Price Transparency Research Articles

Abstract 13262: A Self-Administered Home Inotrope Program for Unfunded Patients With End-Stage Heart Failure

Introduction: Uninsured patients with inotrope-dependent end-stage heart failure (HF) pose a formidable challenge to the healthcare system and innovative solutions are required. We created a health system funded home program for palliative and bridge-to-funding inotrope strategies for unfunded patients. Herein, we report our updated experiences. Methods: We reviewed records of all patients enrolled in the home inotrope program since inception in 2019. Patients must have demonstrated a low cardiac index that was stabilized on a single inotrope. Advanced HF and palliative care consultations are mandatory. Next, a multidisciplinary team educates the patient via a teach-teach back method on how to self-administer intravenous inotropes via a provided continuous infusion pump. After discharge, patients attended weekly clinic appointments for assessment and dressing changes. Clinic appointments, supplies, and medications are provided by the health system at minimal cost to the patient. This project was deemed IRB exempt as a quality improvement project. Results: Thus far the program has enrolled 15 uninsured patients through April 24, 2023 (table). The median duration of inotropic support was 70 (32-143) days. Patients remained at home for 90% of the 1500 total supported days. To date, one patient has received a heart transplant and three patients have received LVAD surgery after obtaining health insurance. Three (20%) patients experienced a catheter-associated infection, with two developing bacteremia. All patients endorsed satisfaction with increased time spent outside of the hospital. This was estimated to have saved >$2,363,000 in self-pay discounted charges for a general care telemetry bed and >$586,000 in professional charges (CPT 99233, estimates via price transparency act). Conclusion: A self-administered home inotrope program for select patients is feasible, safe, and cost-effective. It may also serve as a bridge to funding for advanced therapies.

To be or not to be compliant? Hospitals' initial strategic responses to the federal price transparency rule.

To understand US hospitals' initial strategic responses to the federal price transparency rule that took effect January 2021. Primary interview data collected from 12 not-for-profit hospital organizations in six US metropolitan markets. All but one organization were multihospital systems; the 12 organizations represent a total of 81 hospitals. Exploratory, cross-sectional, qualitative interview study of a convenience sample of hospital organizations across six geographically and compliance diverse markets. In-depth, semi-structured, qualitative interviews with 16 key informants across sampled organizations between November 2021 and March 2022. Interviews solicited data about internal organizational factors and external market factors affecting strategic responses. Transcribed interviews were de-identified, coded, and analyzed using the constant comparative method. Hospitals' strategic responses were influenced internally by the degree of the regulation's alignment with organizational values and goals, and task complexity vis-a-vis available resources. We found extensive variation in organizational capabilities to comply, and all but one organization relied on consultants and vendors to some degree. Key external factors driving strategic responses were hospitals' variable perceptions about how available price information would affect their competitive position, bottom line, and reputation. Organizations with more confidence in their interpretation of the environment, including how peers or purchasers would behave, and greater clarity in their own organization's position and goals, had more definitive initial strategic responses. In the first year, organizations' strategic responses skewed toward compliance, especially for the rule's consumer shopping requirements. A deeper understanding of the realities of operationalizing price transparency policy for hospitals is needed to improve its impact.

“It's not a one operation fits all”: A qualitative study exploring fee setting and participation in price transparency initiatives amongst medical specialists in the Australian private healthcare sector

The Australian government, through Medicare, defines the type of medical specialist services it covers and subsidizes, but it does not regulate prices. Specialists in private practice can charge more than the fee listed by Medicare depending on what they feel ‘the market will bear’. This can sometimes result in high and unexpected out-of-pocket (OOP) payments for patients. To reduce pricing uncertainty and ‘bill shock’ faced by consumers, the government introduced a price transparency website in December 2019. It is not clear how effective such a website will be and whether specialists and patients will use it. The aim of this qualitative study was to explore factors influencing how specialists set their fees, and their views on and participation in price transparency initiatives. We conducted 27 semi-structured interviews with surgical specialists. We analysed the data using thematic analysis and responses were mapped to the Theoretical Domains Framework and the Capability, Opportunity, Motivation and Behavior model. We identified several patient, specialist and system-level factors influencing fee setting. Patient-level factors included patient characteristics, circumstance, complexity, and assumptions regarding perceived value of care. Specialist-level factors included perceived experience and skills, ethical considerations, and gendered-behavior. System-level factors included the Australian Medical Association recommended price list, practice costs, and supply and demand factors including perceived competition and practice location. Specialists were opposed to price transparency websites and lacked motivation to participate because of the complexity of fee setting, concerns over unintended consequences, and feelings of frustration they were being singled out. If price transparency websites are to be pursued, specialists' lack of motivation to participate needs to be addressed.

