Medical Fees Research Articles

Real-life management of neovascular age-related macular degeneration (nAMD) in France: a nationwide observational study using retrospective claims data

Aims Intravitreal anti-vascular endothelial growth factor (anti-VEGF) therapy is standard care for neovascular age-related macular degeneration (nAMD), but the recommended monthly injection regimen is burdensome. Evidence suggests low injection/monitoring frequencies in clinical practice and suboptimal vision outcomes. This observational cohort study uses administrative claims data from the French national healthcare system to assess anti-VEGF treatment patterns and nAMD-specific healthcare resource demands and costs. Patients and methods nAMD patients ≥50 years initiating intravitreal ranibizumab, aflibercept or bevacizumab treatment (2014‒2015), and propensity score-matched non-nAMD patients (controls), were identified from the Echantillon Généraliste de Bénéficiaires database. Outcomes of interest included anti-VEGF treatment patterns, and healthcare resource utilization and associated costs of patients vis-à-vis controls over 24 months. Results Study patients (n = 355) received (mean) 5.2 and 2.4 anti-VEGF injections over 0‒12 and 12‒24 months, respectively. Most patients (79.0%) remained on their initial anti-VEGF agent; among treatment switchers, the most common transition was from ranibizumab to aflibercept. During follow-up, nAMD patients were more likely than controls to require ophthalmology visits (99.7% vs. 44.8%), ocular procedures (optical coherence tomography/angiography/fundoscopy) (96.9% vs. 27.2%), cataract surgery (13.0% vs. 6.7%), and medical transports (38.0% vs. 31.9%). Mean numbers of ophthalmology visits (25.1 vs. 1.2) and medical transports (6.0 vs. 3.5) were higher (p<.01) among nAMD patients. Total reimbursed costs were two-fold higher for nAMD patients than controls (mean €16,799 vs. €8,255) due to higher treatment costs (€6,847 vs. €1,156), medical fees (€1,858 vs. €295), hospital fees (€6,396 vs. €5,235), and transport costs (€358 vs. €259). Excess total healthcare cost was (mean) €5,279 and €7,918 over the first 12 and 24 months of treatment, respectively. Conclusions Current intravitreal anti-VEGF treatment and monitoring requirements place a considerable economic burden on the French healthcare system. New intravitreal therapies with extended dosing intervals and predictable efficacy might reduce demand for ophthalmology services.

Summary of Revision of Medical Fees in 2020 and Introduction of Activities of JIRA Medical Fees Committee

Summary of Revision of Medical Fees in 2020 and Introduction of Activities of JIRA Medical Fees Committee

当院の特定集中治療室（ICU）における早期栄養介入管理加算算定の現状

当院の特定集中治療室（ICU）における早期栄養介入管理加算算定の現状

Public financing versus private billing in a public hospital under management of a Social Health Organization.

to assess the efficiency of management by a Social Health Organization (Organização Social de Saúde - OSS) compared with the private sector; to verify if there are savings for the State Health Secretariat (SES) in management contracts for financing the production of a public hospital versus its production values billed by private methods; and to establish if the amounts billed by the Unified Health System (SUS) table would finance the same procedures. we compiled and tabulated all procedures performed and the materials and drugs dispensed in the Euryclides Jesus Zerbini Transplant Hospital (HTEJZ), managed by the OSS Associação Paulista Para o Desenvolvimento da Medicina (SPDM), in September, October, and November 2018, according to the Brasíndice® table for drugs, the Simpro® table for materials, the CBHPM® table for medical fees, and tables SIGTAP SUS and SIA SUS. We then compared the average values obtained in the private billing with the costing amount reimbursed by the State Health Secretariat and the billing calculated in the SIA-SUS. the average SUS revenue was R$ 2,774,086.91; the monthly reimbursement by the SES was R$ 13,055,700.00; and the average private revenue was R$ 25,084,440.31. the management by the OSS SPDM in the Euryclides de Jesus Zerbini Transplant Hospital was more efficient in the financing / production ratio than it would be to a private hospital. The economy of public funds was significant. The current SUS table reimbursement values would not meet the need for funding for an overly complex hospital.

