Abstract 13913: Payer-Negotiated Prices for Transthoracic Echocardiography

Abstract

Introduction: Transthoracic echocardiography (TTE) is widely used in clinical practice. Medicare pays over $900 million annually for TTE. Using hospital-reported data, we sought to characterize variation in payer-negotiated (commercial) and self-pay prices for TTE within and across hospitals in the US. Methods: As of January 2021, federal price transparency legislation began requiring hospitals to publish chargemaster, discounted self-pay and commercial prices for all hospital services. We used the Turquoise Health database to gather this price data for TTE based on common procedural terminology (CPT) code 93306. Results: A total of 1,949 hospitals nationwide reported commercial prices for CPT 93306. Raw median prices varied widely across the US [$1398 (IQR $1064-$1661)] (Figure A). The median number of commercial plans per hospital was 20 (IQR 8-42) (Figure B). Compared with a median Medicare price of $464 (IQR $445-$493), the median commercial and discounted self-pay prices were $1313 (IQR $744-$1948) and $1422 (IQR $836-$2189) respectively, representing a 2.83- and 3.06-fold markup from the Medicare rate. The median chargemaster price was $2497 (IQR $1731-$3576), corresponding to a 5.38-fold markup. Within hospitals, the 90th percentile payer-negotiated rate was 2.78 (IQR 1.80-5.09) times the 10th percentile price (within-center ratio). Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 2.47 (IQR 1.69-3.75) times that at the 10th percentile hospital (across-center ratio). Conclusions: Self-pay and commercial TTE prices are substantially higher than Medicare prices. There is significant variation in payer-negotiated rates within and across hospitals. More research is needed to understand the factors leading to this price variation and its relation to quality of care and access amidst rising healthcare costs in the US.