Auction-based deep learning-driven smart agricultural supply chain mechanism

Agricultural product prices are subject to significant fluctuations due to variations in sales cycles, impacting people's quality of life and farmers' income while potentially giving rise to social problems. To address this issue in the smart agriculture supply chain, advancements in technologies like big data and artificial intelligence have made it feasible to predict agricultural product demand and price trends. Among the research methods, deep learning, being highly reliant on data and possessing multi-layered implicit information, has emerged as the most popular research method, exhibiting better data representation and prediction capabilities. In this study, we propose an end-to-end agricultural product price prediction model that combines complementary ensemble empirical mode decomposition (CEEMD) with long short-term memory (LSTM). The prediction generated by this model will provide guidance throughout various supply chain links, including production, harvesting, storage, and logistics. Moreover, the study aims to develop auction mechanisms based on the prediction results to achieve an optimal allocation of agricultural products. To address issues of low computational efficiency and limited benefit distribution in the auction process, this study introduces a deep learning-based iterative bilateral auction algorithm (DL-IDA), which improves upon existing methodologies by leveraging the power of deep learning. Empirical analysis is conducted using the daily price of Fuji apples at the Beijing Xinfadi market. The results demonstrate that the CEEMD-LSTM model proposed in this study exhibits superior performance in predicting agricultural product prices. Furthermore, experimental findings validate the effectiveness and superiority of DL-IDA. Compared to existing iterative bilateral auction algorithms, DL-IDA offers better performance in terms of running time, social welfare, buyer benefits, seller benefits, and broker benefits. Consequently, it can contribute to a transparent pricing mechanism for agricultural products.

External reference pricing for medicines in Ukraine: latest trends

Compared to the previous year, the share of healthcare expenditure in the state budget of Ukraine has decreased, which is associated with increased funding for the security and defense sector. In terms of gross domestic product, healthcare spending has reduced to 2.8 %, which corresponds to the figures for 2019. These circumstances indicate the importance of proper budget utilization, including effectively regulating medicine prices. One of the key elements of rational healthcare budget usage is the development and implementation of external reference pricing (ERP). A well-formulated and implemented ERP policy for pharmaceuticals contributes to improving patient access to essential medicines (EMs). The aim of this study is to analyze the current status of ERP implementation in Ukraine and provide recommendations for improving this policy. Materials and methods. During the research process, an analysis of the ERP’s current regulatory framework was conducted, and ERP implementation in Ukraine was assessed according to adherence to the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015. Results. In Ukraine, ERP has been introduced for medicines from the National Essential Medicine Lists (NEML) and the “Affordable Medicines” program. The Ministry of Health (MoH) of Ukraine has approved a Register of marginal wholesale prices for medicines purchased with state budget funds and subject to price regulation. Currently, the register includes 1239 medicinal products, of which 1233 are from NEML and 6 have undergone Health Technology Assessment (HTA). Approximately 58 % of medicines have a set price through ERP, 24 % are regulated by internal reference pricing (IRP), and nearly 18 % have declared prices. This indicates a lack of uniformity in approaches to price regulation for medicines and requires further improvements. According to the latest update of the Register of medicines for reimbursement under the state medical guarantees program, there are 486 medicines, including 72 insulins and 21 immunosuppressive medicines (184 medicines are provided with co-payment). Different approaches, including different reference countries and price calculation algorithms, are applied for the price regulation of medicines in NEML and the “Affordable Medicines” program. An assessment of the implementation of the ERP system in Ukraine based on the 14 best practice principles of ERP proposed by Sullivan, Kanavos & Kalo in 2015 showed that the current policy does not adhere to all principles. Conclusions. The analysis revealed different approaches to pricing for medicines NEML and the “Affordable Medicines” program, indicating the need for harmonizing pricing policies for different lists. The adoption of a unified positive list can contribute to improving pricing policies and efficient resource utilization. Collecting, disseminating, and exchanging data on drug prices is crucial to support transparency in pricing and its control. Regular monitoring of prices in the market will help ensure compliance with pricing policies and take appropriate measures in case of violations. The implementation of a unified pricing regulation policy for medicines in Ukraine is an important step towards European integration and compliance with international standards.

