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

Abstract

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

Private payer‐negotiated prices for FDA‐approved biologic treatments for allergic diseases

“…We next assessed price variation both across hospitals and within hospitals between payers. 6 To compare price variation across hospitals, we first normalized the median payer-negotiated price for each drug at each hospital to the hospital-specific Medicare geographic practice cost index (GPCI). We subsequently calculated the ratio of the 90 th -to-10 th percentile GPCI-normalized median prices for each drug ("across-center ratio").…”

Payer-Negotiated Prices for Telemedicine Services

“…Two-third of states had at least one USNWR-ranked hospital disclosing payer-negotiated prices for telemedicine services as required by law—namely, negotiated rates for all items and services. 3 To promote price transparency, CMS could add telemedicine encounters to the 300 shoppable services required to be disclosed in a consumer-friendly display, as is required for in-person clinic visits, rather than cumbersome machine-readable files.…”

“…Using established methods, 3 we performed a cross-sectional analysis of private payer-negotiated prices of telemedicine services at top US News and World Report (USNWR) hospitals, which are ranked by patient outcomes, care-related indicators, expert opinion, and patient experience. We restricted analysis to each state’s top-ranking hospital disclosing telemedicine pricing given their anticipated resources to comply with price disclosure requirements and offer telemedicine services, as well as in-state requirements to deliver telemedicine.…”

“…We queried each hospital’s website to extract payer-negotiated prices for eight telemedicine encounter codes (Figure 1 ). To compare prices across hospitals, we used established methods 3 to calculate the ratio between the 90th and 10th percentile median negotiated prices (“across-center ratio”) for each service after standardizing for geographic differences in cost of care delivery. To compare prices between payers within hospitals, we calculated the ratio between the 90th and 10th percentile payer-negotiated prices (“within-center ratio”).…”

“…Understanding private reimbursement may help policymakers determine the potential for telemedicine to enhance care efficiency and equity moving forward. Leveraging recent Centers for Medicare & Medicaid Services (CMS) requirements for hospitals to disclose payer-negotiated prices for all items and services, 3 we examined payer-negotiated prices for telemedicine encounters at top-ranked US hospitals.…”