Analysis of Price Transparency for Oncologic Surgery Among National Cancer Institute–Designated Cancer Centers in 2020

Xiao, Roy; Miller, Lauren E.; Workman, Alan D.; Bartholomew, Ryan A.; Xu, Lucy; Rathi, Vinay K.

doi:10.1001/jamasurg.2021.0590

Cited by 18 publications

(26 citation statements)

References 4 publications

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“…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).…”

Section: Discussionmentioning

confidence: 99%

“…19 Turquoise Health uses standardized and automated searching algorithms to scan hospital websites to extract pricing information, and has been used in previously published works. 17,20 These price reports, which include only facility fees, are ostensibly compliant with the CMS regulation effective January 1, 2021, requiring hospitals to publicly disclose payer-specific payments for common "shoppable services," as well as all inpatient services and procedures. 10…”

Section: Data Sourcementioning

confidence: 99%

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

Zhang

Cerullo

Esposito

et al. 2022

Journal of the National Comprehensive Cancer Network

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Background: Cancer center accreditation status is predicated on several factors that measure high-value healthcare. However, price transparency, which is critical in healthcare decisions, is not a quality measure included for accreditation. We reported the rates of price disclosure of surgical procedures for 5 cancers (breast, lung, cutaneous melanoma, colon, and prostate) among hospitals ranked by the American College of Surgeon’s Commission on Cancer (ACS-CoC). Methods: We identified nonfederal, adult, and noncritical access ACS-CoC accredited hospitals and used the commercial Turquoise Health database to perform a cross-sectional analysis of hospital price disclosures for 5 common oncologic procedures (mastectomy, lobectomy, wide local excision for cutaneous melanoma, partial colectomy, prostatectomy). Publicly available financial reporting data were used to compile facility-specific features, including bed size, teaching status, Centers for Medicare & Medicaid wage index, and patient revenues. Modified Poisson regression evaluated the association between price disclosure and ACS-CoC accreditation after adjusting for hospital financial performance. Results: Of 1,075 total ACS-CoC accredited hospitals, 544 (50.6%) did not disclose prices for any of the surgical procedures and only 313 (29.1%) hospitals reported prices for all 5 procedures. Of the 5 oncologic procedures, prostatectomy and lobectomy had the lowest price disclosure rates. Disclosing and nondisclosing hospitals significantly differed in ACS-CoC accreditation, ownership type, and teaching status. Hospitals that disclosed prices were more likely to receive Medicaid disproportionate share hospital payments, have lower average charge to cost ratios (4.53 vs 5.15; P<.001), and have lower net hospital margins (−2.03 vs 0.44; P=.005). After adjustment, a 1-point increase in markup was associated with a 4.8% (95% CI, 2.2%–7.4%; P<.001) higher likelihood of nondisclosure. Conclusions: More than half of the hospitals did not disclose prices for any of the 5 most common oncologic procedures despite ACS-CoC accreditation. It remains difficult to obtain price transparency for common oncologic procedures even at centers of excellence, signaling a discordance between quality measures visible to patients.

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Section: Discussionmentioning

confidence: 99%

Section: Data Sourcementioning

confidence: 99%

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

Zhang

Cerullo

Esposito

et al. 2022

Journal of the National Comprehensive Cancer Network

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“…Uninsured and underinsured patients regularly pay out-of-pocket prices that significantly exceed the reimbursement rates set by private insurance companies and public payers like the United States (US) Medicare and Medicaid Services (CMS). 1 , 2 Overall healthcare costs in the US are considerably higher than in other high-income countries, including both privately- and publicly-insured patients. 3 Several health economists have proposed requiring hospitals to publicly disclose prices, thus promoting competition and allowing patients to “shop” for cheaper care.…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…7 However, studies across several medical specialties suggest that many hospitals are not yet in compliance with the CMS mandate. 1,2 Overall, there is limited information regarding the correlates of price transparency. 8 The purpose of this paper is to identify demographic and hospital characteristics that predict price transparency at any given US hospital.…”

Section: Introductionmentioning

confidence: 99%

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Correlates of Price Transparency for Healthcare Services in United States Hospitals

Younessi¹,

Lin²,

Greenberg³

et al. 2022

CEOR

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Purpose The purpose of this study is to investigate demographic and hospital characteristics that predict hospital price transparency in the United States. Methods We identified 6214 hospitals and extracted characteristics of each using the American Hospital Association Annual Survey, as well as cash prices for a representative selection of commonly performed procedures and visits from the Turquoise Health dataset. Descriptive statistics were used to determine compliance rates and price variation, and a Poisson regression model was used to calculate incidence rate ratios (IRR) and 95% confidence intervals (CI) for predictors of price transparency. Results Price transparency compliance ranged from 13% to 49% of hospitals, and across-center ratios ranged from 244.8 to 4789.0. Number of hospital beds was marginally associated with price transparency for more services (IRR: 1.01 [95% CI: 1.01–1.02]); in contrast, location in the Southern (IRR: 0.91 [95% CI: 0.87–0.96]) or Western (IRR: 0.94 [95% CI: 0.90–0.99]) regions of the US was associated with transparency for fewer services. Conclusion Smaller hospitals as well as those located in the South and West regions were less likely to be compliant with the CMS mandate for price transparency for hospital standard charges. Additionally, the poor usability of price transparency directories on hospital websites limits information access and undermines transparency efforts.

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Payer-Negotiated Prices in the Diagnosis and Management of Thyroid Cancer in 2021

Xiao

Rathi

Gross

et al. 2021

JAMA

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Thyroid cancer is among the most common malignancies in the US, with a 3.6% annual increase in incidence over the past 50 years. 1 Treatment regimens for thyroid cancer are wellestablished, with excellent survival outcomes. However, costs of thyroid cancer care can vary substantially by hospital and impose significant financial burdens on patients 2 ; among patients with cancer, bankruptcy rates are highest for those with thyroid cancer. 3 The Centers for Medicare & Medicaid Services (CMS) recently implemented price transparency reforms to promote informed hospital selection by patients and cost-based competition among hospitals. Effective January 1, 2021, hospitals must disclose commercial payer-specific negotiated prices for all items and services. 4 We characterized price availability and variation for thyroid cancer care at National Cancer Institute (NCI)-Designated Cancer Centers.Methods | We performed a cross-sectional analysis of commercial payer-negotiated prices of services for thyroid cancer at NCI-Designated Cancer Centers. We restricted analysis to cancer centers providing adult clinical care and participating in the Medicare Inpatient Prospective Payment System. We reviewed each center's website to extract (as available) prices for 14 services that are integral to thyroid cancer management, including laboratory tests, radiology studies, medical and surgical treatments, and inpatient care (Supplement).To compare prices between centers, we first normalized the median price for each service at each center to the estimated center-specific 2021 Medicare payment amount, which accounts for factors affecting the cost of care delivery (Supplement). 2 We then determined the ratio between the maximum and minimum normalized median prices for each

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Analysis of Price Transparency for Oncologic Surgery Among National Cancer Institute–Designated Cancer Centers in 2020

Cited by 18 publications

References 4 publications

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

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

Correlates of Price Transparency for Healthcare Services in United States Hospitals

Payer-Negotiated Prices in the Diagnosis and Management of Thyroid Cancer in 2021

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