Consumerism Meets Healthcare Through Price Transparency

Consumerism Meets Healthcare Through Price Transparency

Social Determinants of Health in Imaging-based Cancer Screening: A Case-based Primer with Strategies for Care Improvement.

Health disparities, preventable differences in the burden of disease and disease outcomes often experienced by socially disadvantaged populations, can be found in nearly all areas of radiology, including emergency radiology, neuroradiology, nuclear medicine, image-guided interventions, and imaging-based cancer screening. Disparities in imaging-based cancer screening are especially noteworthy given the far-reaching population health impact. The social determinants of health (SDoH) play an important role in disparities in cancer screening and outcomes. Through improved understanding of how SDoH can drive differences in health outcomes in radiology, radiologists can effectively provide patient-centered, high-quality, and equitable care. Radiologists and radiology practices can become active partners in efforts to assist patients along their imaging journey and overcome existing barriers to equitable cancer screening care for traditionally marginalized populations. As radiology exists at the intersection of diagnostic imaging, image-guided diagnostic intervention, and image-guided treatment, radiologists are uniquely positioned to design these strategies. Cost-effective and socially conscious strategies that address barriers to equitable care can improve both public health and equitable health outcomes. Potential strategies include championing supportive health policy, reducing out-of-pocket costs, increasing price transparency, improving education and outreach efforts, ensuring that appropriate language translation services are available, providing individualized assistance with appointment scheduling, and offering transportation assistance and childcare. ©RSNA, 2023 Quiz questions for this article are available in the supplemental material.

A Decentralized Auction Model for Sustainable Housing Rental Market

The Internet of Things has driven the transformation of the traditional offline rental model to online rental platforms such as Zillow, Zigbang, and Lianjia. These platforms provide abundant housing options, detailed information, convenient communication, and greater price transparency. However, existing online rental platforms are still centralized and rely on third-party intermediaries for settlement, which raises concerns about the integrity of real estate data, transaction security, and price transparency. To improve the real estate leasing business, we propose leveraging the decentralized nature of blockchain technology. By eliminating intermediaries, we can ensure customer privacy and reduce transaction costs. This strategy revolves around smart contracts as a core component, automatically matching landlords and tenants based on their offers, achieving transparency, and maintaining anonymity for both parties. We introduce a novel auction system that combines the features of interactive auctions and sealed-bid auctions, enabling landlords and tenants to engage in range bidding. In this study, we developed a detailed algorithm to define how smart contracts function during the auction process. Through a cost analysis, we demonstrate the economic feasibility and provide a secure, transparent, and reliable approach for online auctions.

Variability in expenses related to spine oncology care: comparison of payer-negotiated rates at National Cancer Institute-Designated Cancer Centers

