Variations in the Open Market Costs for Prostate Cancer Surgery: A Survey of US Hospitals

Pate, Scott C.; Uhlman, Matthew A.; Rosenthal, Jaime; Cram, Peter; Erickson, Beth

doi:10.1016/j.urology.2013.09.066

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…A number of recently published studies have provided insight into the difficulties that hospitals and physicians are having in understanding their own internal costs and prices. [9][10][11] CMS has begun to release large quantities of Medicare data to provider groups in hopes that greater access to data will enhance knowledge and understanding among the provider community. In turn, there is an assumption that improved understanding of utilization and cost data will assist providers in improving efficiency.…”

Section: Discussionmentioning

confidence: 99%

“…8 Currently, hospitals and physicians are largely unaware of the costs of specific tests or procedures. 9,10 This lack of awareness hints at fundamental flaws in how costs are allocated and prices set within health care. 11 At the same time, payors interested in bundled payments are challenged by a lack of concrete studies describing the methods and amounts of money that might be associated with specific diagnoses and conditions (eg, congestive heart failure, cardiac surgery, and joint replacement).…”

Section: Introductionmentioning

confidence: 99%

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Bundled Payments for Elective Primary Total Knee Arthroplasty

Cram

Lü

2014

Geriatr Orthop Surg Rehabil

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Bundled payments have been proposed as a mechanism for restraining health care spending for total knee arthroplasty (TKA), but empirical data are limited. We used Medicare data to examine variation in payments for TKA during a window extending 30 days before to 90 days after TKA for 167 186 patients who underwent elective primary TKA in 2009. Mean Medicare payment was US$23 656. We found that 2.5% of patients incurred payments of >US$50 000 (0.2% >US$100 000). Payments were lower for men and for non-Hispanic whites but higher for patients with greater comorbidity. Episode-of-care payment for primary TKA varies substantially depending upon patient demographics and comorbidity. To the extent that similar patients tend to be clustered within hospitals, bundled payments could inadvertently cause financial harm to certain health systems while rewarding others.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Bundled Payments for Elective Primary Total Knee Arthroplasty

Cram

Lü

2014

Geriatr Orthop Surg Rehabil

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“…Furthermore, busy physician practices often lack the resources necessary to evaluate costs across services, focusing instead on more readily available data such as revenue or reimbursement . Not surprisingly, Pate et al found a range of $10,100 to $135,000 for the cost of radical prostatectomy for an insured patient, with most charges arbitrarily determined and influenced by insurance reimbursement. As society moves toward accountable care organizations and bundled payments as mechanisms to mitigate our growing health care expenditures, however, health systems must become proficient at systematically bending their cost curves .…”

Section: Introductionmentioning

confidence: 99%

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

Laviana

Ilg

Veruttipong

et al. 2015

Cancer

132

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BACKGROUND: Given the costs of delivering care for men with prostate cancer remain poorly described, this article reports the results of time-driven activity-based costing (TDABC) for competing treatments of low-risk prostate cancer. METHODS: Process maps were developed for each phase of care from the initial urologic visit through 12 years of follow-up for robotic-assisted laparoscopic prostatectomy (RALP), cryotherapy, high-dose rate (HDR) and low-dose rate (LDR) brachytherapy, intensity-modulated radiation therapy (IMRT), stereotactic body radiation therapy (SBRT), and active surveillance (AS). The last modality incorporated both traditional transrectal ultrasound (TRUS) biopsy and multiparametric-MRI/TRUS fusion biopsy. The costs of materials, equipment, personnel, and space were calculated per unit of time and based on the relative proportion of capacity used. TDABC for each treatment was defined as the sum of its resources. RESULTS: Substantial cost variation was observed at 5 years, with costs ranging from $7,298 for AS to $23,565 for IMRT, and they remained consistent through 12 years of follow-up. LDR brachytherapy ($8,978) was notably cheaper than HDR brachytherapy ($11,448), and SBRT ($11,665) was notably cheaper than IMRT, with the cost savings attributable to shorter procedure times and fewer visits required for treatment. Both equipment costs and an inpatient stay ($2,306) contributed to the high cost of RALP ($16,946). Cryotherapy ($11,215) was more costly than LDR brachytherapy, largely because of increased singleuse equipment costs ($6,292 vs $1,921). AS reached cost equivalence with LDR brachytherapy after 7 years of follow-up. CONCLU-SIONS: The use of TDABC is feasible for analyzing cancer services and provides insights into cost-reduction tactics in an era focused on emphasizing value. By detailing all steps from diagnosis and treatment through 12 years of follow-up for low-risk prostate cancer, this study has demonstrated significant cost variation between competing treatments. Cancer 2016;122:447-55. V C 2015 American Cancer Society.

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“…3 Wide price variation and limited transparency for hospital services have been well-documented. [4][5][6] By comparison, less attention has been focused on price transparency in outpatient settings, including primary care. A recent survey finds that most patients are interested in obtaining price information before receiving medical services, and over one-third who received primary care sought information before the visit.…”

Section: Introductionmentioning

confidence: 99%

Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

et al. 2017

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BACKGROUND: Cost-sharing in health insurance plans creates incentives for patients to shop for lower prices, but it is unknown what price information patients can obtain when scheduling office visits. OBJECTIVE: To determine whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices, and geographic areas. DESIGN: Simulated patient methodology in which trained interviewers posed as non-elderly adults seeking new patient primary care appointments. Caller insurance type (employer-sponsored insurance [ESI], Marketplace, or uninsured) and plan were experimentally manipulated. Callers who were offered a visit asked for price information. Unadjusted means and regression-adjusted differences by insurance, office types, and geography were calculated. PARTICIPANTS: Calls to a representative sample of primary care offices in ten states in 2014: Arkansas, Georgia, Iowa, Illinois, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas (N = 7865). MAIN MEASURES: Callers recorded whether they were able to obtain a price. If not, they recorded whether they were referred to other sources for price information. KEY RESULTS: Overall, 61.8% of callers with ESI were able to obtain a price, versus 89.2% of uninsured and 47.3% of Marketplace callers (P < 0.001 for differences). Price information was also more readily available in small offices and in counties with high uninsured rates. Among callers not receiving a price, 72.1% of callers with ESI were referred to other sources (billing office or insurance company), versus 25.8% of uninsured and 50.9% of Marketplace callers (P < 0.001). A small fraction of insured callers were told their visit would be free. If not free, mean visit prices ranged from $157 for uninsured to $165 for ESI (P < 0.05). Prices were significantly lower at federally qualified health centers (FQHCs), smaller offices, and in counties with high uninsured and low-income rates.CONCLUSIONS: Price information is often unavailable for privately insured patients seeking primary care visits at the time a visit is scheduled.

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Variations in the Open Market Costs for Prostate Cancer Surgery: A Survey of US Hospitals

Cited by 17 publications

References 18 publications

Bundled Payments for Elective Primary Total Knee Arthroplasty

Bundled Payments for Elective Primary Total Knee Arthroplasty

Utilizing time‐driven activity‐based costing to understand the short‐ and long‐term costs of treating localized, low‐risk prostate cancer

Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

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