114 Compliance with Federal Price Transparency Rules at US Hospitals With Neurosurgical Training Programs

Abstract

INTRODUCTION: The Centers for Medicare & Medicaid Services implemented federal requirements on January 1st, 2021 that require hospitals to provide a list of payer-negotiated prices in a machine-readable file. METHODS: We performed a cross-sectional analysis in March of 2023 of 116 US hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements by searching “price transparency” or “standard charges” with associated hospital on the internet to download machine readable files. The payer-negotiated price for 11 common neurosurgical procedures based on CPT codes for 4 insurance companies were collected (Aetna,Anthem/BCBS,United,Medicare). Pricing using DRG codes were excluded given the range of neurosurgical procedures that are encompassed by a specific DRG code. RESULTS: 92/116 (79.3%) hospitals were compliant with the requirement for machine-readable file with payer-negotiated prices. 45/92 (48.9%) used DRG codes. For the common neurosurgical procedures, hospitals had negotiated price available for at least one insurance company with average private insurance cost and average Medicare costs as follows: ventriculoperitoneal shunt (21/92;$10,698;$1,919), lumbar laminectomy (20/92;$10,343;$4,460), lumbar microdiscectomy (31/92;$9,374;$5,026), anterior cervical discectomy and fusion (28/92;$11,544;$9,859), deep brain stimulator with microelectrode recording (15/92;$10,510;$3,616), craniotomy for tumor (14/92;$6,951;$2,361), stereotactic radiosurgery for brain (18/92;$22,409;$7,362) and spine (14/92;$14,242;$3,306), intrathecal pump placement (31/92;$7,139;$5,064), intracranial aneurysm endovascular treatment (14/92;$9,452;$3352), and diagnostic angiogram (46/92;$11,295;$5,867). CONCLUSIONS: While hospital compliance with federal requirement for machine readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on CPT code was sparce. Overall, meaningful conclusions on procedural related cost for elective procedures will be difficult for patients to make due to the unintelligible format of data and a lack of reporting of cost per CPT code in a comprehensive manner.