Price transparency of prostate cancer care in the United States: An analysis of pricing and disclosure following the centers for medicare and medicaid mandate.


Journal

Prostate cancer and prostatic diseases
ISSN: 1476-5608
Titre abrégé: Prostate Cancer Prostatic Dis
Pays: England
ID NLM: 9815755

Informations de publication

Date de publication:
30 Jan 2023
Historique:
received: 14 08 2022
accepted: 05 01 2023
revised: 18 12 2022
entrez: 30 1 2023
pubmed: 31 1 2023
medline: 31 1 2023
Statut: aheadofprint

Résumé

Starting January 1, 2021, Centers for Medicare and Medicaid Services required United States hospitals to publicly disclose prices of their services provided. We analyzed publicly-disclosed prices of prostate cancer-related services. All United States hospitals were queried for publicly-disclosed prices of total and free prostate-specific antigen, prostate magnetic resonance imaging, prostate biopsy, radical prostatectomy, and intensity-modulated radiation therapy as of May 2022. Prices were adjusted by regional price parity. Hospitals disclosing prices were compared with non-disclosing hospitals. Of 6013 hospitals, 3840 (64%) disclosed pricing for at least one prostate cancer-related service. Compared to non-disclosing hospitals, disclosing hospitals had higher median gross annual revenue ($318,502,426 vs. $62,930,436, p < 0.001) and were more likely to be non-profit (56% vs. 30%, p < 0.001), academic-affiliated (46% vs. 13%, p < 0.001), and in neighborhoods with low hospital density (68% vs 62%, p < 0.001). Self-pay prices were higher than insurance-negotiated prices for all services (p < 0.001) other than prostate biopsy. The range of pricing was widest for self-pay prostatectomy, with a 32-fold difference from 90 Self-pay prices of prostate cancer services were generally higher than insurance-negotiated prices and were higher at for-profit hospitals, academic hospitals, and hospitals in the highest quartile of gross annual revenue. Higher neighborhood hospital density was not associated with higher likelihood of price disclosure nor lower pricing of services, suggesting that local competition does not lead to lower prices and may disincentivize disclosure of prices.

Sections du résumé

BACKGROUND BACKGROUND
Starting January 1, 2021, Centers for Medicare and Medicaid Services required United States hospitals to publicly disclose prices of their services provided. We analyzed publicly-disclosed prices of prostate cancer-related services.
METHODS METHODS
All United States hospitals were queried for publicly-disclosed prices of total and free prostate-specific antigen, prostate magnetic resonance imaging, prostate biopsy, radical prostatectomy, and intensity-modulated radiation therapy as of May 2022. Prices were adjusted by regional price parity. Hospitals disclosing prices were compared with non-disclosing hospitals.
RESULTS RESULTS
Of 6013 hospitals, 3840 (64%) disclosed pricing for at least one prostate cancer-related service. Compared to non-disclosing hospitals, disclosing hospitals had higher median gross annual revenue ($318,502,426 vs. $62,930,436, p < 0.001) and were more likely to be non-profit (56% vs. 30%, p < 0.001), academic-affiliated (46% vs. 13%, p < 0.001), and in neighborhoods with low hospital density (68% vs 62%, p < 0.001). Self-pay prices were higher than insurance-negotiated prices for all services (p < 0.001) other than prostate biopsy. The range of pricing was widest for self-pay prostatectomy, with a 32-fold difference from 90
CONCLUSIONS CONCLUSIONS
Self-pay prices of prostate cancer services were generally higher than insurance-negotiated prices and were higher at for-profit hospitals, academic hospitals, and hospitals in the highest quartile of gross annual revenue. Higher neighborhood hospital density was not associated with higher likelihood of price disclosure nor lower pricing of services, suggesting that local competition does not lead to lower prices and may disincentivize disclosure of prices.

Identifiants

pubmed: 36717642
doi: 10.1038/s41391-023-00643-9
pii: 10.1038/s41391-023-00643-9
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Informations de copyright

© 2023. The Author(s), under exclusive licence to Springer Nature Limited.

Références

Medicare and Medicaid Programs: CY 2020 Hospital Outpatient PPS Policy Changes and Payment Rates and Ambulatory Surgical Center Payment System Policy Changes and Payment Rates. Price Transparency Requirements for Hospitals To Make Standard Charges Public. 84 Fed. Reg. 65524-65606 (November 27, 2019)
Xiao R, Rathi VK, Gross CP, Ross JS, Sethi RKV. Payer-Negotiated Prices in the Diagnosis and Management of Thyroid Cancer in 2021 [published online ahead of print, 2021 Jun 4]. JAMA. 2021;326:184–5. https://doi.org/10.1001/jama.2021.8535
doi: 10.1001/jama.2021.8535
American Cancer Society. Cancer Facts & Figures 2021. Atlanta: American Cancer Society; 2021.
Mahal BA, Aizer AA, Ziehr DR, Hyatt AS, Lago-Hernandez C, Chen Y-W, et al. The association between insurance status and prostate cancer outcomes: implications for the Affordable Care Act. Prostate Cancer Prostatic Dis. 2014;17:273–9.
doi: 10.1038/pcan.2014.23
Agarwal A, Dayal A, Kircher SM, Chen RC, Royce TJ. Analysis of price transparency via national cancer institute-designated cancer centers’ Chargemasters for prostate cancer radiation therapy [published correction appears in JAMA Oncol. 2020 Mar 1;6(3):444]. JAMA Oncol. 2020;6:409–12.
doi: 10.1001/jamaoncol.2019.5690
Anderson GF. From ‘soak the rich’ to ‘soak the poor’: recent trends in hospital pricing. Health Aff (Millwood). 2007;26:780–9.
doi: 10.1377/hlthaff.26.3.780
“Press Release CMS Proposes Rule to Increase Price Transparency, Access to Care, Safety & Health Equity.” Centers for Medicare and Medicaid Services, https://www.cms.gov/newsroom/press-releases/cms-proposes-rule-increase-price-transparency-access-care-safety-health-equity .
“Revenue Trends at U.S. Hospitals.” Definitive Healthcare, https://www.definitivehc.com/blog/revenue-trends-at-u.s.-hospitals .
Lu AJ, Chen EM, Vutam E, Brandt J, Sadda P. Price transparency implementation: Accessibility of hospital chargemasters and variation in hospital pricing after CMS mandate. Health (Amst) 2020;8:100443.
Hut, Nick. “CMS Finalizes Changes to the Price Transparency Penalty, Inpatient-Only List and More for 2022.” Healthcare Financial Management Association, https://www.hfma.org/topics/news/2021/11/cms-finalizes-changes-to-the-price-transparency-penalty--ipo-lis.html .

Auteurs

Aaron Brant (A)

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.

Patrick Lewicki (P)

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.

Stephen Rhodes (S)

Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Camilo Arenas-Gallo (C)

Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Mary O Strasser (MO)

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.

Alec Zhu (A)

Department of Urology, New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.

Lee Ponsky (L)

Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA.

Jonathan E Shoag (JE)

Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA. jxs218@case.edu.

Classifications MeSH