Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Department of Orthopedic Surgery, Warren Alpert Medical School of Brown University, 1 Kettle Point Ave, East Providence, RI, 02914, USA.
Spine J. 2024 Feb;24(2):304-309. doi: 10.1016/j.spinee.2023.10.008. Epub 2023 Oct 29.
As of 2021, the Centers for Medicare and Medicaid Services (CMS) requires all hospitals to publish their commercially negotiated prices. To our knowledge, price variation of spine oncology diagnosis and treatments has not been previously investigated.
The aim of this study is to characterize the availability and variation of prices for spinal oncology services among National Cancer Institute-Designated Cancer Centers (NCI-DCC).
Cross-sectional analysis.
Cancer centers were identified; those that did not provide patient care or participate in Medicare's Inpatient Prospective System were excluded. A cross-sectional analysis was conducted to gather commercially negotiated prices by searching online for "[center name] price transparency OR machine-readable file OR chargemaster." Data obtained was queried using 44 current procedural terminology (CPT) codes for imaging, procedures, and surgeries relevant to spine oncology. Comparison of prices was achieved by normalizing the median price for each service at each center to the estimated 2022 Medicare reimbursement for the center's Medicare Administrator Contractor. The ratios between the lowest and highest median commercial negotiated price within a center and across all centers were defined as "within-center ratio" and "across-center ratio" respectively.
In total, 49 centers disclosed commercial payer-negotiated rates. Mean rate (±SD) for cervical corpectomy was $9,134 (±$10,034), thoracic laminectomy for neoplasm excision was $5,382 (±$5502), superficial bone biopsy was $1,853 (±$1,717), and single-photon emission computerized tomography (SPECT) was $813 (±$232). Within-center ratios ranged from 5.0 (SPECT scan) to 17.8 (radiofrequency bone ablation). Across-center ratios (for codes with > 10 centers reporting) ranged from 9.0 (corpectomy, thoracic, lateral extra-cavitary) to 418.7 (anterior approach cervical corpectomy).
Price transparency for spinal oncology remains elusive despite recent CMS regulatory oversight, with marked heterogeneity in the quality of published rates complicating patients' ability to "shop" for care. Additionally, there continues to be significant variation in commercial rates for spine oncology diagnosis and treatment.
Despite regulation by CMS, prices for spinal oncology services are not uniformly available to patients and vary between NCI-DCC. The findings of this manuscript present potential barriers for patients to compare and obtain affordable care.
截至 2021 年，医疗保险和医疗补助服务中心（CMS）要求所有医院公布其商业协商价格。据我们所知，脊柱肿瘤诊断和治疗的价格变化尚未得到研究。
本研究旨在描述国立癌症研究所指定癌症中心（NCI-DCC）中脊柱肿瘤服务的价格可获得性和变化。
横断面分析。
确定癌症中心；那些不提供患者护理或参与医疗保险住院患者前瞻性系统的中心被排除在外。通过在线搜索“[中心名称]价格透明度或机器可读文件或收费主文件”，对商业协商价格进行了横断面分析。使用与脊柱肿瘤相关的 44 个当前程序术语 (CPT) 代码获取数据。通过将每个中心每个服务的中位数价格归一化为中心的 2022 年医疗保险报销额，来比较价格。每个中心内最低和最高中位数商业协商价格之间的比率定义为“中心内比率”，所有中心之间的比率定义为“中心间比率”。
共有 49 个中心公布了商业支付方协商的费率。颈椎椎体切除术的平均费率（±SD）为$9134（±$10034），胸段椎板切除术用于肿瘤切除为$5382（±$5502），浅层骨活检为$1853（±$1717），单光子发射计算机断层扫描（SPECT）为$813（±$232）。中心内比率范围从 5.0（SPECT 扫描）到 17.8（射频骨消融）。中心间比率（对于有>10 个中心报告的代码）范围从 9.0（颈椎外侧腔外椎体切除术）到 418.7（颈椎前路椎体切除术）。
尽管 CMS 最近进行了监管监督，但脊柱肿瘤的价格透明度仍然难以实现，公布的价格质量存在明显差异，这使得患者“购物”的能力变得复杂。此外，脊柱肿瘤诊断和治疗的商业费率仍然存在显著差异。
尽管 CMS 进行了监管，但脊柱肿瘤服务的价格并未向患者普遍提供，并且在 NCI-DCC 之间存在差异。本文的研究结果为患者比较和获得负担得起的护理带来了潜在障碍。
