Charges for Shoppable Musculoskeletal Imaging Examinations: CMS Transparency Compliance and Variability Among 250 U.S. Hospitals

Petterson, Matthew; Willis, Marc H.; Rosenberg, Jarrett; Boutin, Robert D.

doi:10.2214/ajr.21.27008

Cited by 4 publications

(2 citation statements)

References 5 publications

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“…This large variation in commercial payer-negotiated rates for breast reconstruction parallels that of shoppable procedures within other medical and surgical specialties. 20,[22][23][24][25][26][27]29,30 In comparison with prior studies of otolaryngology procedures that used similar methodology to quantify variability in commercial price, 20,21 the range of across-hospital ratios was comparable (breast reconstruction, 4.5-18.3 vs Wang et al, 20 3.5-18.6) and slightly lower for within-hospital ratios (breast reconstruction 1.6-2.5 vs Wang et al, 20 2.7-5.4), though nonetheless substantial. Overall, this suggests that privately insured patients are paying markedly different prices for breast reconstruction depending on their insurer, plan, and hospital.…”

Section: Discussionmentioning

confidence: 99%

“…In an effort to promote cost-based competition and ultimately reduce the cost of health care, the Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Price Transparency Rule on January 1, 2021, that requires hospitals to disclose discounted cash prices and commercial payer–specific negotiated rates for shoppable services . Over the past year, investigators have leveraged the data made public from this mandate to demonstrate large variation in commercial pricing for procedures within otolaryngology, radiology, ophthalmology, and orthopedics, in addition to general medical and surgical hospital services . For instance, the median commercial negotiated price for colonoscopy among 1225 disclosing hospitals ranged from $3677 to $27 679 among the 10% of highest-price hospitals and $44 to $3676 among the remaining hospitals …”

Section: Introductionmentioning

confidence: 99%

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Commercial Price Variation for Breast Reconstruction in the Era of Price Transparency

et al. 2023

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ImportanceBreast reconstruction is costly, and negotiated commercial rates have been hidden from public view. The Hospital Price Transparency Rule was enacted in 2021 to facilitate market competition and lower health care costs. Breast reconstruction pricing should be analyzed to evaluate for market effectiveness and opportunities to lower the cost of health care.ObjectiveTo evaluate the extent of commercial price variation for breast reconstruction. The secondary objective was to characterize the price of breast reconstruction in relation to market concentration and payer mix.Design, Setting, and ParticipantsThis was a cross-sectional study conducted from January to April 2022 using 2021 pricing data made available after the Hospital Price Transparency Rule. National data were obtained from Turquoise Health, a data service platform that aggregates price disclosures from hospital websites. Participants were included from all hospitals with disclosed pricing data for breast reconstructive procedures, identified by Current Procedural Terminology (CPT) code.Main Outcomes and MeasuresPrice variation was measured via within- and across-hospital ratios. A mixed-effects linear model evaluated commercial rates relative to governmental rates and the Herfindahl-Hirschman Index (health care market concentration) at the facility level. Linear regression was used to evaluate commercial rates as a function of facility characteristics.ResultsA total of 69 834 unique commercial rates were extracted from 978 facilities across 335 metropolitan areas. Commercial rates increased as health care markets became less competitive (coefficient, $4037.52; 95% CI, $700.12 to $7374.92; P = .02; for Herfindahl-Hirschman Index [HHI] 1501-2500, coefficient $3290.21; 95% CI, $878.08 to $5702.34; P = .01; both compared with HHI ≤1500). Commercial rates demonstrated economically insignificant associations with Medicare and Medicaid rates (Medicare coefficient, −$0.05; 95% CI, −$0.14 to $0.03; P = .23; Medicaid coefficient, $0.14; 95% CI, $0.07 to $0.22; P &lt; .001). Safety-net and nonprofit hospitals reported lower commercial rates (coefficient, −$3269.58; 95% CI, −$3815.42 to −$2723.74; P &lt; .001 and coefficient, −$1892.79; −$2519.61 to −$1265.97; P &lt; .001, respectively). Extra-large hospitals (400+ beds) reported higher commercial rates compared with their smaller counterparts (coefficient, $1036.07; 95% CI, $198.29 to $1873.85, P = .02).Conclusions and RelevanceStudy results suggest that commercial rates for breast reconstruction demonstrated large nationwide variation. Higher commercial rates were associated with less competitive markets and facilities that were large, for-profit, and nonsafety net. Privately insured patients with breast cancer may experience higher premiums and deductibles as US hospital market consolidation and for-profit hospitals continue to grow. Transparency policies should be continued along with actions that facilitate greater health care market competition. There was no evidence that facilities increase commercial rates in response to lower governmental rates.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Commercial Price Variation for Breast Reconstruction in the Era of Price Transparency

et al. 2023

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Burn Care Funding in the Era of Price Transparency—Does Verification Signal Bargaining Power?

Stanton,

Pedreira,

Rizk

et al. 2024

Journal of Burn Care &Amp; Research

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The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related Diagnosis Related Groups (DRG) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission) a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of three for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (p<0.001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.

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Publicly Disclosed Pricing for Common Upper-Extremity Procedures: An Analysis of Hospital Chargemasters

Ozdag

Hayes

Boualam

et al. 2023

Hand (New York, N,Y.)

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Background: American hospitals are required to provide price transparency data (known as a chargemaster) for medical services, which is intended to allow consumers to accurately estimate the cost of medical services. Our purpose was to identify hospital compliance in publishing chargemaster documents and to assess the price information published for common upper-extremity services and procedures. Methods: We performed a cross-sectional analysis of publicly available chargemaster data from 122 hospitals, which included the top-20-ranked Honor Roll hospitals from US News and World Report and 2 top-ranked hospitals from each state. Chargemaster files were accessed for each hospital, and price information was recorded for 10 common upper-extremity procedures including radiographs, injections, and surgeries. Mean procedural prices were compared between academic and nonacademic hospitals. Results: Chargemaster files were able to be accessed for 107 (88%) of 122 institutions. Price estimates for imaging studies were more frequently reported (73%) than those of procedures (23%-41%). With 50 hospitals reporting a price estimate, carpal tunnel injection was the most frequently reported procedure, whereas trigger finger release was the least frequently reported (41% and 23%, respectively). Wide price ranges were noted, with mean charges for a total shoulder arthroplasty listed as US $51 723 (range, US $247-US $364 024). Mean prices between academic and nonacademic hospital systems were similar. Conclusions: While most (88%) of the included hospitals have been compliant with publishing their price transparency files, price estimates for common upper-extremity procedures and imaging studies are inconsistently reported and, when present, demonstrate high levels of price variability between and within hospital systems.

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Charges for Shoppable Musculoskeletal Imaging Examinations: CMS Transparency Compliance and Variability Among 250 U.S. Hospitals

Cited by 4 publications

References 5 publications

Commercial Price Variation for Breast Reconstruction in the Era of Price Transparency

Commercial Price Variation for Breast Reconstruction in the Era of Price Transparency

Burn Care Funding in the Era of Price Transparency—Does Verification Signal Bargaining Power?

Publicly Disclosed Pricing for Common Upper-Extremity Procedures: An Analysis of Hospital Chargemasters

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