Sunday, June 19, 202211:30 AM - 12:30 PMGSOR13 Presentation Time: 11:30 AM: Factors Associated with Hospital-Negotiated Prices of Tandem & Ovoids in the U.S. in 2021

Abstract

<h3>Purpose</h3> HDR brachytherapy, such as tandem & ovoids (T&O), is a crucial component of definitive care for locally advanced cervical cancer in the U.S. Its cost and those of other healthcare services are often unknown or unclear at the time of care. Upfront, accessible price transparency may help address patients' financial concern. Effective 1/1/2021, the Hospital Price Transparency Rule (45 CFR Part 180) requires all U.S. hospitals to annually release hospital-related prices. Our project seeks to evaluate the availability, variation, and factors associated with hospital-negotiated prices of T&O in the U.S. <h3>Materials and Methods</h3> We conducted a cross-sectional study of U.S. hospitals in CMS's Care Compare, linking to Turquoise Health (hospital-negotiated prices), Healthcare Cost Report Information System (hospital characteristics), and Social Vulnerability Indices. We identified six T&O-related CPT codes (77280, 77470, 77370, 77318, 77771, and 57155), with their negotiated-prices estimated by payer type. We used regression models to estimate the association of hospital characteristics with commercial prices. <h3>Results</h3> A majority of the hospitals are non-profit (61%), acute care hospitals (69%), and/or non Graduate Medical Education (GME)-participating (72%), with a median operating margin of 0.03 (IQR:-0.03, 0.09), asset-to-liability ratio of 1.79 (1.06, 2.96), and social vulnerability index of 0.53 (0.29, 0.74). 17-28% of hospitals reported T&O-related prices depending on the CPT code. Prices were typically greater for commercial insurance compared to Medicare/Medicaid (+$335-362 simulation, +$550-798 MD plan, +$224-747 physics plan, +$1160-1707 treatment; P<0.001, all tests), except for CPT code 57155 (treatment) where the Medicare price was greater than commercial insurance's price (+403; P<0.001). Table 1 shows the adjusted analysis of commercial prices. <h3>Conclusion</h3> Our analysis shows that negotiated T&O prices in the U.S. is typically higher for commercial insurances, hospitals with higher operating margins, and non GME participating hospitals; it is typically lower for critical access hospitals. Socially vulnerable areas do not consistently enjoy lower prices. Further price transparency research and advocacy could better elucidate this area, thereby promoting economic competition and lower the price for curative cervical cancer treatment.