From the Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA.
J Am Acad Orthop Surg. 2023 Jul 1;31(13):677-686. doi: 10.5435/JAAOS-D-23-00053. Epub 2023 Apr 3.
To improve price transparency, the Centers for Medicare & Medicaid Services (CMS) requires hospitals to post accessible pricing data for common elective procedures along with all third-party-negotiated rates. We aimed to evaluate hospital compliance with CMS regulations for both price estimators and machine-readable files for spinal fusions and to evaluate factors contributing to variability in hospital-negotiated pricing.
We reviewed the top 100 orthopaedic hospitals ranked by US News & World Report to assess compliance with CMS price transparency regulations for all spine diagnosis-related groups. We recorded gross inpatient charge, cash price, and deidentified maximum and minimum rates for the 11 spine diagnosis-related groups (DRGs). Variability was compared with geographic practice costs (GPCI), expected Medicare reimbursements, and poverty rate and median income ratio.
Only 72% of hospitals were fully compliant in reporting spinal fusions on their price estimator, and 39% were fully compliant in reporting all mandatory rates for spinal fusions. The overall estimated cash price was $96,979 ± $56,262 and $62,595 ± $40,307 for noncervical and cervical fusion, respectively. Cash prices at top 50 hospitals were higher for both noncervical and cervical fusions ( P = 0.0461 and P = 0.0341, respectively). The average minimum negotiated rates ranged from 0.88 to 1.15 times the expected Medicare reimbursement, while maximum and cash prices were 3.41 to 3.90 and 2.53 to 4.08 times greater than Medicare reimbursement. GPCI demonstrated little to no correlation with DRG pricing. However, minimum negotiated rates and cash prices demonstrated weak positive correlations with the median income ratio and weak negative correlations with the poverty rate.
Most US hospitals are not fully compliant with CMS price transparency regulations for spinal fusions despite increased overall utilization of price estimators and machine-readable files. Although higher ranked hospitals charged more for spinal fusions, DRG prices remain widely variable with little to no correlation with practice cost or socioeconomic parameters.
为了提高价格透明度，医疗保险和医疗补助服务中心（CMS）要求医院公布常见选择性手术的可及定价数据以及所有第三方协商费率。我们旨在评估医院在脊柱融合术的价格估算器和机器可读文件方面对 CMS 法规的遵守情况，并评估导致医院协商定价差异的因素。
我们审查了《美国新闻与世界报道》排名前 100 的骨科医院，以评估所有脊柱诊断相关组（DRG）对 CMS 价格透明度法规的遵守情况。我们记录了 11 个脊柱 DRG 的总住院费用、现金价格以及去标识的最大和最小费率。将变异性与地理实践成本（GPCI）、预期医疗保险报销以及贫困率和中位数收入比进行比较。
只有 72%的医院在其价格估算器上完全报告了脊柱融合术，39%的医院完全报告了所有强制性的脊柱融合术费率。非颈椎和颈椎融合术的总体估计现金价格分别为 96979 美元±56262 美元和 62595 美元±40307 美元。前 50 名医院的非颈椎和颈椎融合术的现金价格都更高（P=0.0461 和 P=0.0341）。平均最低协商费率范围为预期医疗保险报销的 0.88 至 1.15 倍，而最高和现金价格分别为医疗保险报销的 3.41 至 3.90 倍和 2.53 至 4.08 倍。GPCI 与 DRG 定价几乎没有相关性。然而，最低协商费率和现金价格与中位数收入比呈弱正相关，与贫困率呈弱负相关。
尽管对价格估算器和机器可读文件的总体使用有所增加，但大多数美国医院并未完全遵守 CMS 脊柱融合术价格透明度法规。虽然排名较高的医院对脊柱融合术收费较高，但 DRG 价格仍然差异很大，与实践成本或社会经济参数几乎没有相关性。
