Do Federal Price Transparency Regulations Neglect Oncology Patients?

Abstract

<h3>Purpose/Objective(s)</h3> Financial toxicity is far more prevalent in oncology than in general patient populations and is associated with inferior quality of life and health outcomes. In 2021, the US Centers for Medicare and Medicaid Services (CMS) required all hospitals to publish "shoppable," payer-negotiated prices for ≥ 300 services of which 70 (including specialty care such as joint and cataract surgery) were specified, but oncology price inclusion was optional. National Cancer Institute (NCI)-designated centers are referral sites for cancer care, but the rate at which they choose to report prices for radiation therapy (RT) or systemic therapy is unknown. We predicted that the proportion of NCI-designated cancer centers reporting RT and infusion prices would lag behind their general rate of compliance with publication of shoppable prices. <h3>Materials/Methods</h3> 63 clinical NCI-designated cancer centers were identified. On February 1, 2021, (1 month after regulations took effect), online shoppable price lists and lengthy "chargemaster" documents containing prices for every offered service were identified through search terms such as "price transparency" or "price estimate." These tools were queried for the Current Procedural Terminology (CPT) codes 77385 and 96413 corresponding to the charge per fraction for simple intensity modulated radiation therapy (IMRT) and the first hour of infusion of systemic therapy, respectively. Search terms such as "radiation," "radiotherapy," "IMRT", "chemotherapy," and "infusion" were also used. Primary endpoints were the rate of reporting of shoppable prices for IMRT and infusion. Secondary endpoints were the rate of publication of shoppable prices and the rate of reporting any RT service. Descriptive statistics including proportions and frequency counts were performed. <h3>Results</h3> The price transparency webpages for all 63 institutions were easily identified. 52 (83%) listed shoppable prices in any format including 49 (78%) user-friendly web-based tools and 3 downloadable documents. 9 (17%) and 8 (15%) centers listed prices for IMRT and infusion, respectively, in their shoppable tools, and 20 (38%) listed at least one RT price. When also including negotiated prices found in chargemaster documents, 20 (32%), 23 (37%), and 31 (49%) of the 63 centers listed negotiated IMRT, infusion, and any RT prices, respectively. <h3>Conclusion</h3> Although 83% of NCI-cancer centers are compliant with mandates to report shoppable prices, almost 1 in 5 are noncompliant. Furthermore, less than 1 in 5 report negotiated RT and systemic therapy prices in shoppable tools. Oncology price reporting rates rise when considering chargemaster data, but these documents are opaque and patients may not know they exist. Policy changes such as mandatory RT and infusion price reporting should be considered to mitigate financial burden by improving patient access to reliable oncology price information.