Approaches and Changes among Ward Nurses Found by Nurses, Who Complete the Medical Training to Improve Their Skills for Dementia Care Addition 2, a Kind of Medical Fee in Japan

Approaches and Changes among Ward Nurses Found by Nurses, Who Complete the Medical Training to Improve Their Skills for Dementia Care Addition 2, a Kind of Medical Fee in Japan

Effects of Nurse Practitioners on Reducing Medical Fee and Expected Improvement of Patient Care: Simulation Based on Consultation Fee of Visiting Nursing User and Interview with Visiting Nurse

Effects of Nurse Practitioners on Reducing Medical Fee and Expected Improvement of Patient Care: Simulation Based on Consultation Fee of Visiting Nursing User and Interview with Visiting Nurse

의료기관 종사자의 라이프케어 감정노동과 진료비 삭감 인식도가 삭감률에 미치는 영향

본 연구는 요양의료기관 종사자의 감정노동과 진료비 삭감 인식도가 삭감율에 미치는 영향을 알아보기 위해 대한민국의 의료기관 종사자 414명을 대상으로 설문조사를 실시하여 다음과 같은 결과를 도출하였다. 첫째, 인구사회학적 특성에 따른 삭감률 차이를 살펴본 결과 입원 삭감률과 외래 삭감률은 근무형태, 현 병원 근무경력과 허가 병상 수에서 유의한 차이를 보였다. 둘째, 감정노동, 진료비 삭감 인식도와 삭감률의 상관관계를 분석한 결과 감정노동과 외래 삭감률은 정적 상관, 진료비 삭감 인식도과 입원 삭감률은 부적 상관, 진료비 삭감인식도과 외래삭감률은 부적 상관에 유의한 것으로 나타났다. 셋째, 감정노동은 입원 삭감률에 유의한 정적 영향 미치며, 진료비삭감인식도는 입원 삭감률에 유의한 부적 영향 미치는 것으로 나타났다. 감정노동은 외래삭감률에 유의한 정적 영향을 미치며, 진료비 삭감인식도는 외래삭감률에 유의한 부적 영향을 미치는 것으로 나타났다.

223. Difference in Carbapenem Use by ASP Intervention in Japanese Healthcare Facilities

BackgroundAntimicrobial stewardship program (ASP) interventions have been reported to reduce unnecessary antimicrobial use (AMU). In this study, we investigated the difference in the use of carbapenems by ASP intervention in Japanese healthcare facilities.MethodsData on two components of AMU and ASP registered in Japan Surveillance for Infection Prevention and Healthcare Epidemiology (J-SIPHE) from January to December 2019, were used. Facilities with an infection control team in addition to an antimicrobial stewardship team responsible for the proper use of antimicrobial agents were included in the study. AMU data (such as DOT [Days of Therapy / 100 patient days]) are entered semi-automatically from medical fee statement (receipt) file at each facility. ASP intervention is divided into four categories 1) pre-authorization, 2) prospective audit and feedback (PAF), 3) PAF and required notification (RN), 4) RN. The Kruskal-Wallis test is performed to see overall difference and the Dunn test with the Bonferroni correction is done for each pair of categories.ResultsA total of 114 hospitals were included in the analysis. The median number of beds at participating facilities were 430 [IQR: 281–602], the median average hospital stay was 13.0 days [IQR: 11.4–15.2] and total number of inpatients per month was 10087 [6247–14536]. PAF and RN were the most common ASP interventions for carbapenems (62.5%), followed by RN (33.6%). The median DOT [IQR] of participating facilities were 2.1 [1.2–3.1] and 1) 0.7 [0.2–1.1], 2) 2.7 [2.1–3.4], 3) 2.1 [1.4–3.1] and 4) 2.0 [1.2–3.5] by ASP categories. There are significant differences between 1) and 2), 1) and 3), and 1) and 4) (p=0.014, p< 0.01 and p< 0.01, respectively) while the differences between 2) and 3), 2) and 4), and 3) and 4) are not significant (p=1.00).Table 1. Summary statistics of healthcare facilities by ASP Interventions Figure 1. DOT by ASP Interventions ConclusionOnly 3.5% of ASP interventions belong to 1) pre-authorization category and this might be due to the complexity of registration process. This category was found to have the lowest DOT among all ASP interventions in Japanese healthcare facilities. The variances of DOT were especially large in categories 3) and 4), and more detailed analyses would be necessary to evaluate their efficacies accurately.Disclosures All Authors: No reported disclosures

