Payer-Negotiated Prices in the Diagnosis and Management of Prostate Cancer in 2022

Abstract

<h3>Purpose/Objective(s)</h3> Prostate cancer is the most common cancer diagnosed among American men. Patients face significant financial costs associated with the diagnosis, staging, and treatment of prostate cancer. Recent federal price transparency rules have attempted to allow patients to comparison shop. The purpose of this study was to evaluate efficacy of such policies for prostate cancer-associated services. <h3>Materials/Methods</h3> A cross-sectional analysis of negotiated Blue Cross Blue Shield (BCBS) rates was performed in hospitals across North Carolina. Inclusion criteria were limited to hospitals with greater than 35 beds that provided prostate cancer treatment services (imaging, radiation, and labs). Price transparency was measured by the percentage of hospitals publicizing negotiated rates for each service. Hospital sizes were estimated by bed count and grouped into quartiles. ANOVA testing was used to assess associations between hospital size and BCBS prices for each service. Chi-square analysis was used to compare percentage price transparency between small and large hospitals. <h3>Results</h3> Ninety hospitals were included in this study, with 86.7% of all services displaying negotiated prices. Smaller hospitals (bed size ≤ 150) were less likely to list negotiated prices for all services (81.4% vs. 91.4%, p=0.002). Of the 46 hospitals with gross IMRT charges listed, only 65% included a BCBS negotiated price, which was lower than that for other prostate-cancer related services. There was no apparent association between service price variation and hospital size (Table 1). <h3>Conclusion</h3> Although federal price transparency policies have mandated hospitals to provide accurate price information to patients, such platforms remain difficult to navigate, and smaller hospitals are less likely to comply with these rules. Interestingly, despite the perceived increased negotiating power of larger hospitals, we did not find that larger hospitals command lower BCBS negotiated rates in our study, though these findings are limited due to paucity of negotiated prices listed in smaller hospitals' chargemasters. Additional initiatives are necessary to provide patients with prices in a consistent format to allow true comparison shopping for prostate cancer care services.