Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs

Alexandra Giantini-Larsen; Abhinav Pandey; Zaki Abou-Mrad; Nalini Tata; Ori Barzilai; Mark Bilsky; W Christopher Newman

doi:10.1227/neu.0000000000002858

Compliance With Federal Price Transparency Rules and Cost Estimation at United States Hospitals With Neurosurgical Training Programs

Neurosurgery. 2024 Feb 12. doi: 10.1227/neu.0000000000002858. Online ahead of print.

Authors

Alexandra Giantini-Larsen^{1

2}, Abhinav Pandey², Zaki Abou-Mrad¹, Nalini Tata^{1

2}, Ori Barzilai¹, Mark Bilsky¹, W Christopher Newman¹

Affiliations

¹ Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA.
² Department of Neurosurgery, Weill Cornell Medical Center, New York, New York, USA.

PMID: 38345364
DOI: 10.1227/neu.0000000000002858

Abstract

Background and objectives: The Centers for Medicare & Medicaid Services implemented federal requirements on January 1, 2021, under the Public Health Service Act that require hospitals to provide a list of payer-negotiated prices or "standard charges" in a machine-readable file and in a patient-friendly online estimator for standard services. We sought to assess compliance by United States hospitals associated with neurosurgical training programs with these federal requirements for 11 common neurosurgical procedures.

Methods: We performed a cross-sectional analysis in March 2023 of 116 United States hospitals associated with a neurosurgical training program to assess compliance with the new federal requirements to have a machine-readable, downloadable file with standard charges and a patient-friendly online estimator for two spinal procedures.

Results: A total of 110/114 (96.5%) hospitals were compliant with the requirement for a machine-readable file with payer-negotiated prices. A total of 47/110 hospitals (42.7%) were compliant with downloadable machine-readable files and reported at least one payer-negotiated price for 1 of the 11 common neurosurgical procedures. A total of 45/110 (40.9%) used bundled Diagnosis-Related Group codes, and 18/110 (16.4%) did not contain any price information for neurosurgical procedures. For neurosurgical procedures, the percent difference between the average negotiated private insurance and Medicare price per procedure ranged from 17.5% to 77.6%. Medicare and private insurance data for each procedure were available on average for 10.3 states (SD = 3.8) and 15.6 states (SD = 4.8), respectively.

Conclusion: While hospital compliance with federal requirements for machine-readable files with payer-negotiated prices was high, availability of payer-negotiated prices for 4 major insurance types across 11 common neurosurgical procedures based on Current Procedural Terminology codes was sparce. Consequently, meaningful conclusions on procedure-related charges for elective procedures are difficult for patients to make because of the unintelligible format of data and a lack of reporting of charges per Current Procedural Terminology code in a comprehensive manner.