Application and Analysis of Modern Information Technology in Fine Management of Hospital Medical Insurance

with the continuous development of science and technology and the arrival of the information age, modern information technology is more and more widely used in the fine management of hospital medical insurance. The importance of hospital medical insurance fine management can solve the problems and shortcomings of traditional human management hospital medical insurance and realize the fine management of medical insurance control fee. Therefore, it is necessary to pay more attention to the application of modern information technology in the fine management of hospital medical insurance, clarify the problems and shortcomings in the current application of information technology, and take targeted measures to solve them. Give full play to the role and value of modern information technology carrier, promote the sustainable and stable development of hospitals. Modern information technology has been continuously applied, which plays a key role that can not be ignored and greatly improves the overall quality of hospital medical insurance. This paper objectively analyzes the importance and effective way of applying modern information technology in the fine management of hospital medical insurance from different angles.

A new standardised nomenclature in ophthalmology: Criteria and quantitative evaluation indicators of medical procedures

Abstract Purpose To create a new list of medical procedures in ophthalmology based on the International Classification of Diseases ICD-9-CM. To establish the general principles that define criteria, quantitative indicators, and scales. To develop the algorithms needed to calculate fees for medical procedures. Methods The out-of-date processes were removed from the list, and new techniques were added, descriptors were modified, procedures with similar descriptions were grouped together, and others were relocated to other group according to surgical complexity conditions. The criteria to calculate the medical fees were defined: training and complexity (U), proficient responsibility (R), and health value (V), with their respective quantitative indicators: period of training necessary to master a technique, frequency of complications that worsen the preoperative situation, and days of incapacity for work due to the process. The Relative Value Unit (RVU) was defined as the score sum of R, V and U. The final fee per medical procedure was calculated as the product of the RVU by its unit cost and by the weighting coefficient (WC). Results A new catalogue was prepared with 161 medical procedures, grouped into consultations, diagnostic procedures (DX.PR), therapeutic procedures (TX.PR), and surgical interventions, increasing in complexity from group 0 to group 8. The following characters were described for each one of the procedures: OMC and ICD-9-MC code, descriptor term, group, proposed modification: no changes or minimums in the descriptors, grouping of acts by similar definitions, change of origin group, new procedures, and procedures removed. The indicators for assessment were also scored: U between 1−4 points, and R and V between 0−3 points. Using their sum, the number of RVUs per medical procedure (between 1 and 10) was calculated which, together with the unit cost of the RVU and the WC (between 0.05 and 1), will determine the final rate. Conclusions The new standardised ophthalmological nomenclature updates and improves the old classification, adapting the procedures to the descriptors included in the ICD-9-CM, and incorporating all the new techniques. Additionally, the declaration of the general principles allows defining new criteria, quantitative indicators, rating scales, and algorithms to calculate fees for medical procedures.

