Do You Get What You Pay For? The Relationship of Price and Quality in Hospital Provided Procedures

Esposito, Andrew C.; Laird, William D; Zhang, Yuqi; Cerullo, Marcelo; Li, Andrew X.; Coppersmith, Nathan A; Reddy, Vikram; Leeds, Ira L.; Mongiu, Anne; Longo, Walter E.; Pantel, Haddon

doi:10.1016/j.jss.2022.04.035

Cited by 2 publications

(5 citation statements)

References 20 publications

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“…The tool was mandated by the Patient Protection and Affordable Care Act 7 and developed between 2012 and 2016. EGM currently consists of 54 surgeries and hundreds of condition episodes, each of which is a clinically meaningful construct as defined by physicians on the design team and validated by independent clinical review groups 5 . EGM supports chronic, acute, and procedure episodes, allowing for relationships between episodes, such as a procedure nested within its indication (eg, colectomy within cancer or diverticulitis).…”

Section: Methodsmentioning

confidence: 99%

“…EGM currently consists of 54 surgeries and hundreds of condition episodes, each of which is a clinically meaningful construct as defined by physicians on the design team and validated by independent clinical review groups. 5 EGM supports chronic, acute, and procedure episodes, allowing for relationships between episodes, such as a procedure nested within its indication (eg, colectomy within cancer or diverticulitis). The tool reads administrative claims data chronologically by a beneficiary, identifies episodes of care, and assigns services and their associated payments to the best episode(s) of care.…”

Section: Methodsmentioning

confidence: 99%

“…4 Research suggests that past efforts at price transparency have largely failed, so new approaches are needed. 5 To gather and include all relevant services in a single episode of care requires a fiscal tool known as an episode grouper. In basic terms, an episode grouper moves through administrative billing data to identify services that are related to or assigned to the triggering condition or treatment being examined.…”

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confidence: 99%

“…This would be invaluable not just for patients but also for other stakeholders, such as payers and researchers, as they work to identify high-quality, efficient providers in the market 4 . Research suggests that past efforts at price transparency have largely failed, so new approaches are needed 5 …”

mentioning

confidence: 99%

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Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare

Perloff,

Hasley,

Kumar

et al. 2023

Annals of Surgery

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Objective: To explore the use of an episode grouper to more accurately identify the complete set of surgical services typically provided in a surgical episode of care and the corresponding range of prices, using colectomy for cancer as the example. Background: Price transparency is an important policy issue that will require surgeons to better understand the components and cost of care. Methods: This study uses the Episode Grouper for Medicare business logic to construct colectomy surgical episodes of care for cancer using Medicare claims data for the Boston Hospital Referral Region from 2012 to 2015. Descriptive statistics show the mean reimbursement based on patient severity and stage of surgery, along with the number of unique clinicians billing for care and the mix of services provided. Results: The Episode Grouper for Medicare episode grouper identified 3182 colectomies in Boston between 2012 and 2015, with

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare

Perloff,

Hasley,

Kumar

et al. 2023

Annals of Surgery

View full text Add to dashboard Cite

show abstract

“…Another economic motivation for price transparency focuses on suppliers and their potential for competition, although healthcare markets are notoriously concentrated, with sticky relationships, and legally enforced monopolies (Gaynor & Town, 2011). Recent work has explored whether suppliers will comply with transparency mandates (Hayatghaibi et al, 2022; see also Burkhart et al, 2022; Esposito et al, 2022; Jiang et al, 2022). Price transparency may have other effects in equilibrium (Brown, 2019).…”

Section: Introductionmentioning

confidence: 99%

The effects of price transparency and debt collection policies on intentions to consume recommended health care: A randomized vignette experiment

Robertson,

Epstein,

2023

J Empirical Legal Studies

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New laws promote price transparency in health care, though effects on patient decision‐making are not known. Price disclosure may increase the salience of cost and cause lower‐income patients to decline recommended care, worsening inequities in health outcomes. Whether patients perceive a disclosed cost as higher or lower than their expectations may also affect care decisions, but has not been studied. Scholars and policymakers have paid much less attention to the question of whether patients will have to pay the prices charged (whether disclosed or not), and how expectations regarding collections may also affect healthcare consumption. Some hospitals aggressively collect on unpaid medical bills. Others hospitals do not. Actively disclosing collection policies (whether aggressive or protective) could magnify or counteract effects of price disclosures, especially for low‐income patients. To test the effect of price disclosure and debt‐collection disclosures on willingness to obtain recommended care, we recruited a nationally representative sample (N = 2997) and deployed a full factorial, controlled experiment in a standardized clinical vignette model. We find that disclosing a higher‐than‐anticipated price increases the probability of declining recommended care (odds ratio = 1.900), with larger effects for low‐income individuals. Even more, disclosing aggressive collections increases the risk of declining care (odds ratio = 4.493), at higher rates for low‐income patients. Where patients fear collections, but do not know prices, they are most likely to decline care. Disclosure of an aggressive collections policy makes patients feel less informed, harms patient trust in providers, makes them feel that they were not treated fairly, and undermines their confidence in the value of their care. Mediation analysis shows that about half of the effect of collections risk is via these attitudinal variables.

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Do You Get What You Pay For? The Relationship of Price and Quality in Hospital Provided Procedures

Cited by 2 publications

References 20 publications

Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare

Surgical Episodes of Care for Price Transparency using the Episode Grouper for Medicare

The effects of price transparency and debt collection policies on intentions to consume recommended health care: A randomized vignette experiment

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