Bongiovanni Tasce, Kim Simon P, Kim Anthony, Killelea Brigid, Gross Cary
Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California, USA
National Clinician Scholars Program, Yale University School of Medicine, New Haven, Connecticut, USA.
BMJ Open. 2020 Oct 5;10(10):e035438. doi: 10.1136/bmjopen-2019-035438.
Although demand for price transparency in healthcare is growing, variation in private payors' payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors' payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.
Fair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation's largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.
We performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.
To assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.
Median allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842-$1760, for lobectomy $326-$3066, for VATS $317-$3307 and for prostatectomy $1716-$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850-$1620; lobectomy $861-$2767; VATS $1024-$3122; and prostatectomy $2286-$3563.
There is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.
尽管医疗保健领域对价格透明度的需求不断增长，但私人支付方对外科医生肿瘤切除术的支付差异尚未得到充分描述。我们的目的是利用基于按服务收费允许金额的数据，评估私人支付方对外科医生癌症切除术的支付差异，这些数据由大量商业支付方和第三方管理机构提供。
公平健康（FH）是一个独立的非营利组织，收集和汇编来自全国支付方的索赔数据。FH维护着美国最大的私人计费医疗和牙科索赔数据库，覆盖超过1.25亿参保人员。
我们进行了一项横断面研究，评估了2012年和2013年五种常见癌症手术的私人支付方数据：单纯乳房切除术（SM）、改良根治性乳房切除术（MRM）、开放性肺叶切除术、电视辅助胸腔镜手术（VATS）肺叶切除术和根治性前列腺切除术。
为了评估各地区之间的差异，我们比较了各地区的允许支付中位数。为了评估地区内的变异性，我们评估了允许支付的地区四分位间距的分布。
各地区的允许支付中位数差异很大。对于SM，允许支付中位数从最便宜地区的550美元到最昂贵地区的1380美元不等。对于MRM，范围是842 - 1760美元，肺叶切除术是326 - 3066美元，VATS是317 - 3307美元，前列腺切除术是1716 - 4867美元。地理区域内也存在很大差异。例如，各地区外科医生支付的平均四分位间距为：SM为577美元（第25百分位数）至1132美元（第75百分位数）；MRM为850 - 1620美元；肺叶切除术为861 - 2767美元；VATS为1024 - 3122美元；前列腺切除术为2286 - 3563美元。
对于常见肿瘤切除术，外科医生支付的允许金额在地理区域之间和区域内都存在很大差异。这些允许金额的透明度可能会对患者和雇主的选择产生深远影响，并有助于未来对癌症护理价值的评估。