Community resistance to state Lassa fever rapid response team in Kayauri Community in Toro LGA Bauchi State – Nigeria, January–April 2019

Background: Bauchi State is one of the Lassa fever (LF) high burden states in Nigeria. A family cluster of LF occurred in Kayauri community, a farming settlement made up of three villages: Kayauri Fada, Kayauri Jigawa and Kayauri Salla. Community and family members of the index case refused help from the State LF Rapid Response Team. We investigated to identify the social and cultural factors responsible for the resistance. Methods and materials: We carried out participant observation and in-depth interviews in the affected community. We conducted unstructured one on one interviews among affected community members, community heads, contacts to the confirmed case, family members, LF survivors and community health extension worker using general and open ended questions. Results: Resistance by the community and family of the index case was due to overzealous specimen collection by Local Government Area (LGA) Disease Surveillance and Notification Officer's (DSNO). Concerns regarding improper consenting practices and possibility of being saddled with expensive medical fees also created a lot of suspicion within the community. Conclusion: This case highlights the importance of training for disease surveillance officers carrying out active case search, contact tracing and follow up so as to improve the compliance of the community. We recommend ongoing training and community engagement to remove the potential for distrusts between the community and the disease surveillance officers.

The effects of service quality and perceived price on revisit intention of patients: the Malaysian context

Purpose This paper aims to investigate the effects of service quality and perceived price (monetary and behavioural price) on the revisit intention of patients to hospitals, as well as the mediating role of perceived price on the relationship between service quality and revisit intention. Design/methodology/approach This paper distributes questionnaires to outpatients in three major cities in Malaysia, namely, Penang, Melaka and Johor. Patients who were in the foyer, dispensary area and waiting area were intercepted where their responses were sought. The responses obtained from 400 patients were analysed using the structural equation modelling technique. Besides analysing the path coefficients, this study has examined the common method variance, bias and indirect effects of the relationships. Findings The results suggest that patients pay more attention to certain values in their search for the best health-care service and subsequently move on to new values. Pricing is an effective strategy to promote favourable behavioural intentions amongst patients. Better service quality is reflected in the reasonableness of monetary costs incurred by patients in acquiring health-care services. Patients who received poor services will be more likely to compare such services to the medical costs incurred to ascertain the worthiness of the amount paid. In addition, service quality also influences how patients perceive spending their time and efforts (waiting for nurses and physicians, as well as queueing in hospitals) as worthy and vice-versa. Their revisit intention will also be affected by the extent of which they invest their time, energy and efforts to search for relevant information. Practical implications The hospitals which desire to charge additional fees should enhance their service quality to reflect price equity. This is imperative in view of the pricing structure which can be relatively complex in subsequent follow-up treatments that may affect the decision of patients on the sources of health-care services. Originality/value Given the inevitable increase in medical fees, the perceived price can be a key determinant to the overall judgement patients had in terms of the health-care services received and the time and efforts sacrificed. However, the importance of monetary price and the behavioural price is still relatively unstudied, particularly their influence on revisit intention in the health-care setting.

Trend in medical expenditures for patients with kidney diseases: An analysis from a tertiary hospital in Beijing

