Hospital Prices for Pediatric Tympanostomy Tube Placement and Adenotonsillectomy in 2021

Abstract

Objectives: Hospital prices vary substantially for myringotomy with tympanostomy tube placement (M&T) and adenotonsillectomy (T&A). The Centers for Medicare and Medicaid Services recently implemented hospital price transparency requirements to help families make financially informed decisions about where to seek care. We sought to determine price availability and the extent of price variation for these procedures.Methods: We performed a cross-sectional analysis of the Turquoise Health Hospital Rates Data Platform, which extracts prices for facility fees from publicly available hospital chargemasters. We determined the proportion of hospitals serving pediatric patients that published payer-specific prices for M&T and T&A. We additionally characterized the extent of variation in payer-specific prices both across and within hospitals.Results: Approximately 40% (n = 909 of 2,266 hospitals) serving pediatric patients disclosed prices for M&T or T&A. Among disclosing hospitals, across-center ratios (adjusted for Medicare hospital wage indices) ranged from 11.0 (M&T; 10th percentile adjusted median price: $536.80 versus 90th percentile adjusted median price: $5,929.93) to 23.4 (revision adenoidectomy age >12 years; 10th percentile: $393.82 versus 90th percentile: $9,209.88). Median within-center price ratios for procedures ranged from 2.2 to 2.7, indicating that some private payers reimbursed the same hospital more than twice as much as other payers for the same procedure. Conclusion:The majority of hospitals serving pediatric patients were non-compliant with federal requirements to disclose prices for M&T and T&A. Among disclosing hospitals, there was wide variation in payer-specific prices between and within institutions. Further research is necessary to understand whether disclosure of prices will enable families to make more financially informed decisions.

Variations in Payer‐Negotiated Prices for Head and Neck Reconstructive Surgery

“…Pricing variation has previously been demonstrated in head and neck oncology, pediatric otolaryngology, and adult otolaryngology procedures 6,8,12,18 . To the best of our knowledge, this study is the first to assess pricing variation in reconstructive procedures and to assess the relationship between facility fees and surgical complexity.…”

“…Prices from public payers such as Medicare and Medicaid were not included. Hospitals within the Turquoise database were identified based on previously described methods 12 . Inclusion and exclusion criteria were applied to yield hospitals that had at least 10 payer‐negotiated prices for at least 1 CPT code of interest.…”

“…Hospitals within the Turquoise database were identified based on previously described methods. 12 Inclusion and exclusion criteria were applied to yield hospitals that had at least 10 payernegotiated prices for at least 1 CPT code of interest. Only hospitals that were included in the Medicare Fiscal Year 2023 Inpatient Prospective Payment System (IPPS) Final Rule Impact File were included in order to apply wage indices for a price adjustment to allow for normalized comparisons between hospitals.…”

Hospital‐Negotiated Pricing of Cochlear Implants

“…We compared payer-negotiated prices within each hospital (ie, between different payers contracting with the same hospital) by performing a 2-step calculation to determine the median "within-center ratio" for each manufacturer. [6][7][8][9] First, we calculated the within-center ratio for each included CI at each hospital that disclosed prices by dividing the 90th percentile (higher) adjusted price by the 10th percentile (lower) adjusted price. Second, we determined the mean ± standard error to summarize all within-center ratios for each manufacturer across all hospitals.…”

“…Using established methods, 6‐9 we assessed variations in payer‐negotiated prices across hospitals by calculating the “across‐center ratio.” For each manufacturer, we calculated the GPCI‐adjusted median price at each included hospital and then divided the 90th percentile (higher) adjusted median price by the 10th percentile (lower) adjusted median price. We used 90th and 10th percentile prices to minimize variation due to outliers.…”