BACKGROUNDAs of 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to publish their commercially negotiated prices. To our knowledge, price variation of spine oncology diagnosis and treatments has not been previously investigated. PURPOSEThe aim of this study is to characterize the availability and variation of prices for spinal oncology services among National Cancer Institute-Designated Cancer Centers (NCI-DCC). STUDY DESIGNCross-sectional analysis. METHODSCancer centers were identified; those that did not provide patient care or participate in Medicare's Inpatient Prospective System were excluded. A cross-sectional analysis was conducted to gather commercially negotiated prices by searching online for “[center name] price transparency OR machine-readable file OR chargemaster.” Data obtained was queried using 44 current procedural terminology (CPT) codes for imaging, procedures, and surgeries relevant to spine oncology. Comparison of prices was achieved by normalizing the median price for each service at each center to the estimated 2022 Medicare reimbursement for the center's Medicare Administrator Contractor. The ratios between the lowest and highest median commercial negotiated price within a center and across all centers were defined as “within-center ratio” and “across-center ratio” respectively. RESULTSIn total, 49 centers disclosed commercial payer-negotiated rates. Mean rate (±SD) for cervical corpectomy was $9,134 (±$10,034), thoracic laminectomy for neoplasm excision was $5,382 (±$5502), superficial bone biopsy was $1,853 (±$1,717), and single-photon emission computerized tomography (SPECT) was $813 (±$232). Within-center ratios ranged from 5.0 (SPECT scan) to 17.8 (radiofrequency bone ablation). Across-center ratios (for codes with > 10 centers reporting) ranged from 9.0 (corpectomy, thoracic, lateral extra-cavitary) to 418.7 (anterior approach cervical corpectomy). CONCLUSIONSPrice transparency for spinal oncology remains elusive despite recent CMS regulatory oversight, with marked heterogeneity in the quality of published rates complicating patients' ability to “shop” for care. Additionally, there continues to be significant variation in commercial rates for spine oncology diagnosis and treatment. CLINICAL SIGNIFICANCEDespite regulation by CMS, prices for spinal oncology services are not uniformly available to patients and vary between NCI-DCC. The findings of this manuscript present potential barriers for patients to compare and obtain affordable care.

Growth of Art Auction Houses in India in the Last Decade

Art Auction Houses are companies that allow the buying and selling of sought-after art pieces and collectibles. Today, the popularity of auction houses is growing at an extraordinary speed all over the world. There are a plethora of reasons for this fast growth. Some of these are access to popular and desired artworks, transparency in demand and pricing, and a simple purchasing process. In the last decade, India has seen unparalleled growth in art auction houses with a rise of about 265%. In addition to the boom in sales, the prices of the artworks have almost doubled.

Bugana: Electronic Business to Consumer Marketplace for Farmers' Products of Bago City

City, Philippines, by enabling direct online sales of their agricultural products without intermediaries. This project addresses the challenges farmers face using traditional marketing channels, such as middlemen and retailers, offering a streamlined, accurate, and secure platform for product sales. The system encompasses user account management, product and inventory management, transaction history, reporting, and real-time communication through a mobile app. The study employed Constructive Research Design, allowing in-depth data collection, analysis, and application of the benefactor's requirements. The Agile Development methodology was adopted, including five phases: Requirement Gathering and Analysis, Design, Development, Testing, Deployment and Maintenance. This approach facilitated flexibility and collaboration throughout the project. The result is a cost-effective system with a high return on investment (ROI). Bugana enhances market access, price transparency, and convenience for farmers and customers, marking a significant advancement in agricultural transactions. The findings call for transparent pricing, quality assurance, secure payment options, logistical support, customer service, and broadening system availability to the entire Negros Occidental Province for an even more significant impact.

Rates of price disclosure associated with the surgical treatment of early-stage breast cancer oneyear after implementation of federal regulations.

Mastectomy, breast reconstruction (BR) and breast conserving therapy (BCT) are core components of the treatment paradigm for early-stage disease but are differentially associated with significant financial burdens. Given recent price transparency regulations, we sought to characterize rates of disclosure for breast cancer-related surgery, including mastectomy, BCT, and BR (oncoplastic reconstruction, implant, pedicled flap and free flap) and identify associated factors. For this cross-sectional analysis, cost reports were obtained from the Turquoise Health price transparency platform for all U.S. hospitals meeting national accreditation standards for breast cancer care. The Healthcare Cost Report Information System was used to collect facility-specific data. Addresses were geocoded to identify hospital referral and census regions while data from CMS was also used to identify the geographic practice cost index. We leveraged a Poisson regression model and relevant Medicare billing codes to analyze factors associated with price disclosure and the availability of an OOP price estimator. Of 447 identified hospitals, 221 (49.4%) disclosed prices for mastectomy and 188 42.1%) disclosed prices for both mastectomy and some form of reconstruction including oncoplastic reduction (n = 184, 97.9%), implants (n = 187, 99.5%), pedicled flaps (n = 89, 47.3%), and free flaps (n = 81, 43.1%). Non-profit status and increased market competition were associated with price nondisclosure. 121 hospitals (27.1%) had an out-of-pocket price estimator that included at least one breast surgery. Most eligible hospitals did not disclose prices for breast cancer surgery. Distinct hospital characteristics were associated with price disclosure. Breast cancer patients face persistent difficulty in accessing costs.