Objective To investigate trends in hospitalization expenditures in adults with kidney disease, to analyze the time pattern of outpatient and inpatient medical expenditures for patients with kidney diseases, and to support the health care reform by exploring the causes. Methods Medical expenditure data for kidney disease patients aged ≥18 years from the outpatient and in-patient data of the information center in the Grade?A tertiary hospital in Beijing, China from January 1, 2012, to December 31, 2017, were retrospectively analyzed. It provided descriptive evidence on the time patterns of expenditures per visit and capita, and potential influencing factors of the time changes were further explored. Results It was found that medical expenditures had increased rapidly from 2012 to 2017. The result showed that the average outpatient expenditure per capita for kidney disease patients was 4 598 yuan in 2012, with an increasing tendency to 11 536 yuan in 2017. There was an obvious increase in the average number of visits (per year) from 3.94 in 2012 to 9.11 in 2017. Meanwhile, the mean inpatient expenditures per capita had an increasing tendency from 323 753 yuan in 2012 to 45 904 yuan in 2017. There was also an increase of mean inpatient expenditures per admission from 27 184 yuan in 2012 to 34 933 yuan in 2017, with a similar number of admissions over the 6 years. The increases in outpatient and inpatient expenditures per capita were driven by different reasons. The increase in outpatient expenditures per capita was driven by the increase of patient visits, while the increase in inpatient expenditures per capita was driven by the increase of the expenditures per admission. Also, drug and medical materials were the two categories that had the largest contribution to the inpatient expenditures. Drug expenses were the highest one, with an average of 12 524 yuan per visit in 2017, accounting for 32.4% of the average total expenditure in that year, while the average cost of consumables was 9 215 yuan, accounting for 23.9%. Conclusion The increase of outpatient expenditures per capita was related to the increase of patient visits. Meanwhile, the growth of drug and consumable costs contributed to the total increase in the total inpatient healthcare costs. It is necessary to increase the proportion of treatment costs and medical service fees in the total expenditure.

환경요인을 매개로 라이프 스타일에 따른 조직몰입이 진료비 삭감률에 미치는 영향

본 연구는 의료기관의 환경요인을 매개로 의료기관 종사자들의 라이프 스타일에 따른 조직몰입이 진료비 삭감률에 미치는 영향이 무엇인지 알아보기 위한 연구로 전라도에 있는 의료기관 종사자 300명을 대상으로 설문조사하였다. 본 연구의 결과는 다음과 같다. 첫째, 인구사회학적 특성에 따른 조직 몰입도는 연령, 학력, 성별, 결혼, 직종, 소득과 근무 연수에서 유의한 차이를 보였다. 둘째, 인구사회학적 특성에 따른 환경요인은 결혼, 근무 연수, 병원유형에서 유의한 차이를 보였다. 셋째, 입원삭감률은 직종, 근무 연수 병원유형에서, 외래삭감률은 연령, 결혼, 직종, 근무 연수, 병원유형에서 유의한 차이를 보였다. 넷째, 조직몰입, 환경요인, 삭감률의 상관관계를 알아본 결과 입원 삭감률과 외래 삭감률은 정적 상관이 유의하게 있는 것으로 나타났다. 다섯째, 조직몰입과 환경요인을 동시에 투입하여 입원삭감률에 미치는 영향을 살펴본 결과 조직몰입과 입원삭감률에서 환경요인이 부분매개, 외래삭감률은 조직몰입과 외래삭감률에서 환경요인이 완전매개 하는 것으로 나타났다. 본 연구로 의료기관의 효율적인 운영방안과 효과적인 인력관리를 위한 기초자료를 제공하고자 한다.

Hospitalization costs among immobile patients with hemorrhagic or ischemic stroke in China: a multicenter cross-sectional study

BackgroundIn this study, we aimed to analyze the hospitalization costs for immobile patients with hemorrhagic stroke (IHS) or ischemic stroke (IIS) in China and to determine the factors associated with hospitalization costs.MethodsWe evaluated patients with IHS and IIS hospitalized between November 2015 and July 2016 in six provinces or municipality cities of China. Linear regression analysis was used to examine the association with hospitalization costs and predictors.ResultsIn total, 1573 patients with IHS and 3143 with IIS were enrolled and analyzed. For IHS and IIS, the average length of stay (LoS) was 17.40 ± 12.3 and 14.47 ± 11.55 days. The duration of immobility was 12.11 ± 9.98 and 7.36 ± 9.77 days, respectively. Median hospitalization costs were RMB 47000.68 (interquartile range 19,827.37, 91,877.09) for IHS and RMB 16578.44 (IQR 7020.13, 36,357.65) for IIS. In both IHS and IIS groups, medicine fees accounted for more than one-third of hospitalization costs. Materials fees and medical service fees accounted for the second and third largest proportions of hospital charges in both groups. Linear regression analysis showed that LoS, hospital level, and previous surgery were key determinants of hospitalization costs in all immobile patients with stroke. Subgroup analysis indicated that hospital level was highly correlated with hospitalization costs for IHS whereas pneumonia and deep vein thrombosis were key factors associated with hospitalization costs for IIS.ConclusionsWe found that hospitalization costs were notably higher in IHS than IIS, and medicine fees accounted for the largest proportion of hospitalization costs in both patient groups, perhaps because most patients ended up with complications such as pneumonia thereby requiring more medications. LoS and hospital level may greatly affect hospitalization costs. Increasing the reimbursement ratio of medical insurance for patients with IHS is recommended. Decreasing medicine fees and LoS, preventing complications, and improving treatment capability may help to reduce the economic burden of stroke in China.

