The Commercial Differential for Hospital Prices

Koller, Christopher F.; Khullar, Dhruv

doi:10.1001/jama.2019.9275

Cited by 23 publications

(32 citation statements)

References 6 publications

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“…Patients may use this additional information in 2021 to more accurately price-shop, insurers may use this information to bargain for better reimbursement rates, and other facilities may use this information to alter their pricing strategies and compete more effectively in the more transparent health care market. Therefore, this information is closely guarded by health plans [26]. Thus, hospitals, insurers, lobbying groups, and other stakeholders oppose this regulation because the negotiated prices have immeasurable proprietary strategic value, and disclosure thereof will have far-reaching implications on both price and quality competition.…”

Section: Xsl • Fomentioning

confidence: 99%

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Patel¹,

Mazurenko²,

Ford³

2021

JMIR Form Res

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Background The federal health care price transparency regulation from 2019 is aimed at bending the health care cost curve by increasing the availability of hospital pricing information for the public. Objective This study aims to examine the associations between publicly reported diagnosis-related group chargemaster prices on the internet and quality measures, process indicators, and patient-reported experience measures. Methods In this cross-sectional study, we collected and analyzed a random 5.02% (212/4221) stratified sample of US hospital prices in 2019 using descriptive statistics and multivariate analysis. Results We found extreme price variation in shoppable services and significantly greater price variation for medical versus surgical services (P=.006). In addition, we found that quality indicators were positively associated with standard charges, such as mortality (β=.929; P<.001) and readmissions (β=.514; P<.001). Other quality indicators, such as the effectiveness of care (β=−.919; P<.001), efficient use of medical imaging (β=−.458; P=.001), and patient recommendation scores (β=−.414; P<.001), were negatively associated with standard charges. Conclusions We found that hospital chargemasters display wide variations in prices for medical services and procedures and match variations in quality measures. Further work is required to investigate 100% of US hospital prices posted publicly on the internet and their relationship with quality measures.

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Section: Xsl • Fomentioning

confidence: 99%

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Patel¹,

Mazurenko²,

Ford³

2021

JMIR Form Res

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“…This is particularly true for patients with private insurance, for whom health care prices are negotiated between insurers and clinicians and price transparency is lacking. 11 …”

Section: Introductionmentioning

confidence: 99%

“…This is particularly true for patients with private insurance, for whom health care prices are negotiated between insurers and clinicians and price transparency is lacking. 11 Therefore, we examined the association between hospital type (NCI center vs community hospital) and insurer spending and care utilization during a surgical episode for patients with private insurance who underwent common cancer surgery. We hypothesized that treatment at NCI centers, compared with community hospitals, would be associated with higher surgery-specific prices paid and episode spending and decreased acute care utilization.…”

Section: Introductionmentioning

confidence: 99%

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

et al. 2021

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Key Points Question Are there differences in insurer spending and care utilization for patients with private insurance undergoing cancer surgery at National Cancer Institute (NCI) centers vs community hospitals? Findings In this cross-sectional study of 66 878 patients with breast, colon, or lung cancer, surgery at NCI centers, compared with community hospitals, was associated with higher insurer prices paid and higher 90-day postdischarge payments, without differences in length of stay, emergency department use, or hospital readmission. Meaning In this study of patients with private insurance undergoing cancer surgery, insurer spending for a surgical episode was higher at NCI centers than community hospitals, without differences in care utilization.

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“…These prices are typically proprietary, confidential, and greater than Medicare prices. 1 Recent analysis suggests that average commercial prices can be more than twice Medicare prices. 2 Provider organizations anchor negotiations on ''charge'' amounts, which are unilaterally set and often arbitrarily inflated.…”

mentioning

confidence: 99%

Markup on Services Provided to Medicare Beneficiaries by Otolaryngologists in 2017: Implications for Surprise Billing

Rha

Rathi

Naunheim

et al. 2021

Otolaryngol.--head neck surg.

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The degree of markup between provider charges and Medicare prices reflects the potential balance bill for out-of-network commercially insured patients. Using publicly available Medicare data, we performed a retrospective cross-sectional analysis of markup ratios (MRs; ie, the ratio of submitted charges to Medicare-allowed prices) for services commonly performed by otolaryngologists in 2017. Median MRs were as follows: 2.9 (interquartile range, 2.0-4.3) in facility settings (eg, hospital) and 2.1 (interquartile range, 1.7-2.9) in nonfacility settings (eg, physician office). Among the 10 highest-markup procedures performed by otolaryngologists in facility and nonfacility settings, there was no consistent increase in median MRs between 2012 and 2017 (compound annual growth rates, –4.6% for labyrinthotomy to 24.6% for ultrasound-guided biopsy). Median MRs for these procedures were not consistently lower in states with surprise billing protection laws. These findings may reflect the comparatively low potential to “balance bill” patients for elective otolaryngologic services and the limitations of state-level protections against surprise billing.

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The Commercial Differential for Hospital Prices

Cited by 23 publications

References 6 publications

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Analysis of Hospital Quality Measures and Web-Based Chargemasters, 2019: Cross-sectional Study

Differences in Cancer Care Expenditures and Utilization for Surgery by Hospital Type Among Patients With Private Insurance

Markup on Services Provided to Medicare Beneficiaries by Otolaryngologists in 2017: Implications for Surprise Billing

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