PO-03-184 ASSESSMENT OF PRICE VARIATION IN PERCUTANEOUS LEFT ATRIAL APPENDAGE CLOSURE DEVICE PROCEDURES AT US HOSPITALS

Abstract

Since their approval in the US in 2015, left atrial appendage closure (LAAC) devices have served as an alternative to oral anticoagulation in atrial fibrillation (AF) patients at increased risk of bleeding. However, few studies have explored the commercial cost footprint of LAAC 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 LAAC procedure prices across the US. We queried a commercial database containing hospital-disclosed prices to characterize variation in LAAC procedure prices within and across US hospitals. We then linked this price data to hospital characteristics using Medicare Facility IDs. Univariate analysis was conducted to compare commercial prices across multiple factors. In total, 683 hospitals reported commercial prices for LAAC procedures. Among reporting hospitals, median prices were greater at major investor-owned vs. non-major investor-owned facilities ($10,991 vs. $7,227, p<0.01) and for-profit centers vs. not-for-profit and government centers ($10,991 vs. $7,417 vs. $5,051, p<0.01). Prices were also greater at non-teaching hospitals compared to minor and major teaching hospitals (p<0.01). The Pacific region exhibited the highest median price ($18,652), while the Middle Atlantic exhibited the lowest median price ($5191). There was no association between price and CMS hospital-wide mortality (p=0.21) or all-cause readmissions (p=0.29). Patient hospital ratings were correlated with price (p<0.01) but not CMS overall hospital ratings (p=0.62). Commercial and self-pay prices were 2.30- and 2.61-times higher than the Medicare price. Within hospitals, the 90th percentile payer-negotiated rate was 2.0 (IQR 1.00-4.06) times the 10th percentile rate (within-center ratio). Across hospitals within the same hospital referral region (HRR), the median price at the 90th percentile hospital was 1.54 (IQR 1.00-2.63) times that at the 10th percentile hospital (between-center ratio). Prices for LAAC procedures varied widely, with commercial and self-pay rates over double the Medicare price. Within-center variation in price was higher than between-center variation. Non-teaching, investor-owned, and for-profit hospitals had higher prices; however, there was no association between prices and hospital-wide mortality or readmission rates.Tabled 1Univariate Analysis of Factors Associated with Left Atrial Appendage Closure Device Procedures Commercial PriceCategorical Values (% Reporting)# ofHospitals (%)Median Price ($)Interquartile Range ($)P-ValueRegion (93.6)<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)26 (4.1)59 (9.2)157 (24.6)119 (18.6)57 (8.9)78 (12.2)107 (16.7)26 (4.1)10 (1.6)90915191104657682113425900719911150186524865-125783839-94483652-145313562-113323005-152592780-124784030-114763094-122562891-26874Hospital Type (87.8)<0.01 For-ProfitNot-For-ProfitGovernment154 (25.7)407 (67.8)39 (6.5)10991741750516853-152603077-124772731-14581Major Investor Owned (96.8)<0.01 Major Investor OwnedNot Major Investor Owned173 (26.2)488 (73.8)1099172276997-152603050-12344Teaching Status (93.6)<0.01 Major TeachingMinor TeachingNon-Teaching84 (13.1)332 (52.0)223 (34.9)56488012106162475-91313340-123443840-15260Urban/Rural (100)0.06 UrbanRural620 (90.8)63 (9.2)823488373428-129183634-13784Disproportionate Share Hospital (82.3)0.63 Disproportionate Share Hospital (DSH)Sole Community Hospital (not DSH-eligible)Not DSH474 (84.3)14 (2.5)74 (13.2)81681073987693510-129885052-128633241-14189CMS Hospital-Wide Readmission Rate (82.6)0.26 Above National AverageSame as National AverageBelow National Average227 (40.2)80 (14.2)257 (45.6)8633863286493340-133264079-142673840-12579CMS Hospital-Wide Mortality (80.7)0.25 Above National AverageSame as National AverageBelow National Average99 (18.0)375 (68.1)77 (14.0)8819823789043486-119703544-132163473-15159HCAHPS Patient Overall Hospital Rating (81.1)<0.01 1234517 (3.1)96 (17.3)211 (38.1)209 (37.7)21 (3.8)10991875869649044136316295-205573635-128202856-112883844-146829078-18372CMS Overall Hospital Rating (83.1)0.62 1234526 (4.6)92 (16.2)160 (28.2)186 (32.7)104 (18.3)922490048620761886934492-120864918-126313632-130232864-132513803-13693Comparisons were done via the Kruskal-Wallis test. Open table in a new tab