Factors Associated with Surgical Cost Disclosure Non-Compliance

Abstract

INTRODUCTION: The Price Transparency of Hospital Standard Charges rule (instated 1/1/2021) requires hospitals to disclose payer-specific payments. The purpose of this study was to identify characteristics of hospitals that are not compliant with this rule using carotid revascularization as an example. METHODS: Non-federal, non-military hospitals were divided into those that did and did not disclose price data for carotid endarterectomy or stenting, as determined from Turquoise Health. Predictors of interest included LeapFrog ratings and patient outcomes, as measured by the CDC’s regional rates of stroke. Analyses were further sub-stratified by the competitiveness of the hospital region as measured by the Herfindahl Hirschman Index. RESULTS: A total of 958 hospitals met inclusion criteria. Of these, 523 (54.5%) hospitals disclosed costs while 435 (45.4%) did not. Non-compliant hospitals were in more competitive regions, had smaller patient care volumes, greater profits and greater markups (p < 0.05 for all). Hospitals in the least competitive tertile were less likely to disclose costs if they had higher quality of care (b = 1.32, 95% CI = (1.28-1.34), p < 0.05). Hospitals with lower rates of postoperative stroke were also less likely to report costs (b = 0.992, 95% CI = (0.897-0.997, p < 0.05). However, highly rated hospitals in areas were black patients experienced a higher proportion of the overall stroke rate were less likely to report costs (b = 1.8, 95% CI = (1.6-2.0), p < 0.01). CONCLUSION: Nearly half of all non-federal, non-military hospitals remain non-compliant one year after the rule was instituted. Market competitiveness, quality of care, and stroke rate are all associated with the likelihood of public disclosure. Further analyses are needed to evaluate disclosure trends in other surgical specialties.