Do You Get What You Pay For? The Relationship of Price and Quality in Hospital Provided Procedures

Abstract

Introduction: Starting in 2021, Centers for Medicare and Medicaid Services required hospitals to provide pricing information to allow consumers to compare prices. Patients perceived that the quality of these services also impacts decision-making. This study examines the relationship between procedure price and quality from the patients' perspective.

Materials and methods: Unnegotiated prices of procedures were extracted from hospital websites. Hospital quality was defined as the U.S. News & World Report's score for the specialty performing the procedure. Regional differences in markets were corrected with the Wage Price Index. Spearman's correlations were used for analysis between price and quality.

Results: Overall, 67% (1225/1815) of hospitals had a pricing document. Compliance by procedure was poor with a low of 7% for Current Procedural Terminology (CPT) 93000 and a high of 27% for CPTs 93452 and 62323. Wide variability of prices for all procedures was noted. The smallest difference in price range listed was for CPT 45380 with a 32× difference between the minimum and maximum ($310-$10,023) with the first, second, and third quartiles being $1457, $2759, and $4276, respectively. The largest difference in price range was for CPT 55700 with a 5036× difference between the minimum and maximum ($9-$45,322) with the first, second, and third quartiles being $1638, $2971, and $5342, respectively. Correlation between price and quality was low, with the strongest being rho = 0.369 (P = 0.02) for CPT 93000.

Conclusions: Compliance with price transparency was low with large variability in prices for the same procedure. There was no correlation between hospital price and quality. As currently implemented, poor compliance and wide price variability may limit patients' understanding of procedure costs.

Keywords: Compliance; Price transparency; Quality; Shoppable procedures; US news and world report.