Assessing the true cost of cancer screening: Comparing hospital prices to claims remittance data for common cancer screening tests at top-ranked US hospitals.

Abstract

11055 Background: Patients in the United States often lack information about the price of common cancer screening services across hospitals and payers. Recent legislation in the US, including the 2021 Hospital Price Transparency Final Rule and the No Surprises Act of 2022, require hospitals to post payer-specific negotiated prices for all services, creating a unique opportunity to understand variation in hospital pricing. While there has been much study regarding the wide variations in prices for healthcare screening services, little is known about the relationship between the prices for screening made publicly available by hospitals and the actual claims remittance recorded for those same services. Methods: We extracted payer-specific prices for four common cancer screening tests among 20 top-ranked US hospitals: colonoscopy, low-dose helical computed tomography (CT) scan, mammography, and prostate-specific antigen (PSA). Additionally, we extracted the cash prices published by these same hospitals and determined the median cash price for each screening service. To evaluate price variation for these screening tests, we determined the median and inter-quartile range (IQR) across all payers for these 20 hospitals. We compared this hospital pricing data to the 835 claims remittance data from December 1, 2021 to January 15, 2022. Results: Across 20 top US hospitals, the median hospital price for colonoscopy was $1597 (IQR $1780) and median claims price was $806 (IQR $788). The median hospital price for low-dose CT was $315 (IQR $472) and median claims price was $126 (IQR $83). The median hospital price for mammogram was $300 (IQR $351) and median claims price was $72 (IQR $83). The median hospital price for PSA was $85 (IQR $113) and median claims price was $29 (IQR $10). For all four screening tests, the median cash price was greater than the median negotiated price by an average of 27%. Conclusions: For common cancer screening tests, the distribution of hospital prices is wider than the actual prices reflected in claims data for the same screening services. Median cash prices published by hospitals were greater than the median negotiated rates for all cancer screening services, consistent with trends observed among large academic centers in metropolitan areas. Policies that improve precision in price estimates may help improve adherence in the United States for uninsured patients by providing more accurate information about prices for common cancer screening services. [Table: see text]