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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