An Analysis of Community-Level Socioeconomic Status Effects on Pricing Transparency and Variability of Hand Surgery Procedures.

Abstract

The hospital price transparency final rule requires hospitals to publish pricing information about provided items and services by means of 2 methods: (1) a comprehensive machine-readable file and (2) a display tool of selected shoppable services. Using machine-readable files on hospital websites, the authors examined trends in pricing transparency and variation in association with community-level socioeconomic factors for 3 common hand surgery procedures among Association of American Medical Colleges-affiliated hospitals. Available discount cash prices and payer-specific negotiated prices for CPT codes 64721, 26615, and 25111 were recorded. Multivariate analysis was used to stratify hospitals into 2 groups based on their area's median household income, percentage uninsured, and geographic practice cost index practice expense scores. Generalized linear mixed effects modeling was used to evaluate price variability against community-level financial characteristics of the patient population. Of hospitals that met selection criteria, a majority did not display discount cash prices and payer-specific negotiated prices for the 3 procedures. Hospitals in lower-income areas and areas with a higher percentage of the uninsured tended to charge a higher average payer-specific negotiated price for CPT code 25111. They also tended to have greater variation in payer-specific negotiated prices than hospitals found in higher-income and lower-percentage-uninsured areas. This study demonstrates that considerable pricing variation and incomplete transparency exists for CPT codes 64721, 26615, and 25111 among Association of American Medical Colleges-affiliated hospitals. Patients in lower-income and higher-percentage-uninsured areas are more exposed to a higher variability and average of negotiated prices than those in higher-income areas, which may translate to higher out-of-pocket costs for those with higher coinsurance and less socioeconomic prowess.