Current status and comparison of national health insurance systems for advanced radiation technologies in Korea and Japan.

PurposeThis study aimed to compare the current status of the national health insurance system (HIS) for advanced radiation technologies in Korea and Japan.Materials and methods: The data of the two nations were compared according to the 2019 guidelines on the application and methods of medical care benefit from the Ministry of Health and Welfare of Korea and the 2020 medical fee points list set by the Ministry of Health, Labor and Welfare of Japan.ResultsBoth countries have adopted the social insurance system and the general payment system which is fee-for-service for radiotherapy. However, for proton and carbon ion therapy, the Japanese system has adopted a bundled payment system. Copayment for radiotherapy is 5% in Korea and 30% (7–69 years old) in Japan, with a ceiling system. A noticeable difference is that additional charges for hypofractionation, tele-radiotherapy planning for an emergency, tumor motion-tracking, purchase price of an isotope, and image-guided radiotherapy are allowed for reimbursement in the Japanese system. There are some differences regarding the indication, qualification standards, and facility standards for intensity-modulated radiation therapy, stereotactic body radiation therapy, and proton therapy.ConclusionPatterns of cancer incidence, use of radiotherapy and infrastructure, and national HIS are very similar between Korea and Japan. However, there are some differences in health insurance management systems for advanced radiation technologies.

Impact of postoperative remote infection on length of stay and medical costs in hospitals in Japan.

To analyze the impact of postoperative remote infections (PRIs) on medical expenditure. The subjects of this retrospective study were 338 patients who had undergone gastroenterological surgery at one of the 20 Japanese institutions within the Japan Society for Surgical Infection (JSSI) and mainly authorized as educational institutions. The patients were allocated to 169 pairs of those with a PRI (PRI (+) group) matched with those without a PRI (PRI (-) group). PRIs included pneumonia, urinary tract infection (UTI), catheter-associated blood stream infection (CA-BSI), and antibiotic-associated enteritis. SSI developed in 74 of the 338 patients (22 without PRI and 52 with PRI). The SSI incidence was significantly higher in the PRI (+) group (p < 0.001). The difference in the median postoperative length of hospital stay was 15days, indicating a significant prolongation in the PRI (+) group (p < 0.001). The PRI (+) group also had a higher rate of inter-hospital transfer (p < 0.01) and mortality (p < 0.001). Similarly, the difference in median postoperative medical fees was $6832.3, representing a significant increase in the PRI (+) group (p < 0.001). The postoperative length of hospital stay is longer and the postoperative medical expenditure is higher for patients with a PRI than for those without a PRI.

