Analysis of Price Transparency in New England Hospitals Demonstrates Poor Compliance and Variability
Borivoj Golijanin, BS, Anna Ochsner, BS, Christopher Tucci, MS, RN-BC, CURN, NE-BC, FAUNA, Elias Hyams, MD, Gyan Pareek, MD.
Minimally Invasive Urology Institute at the Miriam Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
BACKGROUND: The Hospital Price Transparency Final Rule came into effect January 2021, and requires all US hospitals to publish prices for items and services offered at their institution to comply with the Centers for Medicare & Medicaid Services (CMS). Specifically hospitals are required to publish, and update estimated prices on a yearly basis in a comprehensive machine readable file and a patient-friendly list of shoppable services. This study evaluated the relationship of price transparency of two urologic procedures among hospitals in New England and hospital ranking.
METHODS: Hospitals in ME, VT, NH, MA, RI, and CT ranked for urology services by U.S. News & World Report (USNWR) were included in this study. This included 71 hospitals total with rankings based out of 100 (best score). Price of robotic/laparoscopic prostatectomy (CPT 55866) and prostate biopsy (CPT 55700) for self-pay individuals was obtained from chargemasters or machine readable files available on hospital websites. Summary statistics were obtained to calculate average price of services by state. Pearson R correlation was used to evaluate correlation between USNWR ranking with price.
RESULTS: Out of 71 hospitals studied, 60.6% (43/71) of the hospitals reported price for prostate biopsy and 45.1% (32/71) reported price of prostatectomy. 40.8% (29/71) hospitals provided prices for both services. Prices were highest in CT for both prostate biopsy (avg. price $11,649.11, SD $3,445.10) and prostatectomy (avg. price $65,298.26, SD $14,294.38) and lowest in Rhode Island for prostatectomy (avg. price $34,067.10, SD $4,214.25) and Maine for prostate biopsy (avg. price $3,118.68, SD $1,550.93). The average price of prostate biopsy in RI was second lowest, after ME, at $3,314.00 and the average price of prostatectomy in Maine was $38,291.45. Information on the remaining states can be seen in Table 1. The average US News ranking of the urology service providing compliant hospitals were as follows: VT 55.2, MA 51.3, RI 48.3, CT 45.6, NH 39.3, ME 33.3 (Table 2). There was a moderate positive correlation between prostatectomy price and ranking (Pearson R = 0.514, p = 0.001).
CONCLUSIONS: Hospital compliance with price transparency requirements and the price of two urological procedures are inconsistent in New England. Although price variability is expected due to differing operating costs and markets, a patient shopping for care is faced with additional challenges when hospitals are not complying with the price transparency requirements. Prostatectomy prices increase with rising USNWR ranking; further efforts to understand causes of price variation are warranted.
Table 1: Average price of two urologic procedures in New England states.
| State | Mean Price CPT 55866 Surgical removal of prostate and surrounding lymph nodes using an endoscope | Mean Price CPT 55700 Biopsy of prostate gland | SD CPT 55866 Surgical removal of prostate and surrounding lymph nodes using an endoscope | SD CPT 55700 Biopsy of prostate gland |
| Maine | $38,291.45 | $3,118.68 | $15,353.28 | $1,550.93 |
| New Hampshire | $48,008.85 | $9,248.20 | $13,812.64 | $7,154.71 |
| Vermont | $48,143.00 | $5,115.00 | - | $21.21 |
| Rhode Island | $34,067.10 | $3,314.00 | $4,214.25 | $0.00 |
| Connecticut | $65,298.26 | $11,649.21 | $14,294.38 | $3,445.10 |
| Massachusetts | $63,616.30 | $8,607.23 | $29,205.53 | $5,840.67 |
Table 2: Average rankings of hospitals offering urology services in New England
| State | Parameter | Avg. USNWR Ranking Regardless of Compliance | Avg. USNWR Ranking for Hospitals That Report Prostate Bx Price | Avg USNWR Ranking for Hospitals That Report Prostatectomy Price | Avg. USNWR ranking for hospitals that report price for both procedures |
| VT | Avg. Ranking | 56.9 | 56.9 | 55.2 | 55.2 |
| # hospitals | 2 | 2 | 1 | 1 | |
| MA | Avg. Ranking | 38.5 | 44.8 | 50.8 | 51.3 |
| # hospitals | 35 | 15 | 9 | 8 | |
| RI | Avg. Ranking | 39.7 | 48.3 | 39.7 | 48.3 |
| # hospitals | 3 | 2 | 3 | 2 | |
| CT | Avg. Ranking | 40.7 | 44.9 | 45.6 | 45.6 |
| # hospitals | 20 | 14 | 9 | 9 | |
| NH | Avg. Ranking | 39.0 | 39.3 | 39 | 39.3 |
| # hospitals | 6 | 5 | 6 | 5 | |
| ME | Avg. Ranking | 36.1 | 36.1 | 33.3 | 33.3 |
| # hospitals | 5 | 5 | 4 | 4 |
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