Huge Variation in Charges for Cancer Services Across NCI Centers

Victoria Stern, MA

October 29, 2021

UPDATED November 2, 2021 // Editor's note: This article has been updated with comments from lead author of paper.

Cancer centers in the United States are charging vastly different prices for the same oncology services, according to an analysis published October 28 in JAMA Oncology.

For example, the price for radiotherapy to treat bone metastases charged to insurers can vary from $300 to just over $33,000 — more than a 100-fold difference.

The pricing spread for a colonoscopy with polyp or tumor removal was also substantial, ranging from $300 to $6,316 — a 21-fold difference.

These differences came to light when researchers dug into data on charges for oncology services at National Cancer Institute (NCI) designated cancer centers.

However, they also found they had little data to go on. In spite of recent federal price transparency regulations mandating that these centers report what they charge for services, the team found that only 1 in 5 NCI centers included in the analysis (13 of 63) complied with the Centers for Medicare & Medicaid Services' (CMS') 2021 price transparency rules. These rules require hospitals to post machine-readable files including prices cash-paying patients pay as well as insurer-negotiated rates.

The researchers, led by Fumiko Chino, MD, a radiation oncologist at Memorial Sloan Kettering Cancer Center in New York City, predict that NCI cancer centers are "likely to continue to keep their pricing opaque given the potential reduction in reimbursement that may follow true transparency."

When asked whether she was surprised by the huge pricing spread for the radiotherapy and colonoscopy services included in the analysis, Chino told Medscape Medical News, "I'm horrified and shocked, but not actually surprised. We're seeing more and more data like this that shows, when it comes to pricing, we're in the Wild West."

It's not only cancer centers that are playing this game. Other recent studies have highlighted significant differences in what hospitals charge for cancer treatments as well as poor compliance with CMS' price transparency requirements. One study, published in June, reported that payer-negotiated rates for thyroid cancer services varied considerably across NCI centers — a 70-fold difference in the median price for radioactive iodine treatment and a 45-fold difference in the median price for neck computed tomography.

Study Details

In the latest analysis, Chino and colleagues collected data from 63 NCI centers between March and June 2021 to determine how many followed CMS price transparency requirements and to evaluate pricing variations among those that did.

Overall, only 21% of these centers (13) posted complete data in a machine-readable file, though 70% (44) had a chargemaster list, in compliance with the older CMS price transparency regulations, and two thirds (41) had a price transparency tool patients could access online.

After combing through pricing data from the 13 compliant centers, Chino and colleagues highlighted two procedures — radiotherapy to bone metastasis and colonoscopy with polyp or tumor removal — as examples of the type of pricing spread one might expect.

Of the 11 NCI centers with complete insurer rates for radiotherapy to bone metastasis, the charges ranged from as low as $297 to as high as $33,411.34, with the average minimum and maximum prices falling within a smaller range of $890 and $13,274, respectively.

For colonoscopy, the seven NCI centers with complete pricing information posted prices ranging from $297 to $6,316, with the average minimum and maximum rates at $2,150 and $3,371, respectively.

When compared with the Medicare maximum allowable rates, the NCI prices were, on average, almost four times higher for radiotherapy ($2,477) and about two times more for colonoscopy ($1,037). And overall, the authors found "some centers charging up to eight times the Medicare maximum allowable rate."

But even among compliant NCI centers, Chino was struck by how difficult it was to find prices for certain types of services. "We initially wanted to provide an example of a chemotherapy, radiation oncology, and surgical service, but it was incredibly hard to find surgical prices," she said. "We also wanted to look at pricing for pembrolizumab (Keytruda), but not enough centers posted that specific data."

Another notable finding: Chino and colleagues saw substantial price ranges within NCI centers. "We found variability not only center to center but also within the same center," said Chino, adding that she plans to address this intercenter variability in an upcoming analysis.

Chino and colleagues noted several limitations to the research, including the possibility that some noncompliant-NCI centers posted price transparency information after the study's data collection period had ended. In addition, the price ranges reported in the analysis reflect payer-negotiated rates, not necessarily a patient's out-of-pocket costs.

Ultimately, what patients pay is quite variable, Chino noted. "After a cancer diagnosis and workup, many patients will have reached their out-of-pocket max for the year, so they may have a co-pay but not coinsurance and these costs will vary. For patients without insurance, cash prices are higher than insurance-negotiated rates, but facilities will typically provide a discount, which is also quite variable."

Whether these rates, or patient-facing price transparency tools in general, "accurately estimate out-of-pocket costs given the complexities of cancer treatment and insurance plan design" remains unclear, the authors wrote. However, even if "price transparency may not immediately translate to improved affordability for patients, availability of data may help inform health policy to contain costs," Chino and colleagues concluded.

Chino was supported in part through a National Institutes of Health/NCI Cancer Center support grant. Author Jordan Johnson, BSRT, MSHA, works at OncoSpark, an oncology value-based care and technology company. The remaining authors have not disclosed any relevant financial relationships.

JAMA Oncol. Published online October 28, 2021. Abstract

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