Analysis of hospitalization expenses of 610 HIV/AIDS patients in Nantong, China

BackgroundThe goal of this study was to describe the expenses related to human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) management and care in Nantong Infectious Disease Hospital from October 2013 through June 2017.MethodsThe information of 610 HIV/AIDS inpatients were collected from the Electronic Medical Record System of the hospital. Univariate and path analysis were employed to evaluate the association between hospitalization expense and its related factors.ResultsThe average hospitalization expenses per person was 5454 RMB (Renminbi, the currency of China, about $808 USD) and 23,555 RMB (about $3489 USD), respectively for HIV/AIDS patients. The average length of hospital stay was 10.0 ± 5.5 days for HIV patients and 21.7 ± 12.4 days for AIDS patients. For HIV patients, laboratory test fees constituted 37.46% of total expenses; while drug fees accounted for the largest proportion for AIDS patients. Path analysis indicated that the length of hospital stay was the most important factor affecting total expenses (total path coefficient = 0.563 for HIV patients and 0.649 for AIDS patients). Total expenses for HIV-infected females was higher than that of males (total path coefficient = 0.217), and the more complications led to higher expenses for AIDS patients.ConclusionsThough antiretroviral therapy (ART) is provided for free in China, associated medical care, particularly hospitalizations and fees, continue to drive up the medical costs of patients living with HIV and AIDS. Understanding the factors influencing these costs are crucial for determining policies and strategies that can reduce the economic burden of HIV/AIDS patients in China.

Efficacy of branched-chain amino acid to increase muscle strength in chronic heart failure patients: an evidence-based case report

Background: Chronic heart failure (CHF) patients can fall into cardiac cachexia (CC), which is marked by the decrease of muscle mass and strength. Cardiac cachexia decreases the functional capacity and quality of life also increases the length of stay, medical fees, complications, and mortality rate. Branched-chain amino acid (BCAA) accounted for 35% of amino acids that build the muscle. We hope that BCAA supplementation can increase muscle strength of CHF patients, especially the elderly who is more prone to fall into CC. Thus, we performed an evidence-based case report to seek an opportunity of BCAA supplementation to an elderly with CHF.Objectives: To determine the efficacy of BCAA supplementation on increasing muscle strength in CHF patients.Methods: Literature searching of the evidence-based case report was performed on Pubmed, Cochrane, and Scopus according to the clinical query. Screening on title, abstract, and full text was done based on eligibility criteria (meta-analysis or clinical trials, suitability to clinical questions, English language, full-text availability, and human studies), followed by duplication filter and critical appraisal.Results: A randomized-controlled trial was found, but it didn’t find a significant difference between the experimental and control groups.Conclusions: BCAA supplementation doesn’t give a significant improvement in muscle strength in CHF patients.

