Posted Prices of Cataract Procedures May Confuse Patients: Study

Kerry Dooley Young

October 12, 2021

Many academic medical centers are trying to comply with a recent federal mandate on price transparency, but data posted on their websites may leave patients' questions about costs unanswered, according to findings from a recent study.

Investigators conducted a study of how hospitals posted on the internet prices for two ophthalmologic procedures: removal of cataract with insertion of lens (current procedural terminology [CPT] code 66984) and removal of recurring cataract in lens capsule using laser (CPT 66821). The study was published online October 7 in JAMA Ophthalmology.

These are among the procedures for which the Centers for Medicare & Medicaid Services (CMS) has specifically ordered hospitals to post prices online in consumer-friendly formats. CMS requirements that took effect in January go beyond a previous mandate for hospitals to post their "chargemasters," or list prices. Those prices often bear little relation to what consumers and insurers actually pay.

The study focused on 247 hospitals affiliated with the Association of American Medical Colleges. The researchers found that 191 hospitals (77.3%) were providing consumer-friendly shoppable services, often through a price estimator or online tool.

That was the good news regarding attempts to comply with the new mandate, one of the authors, Shriji N. Patel, MD, MBA, of Vanderbilt University, Nashville, Tennessee, told Medscape Medical News in an interview.

"For the first swing, that's a very reasonable attempt. It shows that the majority are trying," Patel said. "But when you get into the weeds, you realize that even though many are trying, you realize the effort might be missing the mark, because it's difficult to actually work with this data."

Patel and his co-authors found what they called "usability issues" in some of the websites, such as a need for lengthy searching or requirements that personal information be entered.

Another concern was the often broad range of prices displayed, according to the authors. For removal of cataract with insertion of lens (CPT 66984), prices ranged from $1120.50 to $29,729. For removal of recurring cataract in lens capsule using laser (CPT 66821), prices ranged from $251 to $12,987.

Although hospitals are supposed to show the costs of all items and services needed for a procedure, in some cases, the prices that were provided online accounted only for the hospital component of a procedure, the authors write. As a result, the estimates likely reflect a fraction of the true cost. Other expenses varied widely.

The confusing information may be a particularly tough burden on patients who lack health insurance, the authors write.

"Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices," Patel and co-authors recommend.

In an accompanying commentary, Michael X. Repka, MD, MBA, of the Wilmer Eye Institute, Baltimore, Maryland, suggests that CMS offer hospitals incentives through future rule making to improve the data that are posted.

"For price-transparency programs to be meaningful and allow informed patient choice, the hospital websites need to be simple to navigate with clearly stated total costs," Repka writes.

The study provides a snapshot of the earliest days of the implementation of the new mandate on price transparency. Medscape Medical News asked Ge Bai, PhD, CPA, of Johns Hopkins University, Baltimore, Maryland, who has conducted research on price transparency, to comment on the article. She cautioned against reading too much into the poor quality of some of the initial postings of hospital prices.

"There are various shortcomings right now in how the hospitals disclose, but the majority of hospitals are moving in the right direction," Bai told Medscape. "The rule is about empowering patients and employers and making price transparency possible."

She also disagreed with the suggestion that federal law be revised so as to spell out in more detail what hospitals should disclose. Instead, she said that Congress and the US Department of Health and Human Services should allow some time to see how the demands of consumers, insurers, and employers affect hospitals' approaches to transparency. Hospitals with regional competition could lose business to rivals that have more transparent websites, she said.

"There could be punishment from the market" if hospitals fail to post meaningful price data, Bai said.

This would be less of a concern in cases in which a hospital group dominates a region and thus has more negotiating clout.

"Whether they have high or low prices, they will have contracts" with insurers, Bai said.

The study was supported in part by an unrestricted departmental award from Research to Prevent Blindness Inc and Vanderbilt Institute for Clinical and Translational Research.

JAMA Ophthalmol. Published online October 7, 2021. Full text, Commentary

Kerry Dooley Young is a freelance journalist based in Washington, DC. She is the core topic leader on patient safety issues for the Association of Health Care Journalists. Young earlier covered health policy and the federal budget for Congressional Quarterly/CQ Roll Call and the pharmaceutical industry and the Food and Drug Administration for Bloomberg. Follow her on Twitter at @kdooleyyoung.

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