Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Boston, Massachusetts, USA.
Otolaryngol Head Neck Surg. 2023 Nov;169(5):1154-1162. doi: 10.1002/ohn.407. Epub 2023 Jun 19.
Little is known about pricing for reconstructive procedures of the head and neck. As of January 2021, the Centers for Medicare and Medicaid Services requires hospitals to disclose payer-negotiated prices for services, offering new insight into prices for privately insured patients.
Cross-sectional analysis.
Turquoise database.
Payer-negotiated facility fees for 41 reconstructive surgeries were grouped by procedure type: primary closure, skin grafts, tissue rearrangement, locoregional flaps, or free flaps. Prices were normalized to account for local labor costs, then calculated as percent markup in excess of Medicare reimbursement. The mean percent markup between procedure groups was compared by the Kruskal-Wallis test. Subset analyses were performed to compare mean percent markup using a Student's t test. We also assessed price variation by calculating the ratio of 90th/10th percentile mean prices both across and within hospitals.
In total, 1324 hospitals (85% urban, 81% nonprofit, 49% teaching) were included. Median payer-negotiated fees showed an increasing trend with more complex procedures, ranging from $379.54 (interquartile range [IQR], $230.87-$656.96) for Current Procedural Terminology (CPT) code 12001 ("simple repair of superficial wounds ≤2.5 cm") to $5422.60 ($3983.55-$8169.41) for CPT code 20969 ("free osteocutaneous flap with microvascular anastomosis"). Median percent markup was highest for primary closure procedures (576.17% [IQR, 326.28%-1089.34%]) and lowest for free flaps (99.56% [37.86%-194.02%]). Higher mean percent markups were observed for rural, for-profit, non-Northeast, nonteaching, and smaller hospitals.
Wide variation in private payer-negotiated facility fees exists for head/neck reconstruction surgeries. Further research is necessary to better understand how pricing variation may correlate with out-of-pocket costs and quality of care.
关于头颈部重建手术的定价知之甚少。截至 2021 年 1 月，医疗保险和医疗补助服务中心要求医院披露服务的医保协商价格，这为私人保险患者的价格提供了新的见解。
横断面分析。
绿松石数据库。
根据手术类型将 41 种重建手术的医保协商机构费用分为：一期缝合、皮片移植、组织重排、区域性皮瓣或游离皮瓣。价格经当地劳动力成本调整后，以超出医疗保险报销的加价百分比计算。采用 Kruskal-Wallis 检验比较各手术组间的平均加价百分比。采用 Student t 检验进行亚组分析，以比较平均加价百分比。我们还通过计算 90 百分位/10 百分位平均价格的比值来评估价格的变异性，该比值既可以跨医院计算，也可以在医院内计算。
共纳入 1324 家医院（85%为城市医院，81%为非营利性医院，49%为教学医院）。医保协商费用中位数随手术复杂程度的增加而呈上升趋势，从 12001 号（CPT 代码，“<2.5cm 的浅表伤口的简单修复”）的 379.54 美元（四分位距[IQR]，230.87 美元至 656.96 美元）到 20969 号（CPT 代码，“带吻合术的游离骨皮瓣”）的 5422.60 美元（IQR，3983.55 美元至 8169.41 美元）。一期缝合术的中位加价率最高（576.17%[IQR，326.28%至 1089.34%]），游离皮瓣最低（99.56%[37.86%至 194.02%]）。农村、营利性、非东北地区、非教学医院和规模较小的医院的平均加价率较高。
头颈部重建手术的私人医保协商机构费用差异很大。需要进一步研究，以更好地了解定价差异如何与自付费用和护理质量相关。