Chargemasters and price transparency in dermatology

To the Editor: A chargemaster is a comprehensive listing of items billable to a patient or their insurance provider. Chargemasters contain anywhere from 20,000 to 50,000 prices, which include medical procedures, equipment fees, drugs, supplies, and diagnostic tests.1Kongstvedt P.R. Essentials of Managed Health Care. Jones & Bartlett Learning, 2012: 114-115Google Scholar Every hospital maintains its own chargemaster. On June 24, 2019, in an attempt to increase health care price transparency, the Trump administration mandated that all hospitals make their chargemaster public.2Trump D. Executive Order on Improving Price and Quality Transparency in American Healthcare to Put Patients First. The White House, The United States Government.www.whitehouse.gov/presidential-actions/executive-order-improving-price-quality-transparency-american-healthcare-put-patients-first/Date: 2019Date accessed: June 30, 2019Google Scholar Currently, there are no mandated criteria or guidelines for these published chargemasters. The prices listed within each chargemaster are not reflective of the negotiated prices with third-party payers. However, these prices are, in most instances, the basis for which self-pay patients are charged. Self-pay patients are more likely to price shop, and these lists will not only influence their decision where to receive care but may also deter patients from seeking care altogether. We sought to determine the utility of this executive order by searching for and characterizing several features of chargemasters from the 101 largest United States hospitals, determined by bed size (Table I).Table IHospital and chargemaster characteristicsHospitals characteristicsNumber (%)Region 1. Northeast27 (26.7) 2. Midwest22 (21.8) 3. South46 (45.5) 4. West6 (5.9)Division 1. New England7 (6.9) 2. Mid-Atlantic20 (19.8) 3. East North Central15 (14.9) 4. West North Central7 (6.9) 5. South Atlantic26 (25.7) 6. East South Central6 (5.9) 7. West South Central14 (13.9) 8. Mountain1 (1.0) 9. Pacific5 (5.0)Found in 10 minutes No4 (4.0) Yes97 (96.0)List readable, n (%) NA4 (4.0) No5 (5.0) Yes92 (91.0)Searchable, n (%) NA9 (8.9) No9 (8.9) Yes83 (82.2)CPT codes on list NA9 (8.9) No84 (83.2) Yes8 (7.9)Office visit level separated NA22 (21.8) No19 (18.8) Yes60 (59.4)BX abbreviation used NA25 (24.8) No46 (45.5) Yes30 (29.7)TANGENTL abbreviation NA25 (24.8) No69 (68.3) Yes7 (6.9)Used complexity level time in place of level 2 or 3 NA19 (18.8) No64 (63.4) Yes18 (17.8)BX, Biopsy; CPT, Current Procedural Terminology (American Medical Association, Chicago, IL); NA, not available; TANGENTL, tangential biopsy. Open table in a new tab BX, Biopsy; CPT, Current Procedural Terminology (American Medical Association, Chicago, IL); NA, not available; TANGENTL, tangential biopsy. We found price information for 97 hospitals (96.0%) that was “accessible” (eg, found via internet search by 1 of the authors in ≤10 minutes). There were 92 hospitals (91.1%) with readable lists and 83 hospitals (82.2%) with searchable lists. Only 8 hospitals (7.9%) included Current Procedural Terminology (CPT; American Medical Association, Chicago, IL) codes. There were 30 hospitals (29.7%) with lists that used a “BX” abbreviation for biopsy. Seventy-six hospitals listed a skin biopsy price (median, $487; range, $113-$4382). The relationship between the price charged for a skin biopsy had a strong positive correlation with the price charged for an additional skin biopsy (Spearman ρ = 0.733). The relationship between the price charged for a new level 2 patient had a strong positive correlation with the price charged for an established level 3 patient (Spearman ρ = 0.912). Relationships were weak between other prices. We found that approximately 18% of chargemasters were not searchable (ie, listed in a way that does not allow a search function to find specific terminology). This creates a nearly impossible task for a patient to sort through up to 50,000 items. If a patient had contacted their physician regarding an upcoming procedure, CPT codes are unique billing identifiers that could be provided for a patient to find on the chargemaster. However, only 8% of chargemasters listed CPT codes. Nearly 30% of hospitals listed “BX” for biopsy. Abbreviations like this may be cryptic for patients. With respect to cost, we found the median office visit price for a new level 2 or established level 3 patient was $270 and $275, respectively, and a single biopsy had a median price of $487 (Table II). Although we do realize most patients do not pay these prices, we fear a cost-conscious patient researching medical costs might delay or avoid necessary care altogether due to these inflated prices. Most prices included in our study had a weak correlation, providing evidence these costs may be determined arbitrarily. This executive order may be the start of increased price transparency for our patients, but there remains much work to do.Table IIPrice summaryVariablePrice, $Skin biopsy, n76 Mean (SD)622.65 (581.82) Median (IQR)487.0 (302.0-671.50) Minimum, maximum113.00, 4382.02Additional skin biopsy, n69 Mean (SD)358.77 (379.74) Median (IQR)247.00 (141.00-407.00) Minimum, maximum10.00, 1949.77New level 2 patient, n79 Mean (SD)295.43 (166.48) Median (IQR)270.00 (175.00-379.00) Minimum, maximum55.00, 1000.00Established level 3 patient, n81 Mean (SD)312.88 (189.82) Median (IQR)275.00 (164.00-374.00) Minimum, maximum55.00, 1000.00IQR, Interquartile range. Open table in a new tab IQR, Interquartile range.