PO-03-182 ASSESSMENT OF PRICE VARIATION IN CARDIOVASCULAR CATHETER ABLATIONS AT US HOSPITALS

Abstract

Ablation of atrial fibrillation (AF) and ventricular tachycardia (VT) comprise a significant proportion of catheter ablation procedures. However, few studies have explored the commercial cost footprint of these procedures, despite the 2021 Hospital Price Transparency Final Rule mandating US hospitals publish their insurer-negotiated prices. This study sought to characterize and identify factors contributing to variation in AF and VT ablation prices across the US. We queried a commercial database containing hospital-disclosed prices to characterize variation in ablation procedure prices within and across US hospitals. This price data was linked to hospital characteristics using Medicare Facility IDs. Univariate analysis was conducted to compare median prices across multiple factors. In total, 1,030 hospitals reported commercial prices for AF ablation, while 1,006 reported prices for VT ablation. For AF ablation, median prices were higher at major investor-owned facilities (p<0.01), while for VT ablation, investor-owned facilities had lower prices (p<0.01). For both AF and VT ablation, the New England region exhibited the highest median price ($28,141 and $28,145, respectively), while the Middle Atlantic exhibited the lowest median price ($16,829 and $15,666, respectively). Higher prices were associated with better than average all-cause readmission rates (p<0.01 for AF and VT ablation) and higher patient hospital ratings (p<0.01 for both). However, CMS hospital ratings (AF: p=0.42; VT: p=0.08) and hospital-wide mortality were not associated with price (AF: p=0.36; VT: p=0.56). For both AF and VT ablation, commercial rates did not differ widely from the Medicare price. Within hospitals, the 90th percentile payer-negotiated rate was 2.42 (IQR 1.34-4.61) times the 10th percentile rate (within-center ratio) for AF ablation and 2.40 (IQR 1.41-5.16) for VT ablation. Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 1.54 (IQR 1.00-2.63) times that at the 10th percentile hospital (between-center ratio) for AF ablation and 1.47 (IQR 1.00-2.61) for VT ablation. Prices for ablation procedures varied widely within and between hospitals. Commercial markup from the Medicare price was limited. Several factors correlated closely with reimbursement, including hospital-wide readmissions and patient ratings. However, there was no association between price and hospital-wide mortality or CMS rating.Tabled 1Univariate Analysis of Factors Associated with Cardiovascular Catheter Ablations Commercial Price (PO-03-182)Atrial Fibrillation AblationVentricular Tachycardia AblationCategorical Values(% Reporting)# ofHospitals(%)MedianPrice($)IQR($)P-Value †# ofHospitals(%)MedianPrice($)IQR($)P-Value †Region (92.1, 92.4)<0.01<0.01 New England (CT, MA, ME, NH, RI, VT)Middle Atlantic (NJ, NY, PA)South Atlantic (DC, DE, MD, VA, WV, C, SC, GA, FL)East North Central (OH, IN, IL, MI, WI)East South Central (KY, TN, AL, MS)West North Central (MN, IA, MO, ND, SD, NE, KS)West South Central (AR, LA, OK, TX)Mountain (MT, ID, WY, CO, NM, AZ, UT, NV)Pacific (WA, OR, CA, AK, HI)37 (3.9)112 (11.8)226 (23.8)188 (19.8)79 (8.3)97 (10.2)140 (14.8)42 (4.4)28 (3.0)28141168291808220065215512439926517258912460626243-305588362-2330411750-2588211817-2913316087-2799216203-2839416641-3176322631-3315017616-3916037 (4.0)108 (11.6)226 (24.3)176 (18.9)81 (8.7)91 (9.8)142 (15.3)40 (4.3)29 (3.1)28145156661808217831211982081224674258892727725174-309468071-2164711019-2589111817-2823914531-2789011792-2672412432-3169522516-3274423006-42535Hospital Type (88.7, 89.2)0.06<0.01 For-ProfitNot-For-ProfitGovernment194 (21.2)651 (71.2)69 (7.5)21798216562256111338-2817712739-3033818147-31958190 (21.2)640 (71.3)67 (7.5)1734020544233759273-2646612003-3020416843-36485Major Investor Owned (96.6, 96.7)<0.01<0.01 Major Investor OwnedNot Major Investor Owned222 (22.3)773 (77.7)221512002711751-2798113330-30470215 (22.1)758 (77.9)16841211819273-2588912720-30719Teaching Status (92.1, 92.4)0.830.59 Major TeachingMinor TeachingNon-Teaching132 (13.9)624 (65.8)193 (20.3)21940216132165611551-3022112443-2962315899-30347129 (13.9)492 (52.9)309 (33.2)20856198602085510934-3090211763-2852812365-28998Urban/Rural (99.9, 100.0)0.760.35 UrbanRural937 (91.1)92 (8.9)217882167712584-2960114804-30488917 (91.2)89 (8.8)201252161911823-2895314803-29936Disproportionate Share Hospital (82.4, 83.0)0.02<0.01 Disproportionate Share Hospital (DSH)Sole Community Hospital (not DSH-eligible)Not DSH692 (81.5)38 (4.5)119 (14.0)21583264502113412124-2958119779-3331412829-30029684 (81.9)35 (4.2)116 (13.9)19706263661900511782-2885921826-3236511935-28034CMS Hospital-Wide Mortality (80.4, 80.7)0.360.56 Above National AverageSame as National AverageBelow National Average159 (19.2)553 (66.8)116 (14.0)21470216212383713394-30164127226-2968912021-32762158 (19.5)537 (66.1)117 (14.4)19465203562162111985-2811311854-2927311834-33024CMS Hospital-Wide Readmission Rate (82.2, 82.7)<0.01<0.01 Above National AverageSame as National AverageBelow National Average346 (40.9)123 (14.5)378 (44.6)23431237131916215948-3173916936-2945211091-28180340 (40.9)121 (14.5)371 (44.6)22515221981855914028-3145011730-3021710846-27912HCAHPS Patient Overall Hospital Rating (80.8, 81.2)<0.01<0.01 1234540 (4.8)149 (17.9)303 (36.4)311 (37.4)29 (3.5)156711863621198243192950211775-2284713066-2704511718-2878915103-3175120076-3437136 (4.4)142 (17.4)298 (36.5)312 (38.2)29 (3.5)168121684519526239822823610945-2206610870-2393610687-2799114446-3180418905-34272CMS Overall Hospital Rating (82.0, 83.2)0.420.08 1234543 (5.1)160 (18.9)246 (29.1)264 (31.2)132 (15.6)184712122321716223762208312445-2486412816-2831411471-2992111841-3046515648-3180541 (4.9)154 (18.6)244 (29.4)260 (31.3)131 (15.8)154061861620466203732252710378-2254411751-2589311228-2914511782-3060212829-31296† Comparisons were done via the Kruskal-Wallis test. 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