The effects of price transparency and debt collection policies on intentions to consume recommended health care: A randomized vignette experiment

AbstractNew laws promote price transparency in health care, though effects on patient decision‐making are not known. Price disclosure may increase the salience of cost and cause lower‐income patients to decline recommended care, worsening inequities in health outcomes. Whether patients perceive a disclosed cost as higher or lower than their expectations may also affect care decisions, but has not been studied. Scholars and policymakers have paid much less attention to the question of whether patients will have to pay the prices charged (whether disclosed or not), and how expectations regarding collections may also affect healthcare consumption. Some hospitals aggressively collect on unpaid medical bills. Others hospitals do not. Actively disclosing collection policies (whether aggressive or protective) could magnify or counteract effects of price disclosures, especially for low‐income patients. To test the effect of price disclosure and debt‐collection disclosures on willingness to obtain recommended care, we recruited a nationally representative sample (N = 2997) and deployed a full factorial, controlled experiment in a standardized clinical vignette model. We find that disclosing a higher‐than‐anticipated price increases the probability of declining recommended care (odds ratio = 1.900), with larger effects for low‐income individuals. Even more, disclosing aggressive collections increases the risk of declining care (odds ratio = 4.493), at higher rates for low‐income patients. Where patients fear collections, but do not know prices, they are most likely to decline care. Disclosure of an aggressive collections policy makes patients feel less informed, harms patient trust in providers, makes them feel that they were not treated fairly, and undermines their confidence in the value of their care. Mediation analysis shows that about half of the effect of collections risk is via these attitudinal variables.

Managing a High Uncertainty Scenario through a Real Option Assessment: Evidence from a Copper Concentrate Trader

Commodity markets are highly volatile markets where uncertainty management is critical for success. Certain commodities, such as copper concentrates, experience even higher levels of volatility and uncertainty. This is fundamentally due to the absence of a reference market that allows for a transparent price discovery, along with many factors affecting the price and trade of any commodity. Traders also lack the possibility of fully hedging their exposure to copper concentrate prices as there is no derivative market directly available for the commodity. Consequently, this paper analyses the copper concentrate trading business resorting to the Real Options methodology to assess the high volatility and uncertainty which dominates in this area of commodity markets. The results obtained indicate that this method can be applied by copper concentrate traders to separate the price uncertainty from their business operative and financial planning for the future. This provides them with a reliable tool to lower the level of uncertainty affecting their long-term goals, as well as keeping the risk that they are taking under control. It also gives them higher managerial flexibility.

Price, Service Quality and Shipping Costs as Intervening Factors on Consumer Behavior To Determine Repeat Purchase Intentions on The Shopee Marketplace in Indonesia

The purpose of this study is to determine the effect of price and service quality on consumer behavior to determine repurchase intentions at the Shopee marketplace in Indonesia through the variable shipping cost as an intervening factor. The research method used in this research is quantitative descriptive research method using data analysis, namely path analysis using PLS 3.0 software. Based on the results of the research analysis, the conclusion of this study is that partially the price and service quality variables affect the consumer behavior variable to determine repurchase intentions in the marketplace on the Shopee platform. Simultaneously, the price and service quality variables affect the consumer behavior variable to determine repurchase intentions in the marketplace on the Shopee platform through the shipping cost variable as an intervening factor. in the context of repeat purchase intentions from an Islamic perspective, businesses should focus on adhering to Islamic principles of fair pricing, ethical conduct, and transparency in pricing and shipping. The implications of this research will be very useful in optimizing Shopee business operations and providing better services to customers, with the hope of increasing repeat purchase intentions and strengthening Shopee's position in the e-commerce market in Indonesia.

