Compliance with federal price transparency rules and cost estimation at United States hospitals with neurosurgical training programs Journal Article


Authors: Giantini-Larsen, A.; Pandey, A.; Abou-Mrad, Z.; Tata, N.; Barzilai, O.; Bilsky, M.; Newman, W. C.
Article Title: Compliance with federal price transparency rules and cost estimation at United States hospitals with neurosurgical training programs
Abstract: BACKGROUND AND OBJECTIVES: The Centers for Medicare & Medicaid Services implemented federal requirements on January 1, 2021, under the Public Health Service Act that require hospitals to provide a list of payer-negotiated prices or “standard charges” in a machine-readable file and in a patient-friendly online estimator for standard services. We sought to assess compliance by United States hospitals associated with neurosurgical training programs with these federal requirements for 11 common neurosurgical procedures. METHODS: We performed a cross-sectional analysis in March 2023 of 116 United States hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements to have a machine-readable, downloadable file with standard charges and a patient-friendly online estimator for two spinal procedures. RESULTS: A total of 110/114 (96.5%) hospitals were compliant with the requirement for a machine-readable file with payer-negotiated prices. A total of 47/110 hospitals (42.7%) were compliant with downloadable machine-readable files and reported at least one payer-negotiated price for 1 of the 11 common neurosurgical procedures. A total of 45/110 (40.9%) used bundled Diagnosis-Related Group codes, and 18/110 (16.4%) did not contain any price information for neurosurgical procedures. For neurosurgical procedures, the percent difference between the average negotiated private insurance and Medicare price per procedure ranged from 17.5% to 77.6%. Medicare and private insurance data for each procedure were available on average for 10.3 states (SD = 3.8) and 15.6 states (SD = 4.8), respectively. CONCLUSION: While hospital compliance with federal requirements for machine-readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on Current Procedural Terminology codes was sparce. Consequently, meaningful conclusions on procedure-related charges for elective procedures are difficult for patients to make because of the unintelligible format of data and a lack of reporting of charges per Current Procedural Terminology code in a comprehensive manner. © Congress of Neurological Surgeons 2024. All rights reserved.
Keywords: controlled study; major clinical study; united states; neurosurgery; medicaid; medicare; training; public health service; cross-sectional study; disease management; compliance; human; article; current procedural terminology; pharmacoeconomics; diagnosis related group; price transparency; cost estimator
Journal Title: Neurosurgery
Volume: 95
Issue: 1
ISSN: 0148-396X
Publisher: Wolters Kluwer  
Date Published: 2024-07-01
Start Page: 215
End Page: 223
Language: English
DOI: 10.1227/neu.0000000000002858
PUBMED: 38345364
PROVIDER: scopus
DOI/URL:
Notes: Article -- Source: Scopus
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MSK Authors
  1. Mark H Bilsky
    319 Bilsky
  2. William Christopher Newman
    24 Newman
  3. Nalini Tata
    1 Tata