Do New Hospital Price Transparency Regulations Reflect Value in Arthroplasty?

Taylor D'Amore, MD; Graham S. Goh, MD; P. Maxwell Courtney, MD; Gregg R. Klein, MD

Disclosures

J Am Acad Orthop Surg. 2022;30(8):e658-e663. 

In This Article

Results

In total, 94 of 101 hospitals (93.1%) posted some shoppable services information on their websites as required by CMS. Three hospitals did not post any information while four hospitals presented data in a format that could not be accessed. Only 21 of 101 hospitals (20.8%) were fully compliant by publishing all price transparency data; 86 hospitals (91.5%) posted gross charges related to DRG charges, 36 (38.3%) posted minimum charges, 37 (39.4%) posted maximum charges, 60 (63.8%) posted cash prices, and 28 (29.8%) posted payer-specific prices. Ninety-seven hospitals (96.0%) posted chargemaster data, which represents the charge for procedures and products used by patients,[11] whereas 82 (81.2%) posted price estimators on their websites, of which 15 required personal identifying information to be entered before prices could be estimated.

The mean inpatient charge for THA and TKA was $72,112 with a median of $65,251 (range, $14,717 to $195,264), cash pay price was $39,406 on average with a median of $35,475 (range, $2,920 to $110,858), and minimum and maximum payer rates were $16,140 and $57,949, respectively. Of the 45 hospitals that posted both mean inpatient charge and cash pay price, only 4 (8.9%) had a greater cash pay price compared with mean inpatient charge. The mean CMS reimbursement was $20,299 (range, $16,719 to $25,957), giving a charge to reimbursement ratio of 3.49 ± 1.61. Although better hospital ranking was weakly correlated with higher hospital charges (coefficient 0.223; P = 0.049), there was no correlation between mean inpatient charges and CMS-adjusted complications (coefficient 0.130; P = 0.266) or readmissions (coefficient 0.040; P = 0.735).

A subgroup analysis of the top-tier, middle-tier, and bottom-tier hospitals was conducted, which revealed that only 6 hospitals (19.4%), 9 hospitals (28.1%), and 6 hospitals (19.4%) were fully compliant with the price transparency regulation, respectively (P = 0.626). A significant difference in mean inpatient charges was noted among the three groups (P = 0.040). The mean inpatient charge for THA and TKA was $84,376 (median, $73,957) in the top tier, $73,277 (median, $69,276) in the middle tier, and $58,050 (median, $59,361) in the bottom tier. Pairwise comparisons showed that the absolute difference in reported charges was $26,325 between the top and bottom tiers (P = 0.017), $11,098 between the top and middle tiers (P = 0.665), and $15,227 between the middle and bottom tiers (P = 0.295). Consistent with the main analysis, no correlations between mean inpatient charges and CMS-adjusted complications or readmissions were noted within each tier.

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