Lower commercial rates for breast surgical procedures are associated with socioeconomic disadvantage: A transparency in coverage analysis Journal Article

  

Authors:	Rochlin, D. H.; Wang, Y.; Amakiri, U. O.; Levy, J.; Boe, L.; Sheckter, C. C.; Anderson, G.; Mehrara, B. J.; Nelson, J. A.; Matros, E.
Article Title:	Lower commercial rates for breast surgical procedures are associated with socioeconomic disadvantage: A transparency in coverage analysis
Abstract:	Background: The Centers for Medicare & Medicaid Services (CMS) implemented the Transparency in Coverage Rule in 2022, which requires payers to disclose commercial rates for the first time in the history of the US healthcare system. The purpose of this study was to characterize payer-disclosed commercial facility rates and examine the relationship with county-level social disadvantage for common breast surgical procedures. Materials and Methods: We performed a cross-sectional study of 2023 pricing data for 14 ablative and reconstructive breast procedures from Turquoise Health. Socioeconomic disadvantage was quantified using the Social Vulnerability Index (SVI). Within- and across-payer ratios quantified rate variation. Linear regression assessed the relationship between relative value unit (RVU)-adjusted median commercial rates and facility-level variables including SVI quartile. Results: There were 4,748,074 unique commercial rates disclosed by four payers from negotiations with 10,023 hospitals. Rates varied by a factor of 9.8–15.6 within and 10.0–18.1 across payers. RVU-adjusted commercial rate decreased in a stepwise fashion as SVI quartile increased and varied by payer (p < 0.001). Higher RVU-adjusted rates were associated with hospitals compared with ambulatory facilities (β = 138, 95% CI 138–139, p < 0.001). Lower rates were associated with areas of less healthcare infrastructure (β = − 37, 95% CI − 38 to − 37, p < 0.001). Conclusions: Facility rates for breast surgical procedures varied significantly within and between payers and were higher for hospitals compared with ambulatory surgery centers. Facilities in areas of higher social vulnerability were associated with lower negotiated rates. The health equity implications of lower payment in areas of higher disadvantage, particularly in terms of access to care, deserve further investigation. © Society of Surgical Oncology 2024.
Keywords:	breast surgery; health equity; social vulnerability index; price variation; commercial facility rates; transparency in coverage
Journal Title:	Annals of Surgical Oncology
Volume:	32
Issue:	5
ISSN:	1068-9265
Publisher:	Springer
Date Published:	2025-05-01
Start Page:	3695
End Page:	3704
Language:	English
DOI:	10.1245/s10434-024-16738-z
PUBMED:	39719512
PROVIDER:	scopus
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85212863787&doi=10.1245%2fs10434-024-16738-z&partnerID=40&md5=04939e12e7b6e201eb79af25aacde4f5
Notes:	The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PubMed record and PDF. Corresponding MSK author is Danielle H. Rochlin -- Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/224806