Price Transparency in Skull Base Surgery: The Price to Operate

Background: The escalating healthcare costs in the United States have raised concerns among healthcare systems, medical professionals, and individual patients. To address the burden of medical expenditure, the Centers for Medicare and Medicaid Services (CMS) implemented a cost transparency initiative on January 1, 2021. This mandate requires all U.S. hospitals to provide accessible pricing information online, including a comprehensive machine-readable file and a user-friendly display of shoppable services. However, recent research reveals that many hospitals have not fully complied with this policy. Some lack functional cost estimators on their websites, and others do not provide pricing information for all services, creating inconsistency and hindering transparent pricing access for consumers. To address this issue, this research focuses on the compliance of hospitals with the CMS price transparency mandate, particularly in the context of common skull base procedures.

Methods: A list of the top 70 neurosurgery and otolaryngology hospitals in the United States according to the U.S. News and World Report rankings was collected and cross referenced. Hospital characteristics were determined through Google searches and the National Readmissions Database (NRD), aiming to limit bias from search history. To evaluate compliance with the CMS price transparency mandate, researchers conducted Google searches for each hospital's cost estimator tool, recording its presence and accessibility time. Using the cost estimator tool, they searched for specific skull base procedure prices, CPT codes, and contact information for personalized estimates. Additionally, searches determined whether the hospital performs skull base surgeries or offers stereotactic radiosurgery, utilizing the Acoustic Neuroma Association website and Google ([Figs. 1] and [2]).

Results: Of the top 70 hospitals for neurosurgery and otolaryngology in the United States, 57 (81%) were privately funded hospitals. The majority were identified as urban teaching hospitals (n = 68; 97%). In terms of geographical location, 19 (27%) were in the Northeast, 21 (30%) were in the Midwest, 20 (29%) were located in the South, and 10 (14%) were located in the West. Many hospitals were classified as having a large bed size (n = 47; 67%). Of the 70 hospitals, 4 (5.7%) did not have a cost estimation Website. Of the 66 hospitals with a cost estimation website, the average time to locate the cost of the skull-based procedures was 17.8 minutes, with the fastest search time of 12 minutes and the maximum search time of 28 minutes. Only two (2.9%) hospitals had information readily available for skull base procedures. A total of 19 hospitals (27%) did not include contact information for personalized cost estimation. Six of the hospitals (8.6%) did not perform skull-based procedures. The most common type of stereotactic radiosurgery offered was gamma knife radiosurgery (n = 50; 71%).

Conclusion: The CMS price transparency guidelines are not designed to encompass skull base procedures. This prevents patients from having a clear understanding of their treatment cost. Due to this ambiguity patients are unable to make informed financial decisions with their physician when it comes to selecting treatment options.

Fig. 1

Fig. 2

Publikationsverlauf

Artikel online veröffentlicht:
05. Februar 2024