Health Care Price Transparency in Ophthalmology

Abstract

transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients.OBJECTIVE To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter economic evaluation study, publicly available price transparency web pages from Association of American Medical Colleges affiliate hospitals were parsed for standard charges and usability metrics. Price transparency data were collected from hospital web pages that met the inclusion criteria. Geographic practice cost indices for work, practice expense, and malpractice were sourced from the Centers for Medicare & Medicaid Services. Data were sourced from February 1 to April 30, 2021. Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges.MAIN OUTCOMES AND MEASURES Availability and variability of standard prices for Current Procedural Terminology (CPT) codes 66984 (removal of cataract with insertion of lens) and 66821 (removal of recurring cataract in lens capsule using laser). RESULTSOf 247 hospitals included, 191 (77.3%) provided consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool. For CPT code 66984, 102 hospital (53.4%) provided discount cash pay estimates with a mean (SD) price of $7818.86 ($5407.91). For CPT code 66821, 71 hospital (37.2%) provided discount cash pay estimates with a mean (SD) price of $2041.72 ($2106.44). The top quartile of hospitals, prices wise, listed included prices higher than $10 400 for CPT code 66984 and $2324 for CPT code 66821. Usability issues were noted for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. Multiple regression analysis found minimal explanatory value for geographic practice cost indices for cash discount prices for CPT codes 66984 (adjusted R 2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R 2 = 0.64; 95% CI, 0.51-0.77; P < .001).CONCLUSIONS AND RELEVANCE Despite recent legislature that codified price transparency requirements, some current standard charges remain ambiguous, with substantial interhospital variability not explained by geographic variability in costs. Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices.

Less Than One-third of Hospitals Provide Compliant Price Transparency Information for Total Joint Arthroplasty Procedures

“…The Hospital Compare database provided information for all Medicare hospitals in the United States (n = 5326). Per previous methods [3,5], we excluded children's hospitals and psychiatric hospitals. Similarly, we excluded Veterans Affairs hospitals and active military base hospitals because they are not required to report prices under the CMS rule.…”

“…Our secondary study goal was to determine whether hospitals are providing these data in a consumer-friendly format. Per previous methods, consumer-friendliness was defined based on internet search [5,42,50]. To assess the usability of the pricing features on hospital websites, reviewers documented whether the following criteria were met: (1) languages other than English were offered, (2) it took fewer than 15 minutes to locate pricing information, (3) a phone number or email address provided for questions, and (4) there was a description of procedure in common terms.…”

Evaluation of Prices for Surgical Procedures Within and Outside Hospital Networks in the US

“…However, compared with prior studies, our findings report more rates than previously described. 3 , 4 , 5 Second, there may be appropriate reasons why prices of these procedures vary across hospitals that could not be identified with raw price data. We attempted to mitigate these differences by applying the CMS area wage index to account for important factors that help determine appropriate pricing for health care services.…”

Transparency and Variability in Pricing for Pediatric Outpatient Imaging in US Children’s Hospitals

“…Although our study is focused on top pediatric hospitals, our results are consistent with prior reports that found most hospitals deficient in the machinereadable file stipulation. [3][4][5][6] Additionally, imaging prices did not include the professional component for examination interpretation, which further restricts the effectiveness of the transparency policy.…”