Patient-Level Savings Using the Mark Cuban Cost Plus Drugs Company for Radiation Oncology Patients

In 2022, the Mark Cuban Cost Plus Drugs Company (MCCPDC) launched with the goal of offering affordable generic drugs directly to patients through a transparent pricing model. This study aims to evaluate the patient-level potential savings per prescription for patients undergoing radiation oncology treatment, regardless of insurance status. We analyzed prescription patterns of radiation oncologists in 2019 using the Medicare Part D database and selected the top 100 most frequently prescribed drugs for further analysis. To evaluate potential cost savings, we obtained prescription data from the Medical Expenditure Panel Survey (MEPS) for 2019. We filtered the MEPS data based on the top 100 non-controlled drugs prescribed by radiation oncologists (MCCPDC does not sell controlled substances). We calculated the mode for the scripts of each drug and compared the prices to those offered by MCCPDC then adjusted the prices for inflation using the Consumer Price Index (CPI). We stratified scripts by payor type, including public (Medicare and Medicaid), private, and self-pay, and compared the cash price at MCCPDC to the out-of-pocket costs for patients. Our analysis included 25,421 prescriptions. Of these, 49% were covered by public payors (Medicare or Medicaid), 25% were covered by private entities (including private insurance), and 26% were self-pay. Savings were defined as the cash price at MCCPDC being lower than the copay. 40% of prescriptions had savings when purchased through MCCPDC regardless of coverage status. Savings were seen on 17% of scripts for patients covered by Medicare or Medicaid, 39% for those with private coverage, and 84% for patients who self-pay. The average savings per script were $8.80 for public payors, $6.33 for private payors, and $11.32 for self-payors. The medication with the highest average potential savings, regardless of coverage, was tadalafil, with savings of $54.63 per prescription. Among public payors, solifenacin had the highest average potential savings, with savings of $37.07 per prescription. For private payors, memantine had the highest potential savings at $62.83 per prescription. For self-pay patients, the medication with the highest potential savings was levetiracetam, with savings of $740.34 per prescription. Our study demonstrates that MCCPDC can provide substantial cost savings to patients when compared to out-of-pocket costs, regardless of insurance status. This is the first analysis to demonstrate such cost-savings at the patient-level. Radiation oncologists should consider discussing MCCPDC with patients when prescribing medications, as it has potential to reduce the financial toxicity burden for many patients.

174 Price Transparency and Variation in Emergency Department Visits by Payer Type: A Nationwide Analysis

174 Price Transparency and Variation in Emergency Department Visits by Payer Type: A Nationwide Analysis

Potential Federal Policies to Reduce or Limit Commercial Plan Payments to Hospitals and Physicians

