute-designated cancer centers (Chino et al, 2021; Herb et al, 2022; Mathew et al, 2022a; Xiao et al, 2021), children's hospitals (Hayatghaibi et al, 2022), Association of American Medical Colleges-affiliated hospitals (Berkowitz et al, 2021), and U.S. News & World Report Honor Roll hospitals (Cram et al, 2021). Some studies also have examined price variation for specific procedures, including ophthalmological procedures (Berkowitz et al, 2021), pediatric tonsillectomy (Ayoub & Balakrishnan, 2022), sports medicine (Schultz et al, 2021), cancer prevention and treatment (Mathew et al, 2022b; Xiao et al, 2021), telemedicine (Wu et al, 2022) and cardiovascular tests and procedures (Oseran et al, 2022). Although providing timely information on early compliance, one limitation is that these sampled hospitals are disproportionately large, urban, and system-affiliated.…”