Most Major Hospitals Fail to Comply with Federal Price Transparency Regulations

Jacob L Kotlier; Amir Fathi; Joshua M Yazditabar; Meng-Yung Ong; Joshua Valenzuela; Albert Yang; Aamir Ahmad; Ryan D Freshman; Joseph N Liu; Frank A Petrigliano

doi:10.1016/j.arthro.2024.04.033

Most Major Hospitals Fail to Comply with Federal Price Transparency Regulations

Arthroscopy. 2024 May 10:S0749-8063(24)00339-6. doi: 10.1016/j.arthro.2024.04.033. Online ahead of print.

Affiliations

¹ Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA. Electronic address: Kotlierja@gmail.com.
² Keck School of Medicine of USC, Department of Orthopaedic Surgery, Los Angeles, CA.

PMID: 38735409
DOI: 10.1016/j.arthro.2024.04.033

Abstract

Purpose: This study aims to present hospital compliance with federal price transparency regulations for sports medicine procedures.

Methods: Online price estimator and machine-readable files were recovered for U.S. News and World Report's (USNWR) top 100 orthopedic hospitals. From June to November 2023, compliance and monetary values were recorded for each of Centers for Medicare and Medicaid Services (CMS) price transparency regulations. Price estimator data was assessed based on hospital placement in the bottom and top 50 of the 100 institutions under review, as well as by region (Northeast, South, Midwest, West). Statistical analyses included two-sample t-tests and Kruskal Wallis tests.

Results: 95% of hospitals had a price estimator tool for both subacromial decompression (Current Procedural Terminology (CPT): 29826) and meniscectomy (CPT: 29881). Only 38% were compliant with all regulations for subacromial decompression and 39% for meniscectomy; the remaining did not list minimum or maximum procedure charges. Higher ranked hospitals were significantly more likely to charge a higher cash price for subacromial decompression and meniscectomy (p = 0.040 and p = 0.009 respectively). Compliance with machine-readable file reporting was poor with less than 20% meeting requirements for each CPT code. Reported prices varied greatly by hospital.

Conclusions: This study demonstrates that USNWR top 100 orthopedic hospitals exhibit poor overall compliance with federal price transparency regulations for sports medicine procedures. Most often they lack full compliance by not reporting minimum or maximum charges as part of their price estimator tool or do not report procedure prices in their machine-readable files. Hospitals also exhibit wide variation in prices reported for specific procedures.

Clinical relevance: Consumer price transparency continues to be an important goal in healthcare as it allows patients to make informed decisions when selecting appropriate treatment options and providers. To realize the full benefits of price transparency hospitals should address areas of improvement.