Summary The Congressional Budget Office (CBO) is a nonpartisan federal agency that, aligned with its mission to support the U.S. Congressional budget process, frequently analyzes policies affecting health care providers’ payment rates or their costs of providing care. Such policies can directly affect providers’ revenues by changing the administered prices for services covered by Medicare or by affecting the negotiated prices paid to providers by commercial insurers. CBO does not make policy recommendations. Rather, the agency’s role is to produce independent analyses of policy approaches and examine their implications for the federal budget and other related outcomes. Here, the authors describe a September 2022 report that was prepared on the basis of a congressional request. The agency reviewed three families of policies that are frequently mentioned as solutions for the growth in the negotiated prices paid in commercial plans: promoting competition among providers, promoting price transparency, and capping the level or growth rate of prices. The effects on prices expected within the first 10 years for each of the approaches considered would range from very small reductions if the price transparency policies were adopted (0.1%–1.0%) to small reductions if the competition policies were adopted (more than 1.0%–3.0%) and moderate (more than 3.0%–5.0%) to large (more than 5.0%) reductions if both the level and growth of prices were capped. Those estimates, although uncertain, represent CBO’s best assessments of the effects of the policies using evidence from the research literature and the most recently available data. CBO projects that, under current law, commercial insurers would pay $1.5 trillion in claims from hospitals and physicians in 2032. If hospital and physician prices fell by 1%, premiums for commercial health insurance plans could be reduced by a total of $13 billion in that year. Reductions in premiums in turn would reduce the federal budget deficit by increasing tax revenues (because the amount of premiums excluded from taxable income would be lower) and by reducing subsidies for health insurance for the self-employed and people eligible for subsidies under the Patient Protection and Affordable Care Act. As a result, the federal government’s subsidies for commercial health insurance premiums would be reduced by $4.8 billion in 2032 or 0.2% of the budget deficit projected for that year under current law. The authors did not project the effects of the policies on outcomes other than prices, premiums, and the federal budget — such as access to care, quality of care, and providers’ costs — because of limited and conflicting evidence and because the policies’ effects on prices were generally small. CBO recently issued a call for more research on the effects of policies significantly affecting providers’ revenues on other outcomes that would help the agency better analyze the effect of related policies in the future.

Negotiated Rates for Surgical Cancer Care in the Era of Price Transparency-Prices Reflect Market Competition.

To measure commercial price variation for cancer surgery within and across hospitals. Surgical care for solid-organ tumors is costly, and negotiated commercial rates have been hidden from public view. The Hospital Price Transparency Rule, enacted in 2021, requires all hospitals to list their negotiated rates on their website, thus opening the door for an examination of pricing for cancer surgery. This was a cross-sectional study using 2021 negotiated price data disclosed by US hospitals for the 10 most common cancers treated with surgery. Price variation was measured using within-hospital and across-hospital ratios. Commercial rates relative to cancer center designation and the Herfindahl-Hirschman Index at the facility level were evaluated with mixed effects linear regression with random intercepts per procedural code. In all, 495,200 unique commercial rates from 2232 hospitals resulted for the 10 most common solid-organ tumor cancers. Gynecologic cancer operations had the highest median rates at $6035.8/operation compared with bladder cancer surgery at $3431.0/operation. Compared with competitive markets, moderately and highly concentrated markets were associated with significantly higher rates (HHI 1501, 2500, coefficient $513.6, 95% CI, $295.5, $731.7; HHI >2500, coefficient $1115.5, 95% CI, $913.7, $1317.2). National Cancer Institute designation was associated with higher rates, coefficient $3,451.9 (95% CI, $2853.2, $4050.7). Commercial payer-negotiated prices for the surgical management of 10 common, solid tumor malignancies varied widely both within and across hospitals. Higher rates were observed in less competitive markets. Future efforts should facilitate price competition and limit health market concentration.

Healthcare price transparency in North America and Europe.

Healthcare price transparency is an effort to inform patient decision-making, but also to decrease prices and their variation across healthcare systems for equivalent medical services. The initiative is meaningful only for medical services that are shoppable-such as imaging examinations-for which patients incur out-of-pocket costs. Therefore, several countries in which patients commonly share a portion of their healthcare costs have been implementing mandates to improve healthcare price transparency. However, the provisional implementation has many issues, especially in the United States, including provider non-compliance and limited accessibility of price transparency tools by the general public. Many of the existing tools are not user-friendly, are difficult to navigate, focus on charges and health plan negotiated rates rather than patients' out-of-pocket costs, and disclose prices on the service level instead of per episode of care. As such, the disclosed amounts are often not reliable. Many price transparency tools also lack valid and measurable quality metrics, which can result in a selection of high-cost care as a proxy for high-value care, as well as an increase in healthcare prices when providers want to imply they offer high-quality care. Nevertheless, the impact of the initiatives on patients' decision-making and healthcare costs remains unclear. While transparency initiatives are patient-centric, efforts should be made to increase patient engagement, provide accurate patient-specific out-of-pocket cost information, compare available treatment and provider alternatives, and couple price information with quality metrics to enable making fully informed decisions.