Introduction: On January 1, 2021, the Centers for Medicare and Medicaid Services (CMS) implemented the Hospital Price Transparency Final Rule to promote price competition and improve hospital care affordability. Hospitals in the US are required to disclose, among other items, the cash prices and the payer-specific negotiated prices for CMS-specified, high-volume common services. We investigated the compliance rate and descriptive costs for breast cancer services in the central New Jersey region. Methods: We collected CMS-specified hospital services representing 4 unique Current Procedural Terminology (CPT)/diagnosis related group codes (screening mammography, US guided biopsy, mastectomy, partial lumpectomy). Cash prices and payer-specific negotiated prices for these services were obtained from Turquoise Health, a data service company that specializes in collecting pricing information from hospitals. We collected the median cash price, the proportion of hospitals for which the cash price was lower than its median commercial negotiated price, interquartile ranges (IQR) for cash prices across all services by practice type, and the correlation between cash price of service and neighborhood poverty level. Results: 106 hospitals in a 50-mile radius from central New Jersey were reviewed, representing 22 academic and 84 community clinics. Of these, only 4 hospitals disclosed both their cash price and commercially negotiated price for all services. Overall, there was a correlation for mammography cash price and neighborhood level of poverty (Rs -0.34, p = 0.026). No correlations were noted for the other services. Cash prices varied substantially across hospitals, as evidenced by large IQR for US-guided biopsy $ 1877.19 (1647.05 – 5388.2), mastectomy $6417.00 (4847.34 – 48166.69), and lumpectomy $3820.00 (3021.76 – 17041.84) in academic centers. When compared to community hospitals, academic institutions were more likely to set their cash prices below negotiated insurance prices. Discussion: Of the 106 hospitals investigated, only 4 disclosed both their cash price and commercially negotiated price. As evidenced by the negative correlation between the cash median cash price of screening mammography and neighborhood level of poverty, hospitals encourage entry into the health system. Unfortunately, downstream costs for diagnosis and treatment are unpredictable and present major challenges in preventing financial toxicity and assuring health equity. Because of its descriptive nature, this study was unable to identify factors or outcomes associated with the cash price variation. Uninsured or underinsured patients who choose to take the cash price offered by hospitals remain extremely vulnerable. Citation Format: Alexandra Noveihed, Naveena Lall, Qasim S. Hussaini, Roy Elias, Arjun Gupta, Ramy Sedhom. Cash, Commercial Negotiated Prices, and Correlations with Neighborhood Poverty Levels for Shoppable Breast Cancer Services [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-08-10.

Introduction: Place of death (PoD) studies are often used to motivate and monitor progress on health inequities for persons with cancer. It remains unclear whether aggregation of Asian race masks disparities in health equity for care at the end of life. Methods: De-identified death certificate data were obtained via the National Center for Health Statistics. All adult (>18 years of age) breast cancer deaths from 2018 to 2019 were included. Multinomial logistic regression was used to test for differences in place of death associated with sociodemographic variables. Results: From 2018 through 2019, 81,772 died from breast cancer in the United States. Overall, persons of Asian descent were less likely to die at home compared to White patients. Disaggregation noted significant differences in likelihood of hospice facility use. For example, Filipino race was approximately 5 times more likely to utilize hospice facilities (CI 3.764, 8.718; p< 0.001) compared to Whites, whereas Chinese race was significantly less likely (OR 0.49, 95% CI 0.307 to 0.627, p< 0.001). American Indian (OR 0.006), Asian Indian (OR 0.016), and Samoan (0.011) were the least likely to die in a nursing facility. While trends were overall similar when compared to White, Black and Hispanics, the likelihood of PoD among Asian subgroups were significantly different. Conclusion: Our data highlights notable differences in PoD only apparent with disaggregation of Asian race. While this study remains exploratory in nature, and reasons to explain these disparities are necessary, disaggregation of the Asian Pacific Island category is imperative to unmask disparities to improve health equity among all indigenous populations. Association Between Race and Place of Death for Patients with Breast Cancer Table 1. Number of deaths due to breast cancer in 2018 and 2019, by race. Odds ratios for the association between race and place of death from multinomial regression. Citation Format: Naveena Lall, Alexandra Noveihed, Qasim S. Hussaini, Amanda L. Blackford, Arjun Gupta, Ramy Sedhom. Does Aggregation Hide Place of Death Disparities for Asians with Breast Cancer? [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-32.