Variable Accessibility to Consumer Pricing Among Breast Cancer Operations.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
Aug 2023
Aug 2023
Historique:
received:
10
10
2022
accepted:
20
03
2023
medline:
7
7
2023
pubmed:
18
4
2023
entrez:
17
4
2023
Statut:
ppublish
Résumé
The Centers for Medicare & Medicaid Services (CMS) mandate that every US hospital provide public online pricing information for services rendered. This allows patients to compare prices across hospital systems before establishing care. The goal of this project was to evaluate hospital compliance and patient-level accessibility to price transparency for common breast cancer surgical procedures. A sample case of a 62-year-old female with a T2N0 breast cancer was chosen. The patient would have the option of undergoing a partial mastectomy or mastectomy, both with sentinel lymph node biopsy (SLNB). Eight Massachusetts academic medical centers were evaluated. Searches were performed by authors for each hospital system and procedure using the sample case. Every hospital had a cost calculator on its website. The average success rate of establishing a cost for partial mastectomy, mastectomy, and SLNB was 58, 35, and 25%, respectively. The median time to reach the cost calculator tool was 32 s (range 25-37 s). In successful attempts, the median pre-insurance estimated cost of a partial mastectomy was $16,509 (range $11,776-22,169), compared with $24,541 (range $16,921-25,543) for mastectomy and $12,342 (range $4034-20,644) for SLNB. SLNB costs varied significantly across hospitals (p = 0.025), but no statistically significant difference was observed for partial mastectomy or mastectomy. Despite new regulatory requirements by CMS for increased price transparency for surgical procedures, our results demonstrate poor success rates in obtaining cost estimates and significant variability of reported hospital charges. Further efforts to improve the quality of hospital cost estimate calculators are necessary for informed decision-making for patients with breast cancer.
Sections du résumé
BACKGROUND
BACKGROUND
The Centers for Medicare & Medicaid Services (CMS) mandate that every US hospital provide public online pricing information for services rendered. This allows patients to compare prices across hospital systems before establishing care. The goal of this project was to evaluate hospital compliance and patient-level accessibility to price transparency for common breast cancer surgical procedures.
METHODS
METHODS
A sample case of a 62-year-old female with a T2N0 breast cancer was chosen. The patient would have the option of undergoing a partial mastectomy or mastectomy, both with sentinel lymph node biopsy (SLNB). Eight Massachusetts academic medical centers were evaluated. Searches were performed by authors for each hospital system and procedure using the sample case.
RESULTS
RESULTS
Every hospital had a cost calculator on its website. The average success rate of establishing a cost for partial mastectomy, mastectomy, and SLNB was 58, 35, and 25%, respectively. The median time to reach the cost calculator tool was 32 s (range 25-37 s). In successful attempts, the median pre-insurance estimated cost of a partial mastectomy was $16,509 (range $11,776-22,169), compared with $24,541 (range $16,921-25,543) for mastectomy and $12,342 (range $4034-20,644) for SLNB. SLNB costs varied significantly across hospitals (p = 0.025), but no statistically significant difference was observed for partial mastectomy or mastectomy.
CONCLUSION
CONCLUSIONS
Despite new regulatory requirements by CMS for increased price transparency for surgical procedures, our results demonstrate poor success rates in obtaining cost estimates and significant variability of reported hospital charges. Further efforts to improve the quality of hospital cost estimate calculators are necessary for informed decision-making for patients with breast cancer.
Identifiants
pubmed: 37067741
doi: 10.1245/s10434-023-13520-5
pii: 10.1245/s10434-023-13520-5
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
4631-4635Informations de copyright
© 2023. Society of Surgical Oncology.
Références
Glennie RA, Barry SP, Alant J, Christie S, Oxner WM. Will cost transparency in the operating theatre cause surgeons to change their practice? J Clin Neurosci. 2019;60:1–6.
doi: 10.1016/j.jocn.2018.09.024
pubmed: 30626523
Gupta R, Tsay C, Fogerty R. Promoting cost transparency to reduce financial harm to patients. AMA J Ethics. 2015;17(11):1073–8.
doi: 10.1001/journalofethics.2015.17.11.mhst1-1511
pubmed: 26595250
Siegel RL, Miller KD, Fuchs HE, Jemal A. Cancer statistics, 2021. CA Cancer J Clin. 2021;71(1):7–33.
doi: 10.3322/caac.21654
pubmed: 33433946
Berlin NL, Chung KC, Matros E, Chen JS, Momoh AO. The costs of breast cancer reconstruction and implications for episode-based bundled payment models. Plast Reconstr Surg. 2020;146(6):721e–30e.
