193 Price Transparency and Cash Discounts for Implantable Pulse Generator Implantation in the United States

Abstract

INTRODUCTION: Since the Healthcare PRICE Transparency Act (January 2021), hospitals are required to publicly disclose standard prices for care and procedures. METHODS: This is a cross-sectional study conducted with data obtained from Turquoise Health from January to April 2021. Current procedural terminology (CPT) code 61885 was used to query cases of DBS IPG connected to a single electrode. Inclusion criteria required reporting of both commercial and cash prices. Hospitals were filtered for cash to commercial price ratios <2. The Healthy Marketplace Index (HMI) was used to assess city-level hospital competition and the 2022 Lown Institute Hospital Index (LIHI) was used to assess hospital bed size. Differences in continuous variables were analyzed with a Kruskal-Wallis test. RESULTS: Eight-hundred forty-six centers met inclusion criteria, of which 98 (11.6%) provided commercial and cash prices and a cash to commercial ratio of <2. Of those 98, the median commercial price was $18,562 (IQR $1,572-28,476) and the median cash price was $4,340 ($1,596-27,223), with a median intrahospital cash to commercial price ratio of 0.78. Sixty-eight of those 98 (69.4%) hospitals provided a discount for cash payments (cash:commercial ratio<1) of 41% relative to commercial and 39% discount relative to Medicare prices (p<0.001). Medicaid prices significantly differed between hospital sizes. Univariate analysis demonstrated that hospital size and market share were not significant predictors of providing a fair cash estimate. Twenty-eight (56%) states provided a cash discount. CONCLUSIONS: Prices for IPG implantation varied greatly, with self-pay cash pricing providing significant discounts relative to commercial pricing. Cost data should be systematically analyzed and leveraged to increase cost awareness of the procedure, inform hospital reimbursements, and broaden patient accessibility to this valuable therapy.