doi: 10.1097/PRS.0000000000007329
pubmed: 33234949
pmcid: 8503817
Greenup RA, Rushing C, Fish L, et al. Financial costs and burden related to decisions for breast cancer surgery. J Oncol Pract. 2019;15(8):e666–76.
doi: 10.1200/JOP.18.00796
pubmed: 31356147
pmcid: 7846052
Ehsan AN, Wu CA, Minasian A, et al. Financial toxicity among patients with breast cancer worldwide: a systematic review and meta-analysis. JAMA Netw Open. 2023;6(2):e2255388.
doi: 10.1001/jamanetworkopen.2022.55388
pubmed: 36753274
pmcid: 9909501
Greenup RA. Financial toxicity and shared decision making in oncology. Surg Oncol Clin N Am. 2022;31(1):1–7.
doi: 10.1016/j.soc.2021.08.001
pubmed: 34776059
Greenup RA, Rushing CN, Fish LJ, et al. Perspectives on the costs of cancer care: a survey of the American society of breast surgeons. Ann Surg Oncol. 2019;26(10):3141–51.
doi: 10.1245/s10434-019-07594-3
pubmed: 31342390
pmcid: 7418033
Hospital Price Transparency. CMS, 2021. https://www.cms.gov/hospital-price-transparency .
De la Cruz Ku G, Karamchandani M, Chambergo-Michilot D, et al. Does breast-conserving surgery with radiotherapy have a better survival than mastectomy? A meta-analysis of more than 1,500,000 patients. Ann Surg Oncol. 2022;29:6163–88.
doi: 10.1245/s10434-022-12133-8
pubmed: 35876923
Brill S. Bitter pill: why medical bills are killing us. Time. April 4, (2013) http://www.time.com/time/magazine/article/0,9171,2136864,00.html .
Carrera PM, Kantarjian HM, Blinder VS. The financial burden and distress of patients with cancer: understanding and stepping-up action on the financial toxicity of cancer treatment. CA Cancer J Clin. 2018;68(2):153–65.
doi: 10.3322/caac.21443
pubmed: 29338071
pmcid: 6652174
Delgado-Guay M, Ferrer J, Rieber AG, et al. Financial distress and its associations with physical and emotional symptoms and quality of life among advanced cancer patients. Oncologist. 2015;20:1092–8.
doi: 10.1634/theoncologist.2015-0026
pubmed: 26205738
pmcid: 4571810
Desai S, Hatfield L, Hicks A. Association between availability of a price transparency tool and outpatient spending. JAMA. 2016;315(17):1874–81.
doi: 10.1001/jama.2016.4288
pubmed: 27139060
Higgins A, Brainard N, Veselovskiy G. Characterizing health plan price estimator tools: findings from a national survey. Am J Manag Care. 2016;22(2):126–31.
pubmed: 26885672
Herb J, Williams B, Stitzenberg K. Hospital price transparency are inadequate to inform patients needing major gastrointestinal cancer operations. Ann Surg Oncol. 2022;29:45–6.
doi: 10.1245/s10434-021-10244-2
pubmed: 34095959
Xiao R, Miller LE, Workman AD, Bartholomew RA, Xu LJ, Rathi VK. Analysis of price transparency for oncologic surgery among national cancer institute-designated cancer centers in 2020. JAMA Surgery. 2021;156(6):582–5.
doi: 10.1001/jamasurg.2021.0590
pubmed: 33851977
pmcid: 8047718
Ayoub NF, Balakrishnan K. Price transparency and compliance with federal regulation for pediatric tonsillectomy. Otolaryngol Head Neck Surg. 2021;1945998211047146.
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. JAMA Oncol. 2020;6(3):409–12.
doi: 10.1001/jamaoncol.2019.5690
pubmed: 31944219
pmcid: 6990958
Billig JI, Lan WC, Chung KC, Kuo CF, Sears ED. The increasing financial burden of outpatient elective surgery for the privately insured. Ann Surg. 2020;272(3):530–6.
doi: 10.1097/SLA.0000000000004201
pubmed: 32740255
Linde S, Egede LE. Hospital price transparency in the United States: an examination of chargemaster, cash, and negotiated price variation for 14 common procedures. Med Care. 2022;60(10):768–74.
doi: 10.1097/MLR.0000000000001761
pubmed: 35948351
Fu SJ, Rose L, Dawes AJ, et al. Out-of-pocket costs among patients with a new cancer diagnosis enrolled in high-deductible health plans vs traditional insurance. JAMA Netw Open. 2021;4(12):e2134282.
doi: 10.1001/jamanetworkopen.2021.34282
pubmed: 34935922
pmcid: 8696568