Health Care Price Transparency in Ophthalmology
Health Care Price Transparency in Ophthalmology
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DOI：
10.1001/jamaophthalmol.2021.3951
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发表时间：
2021-10-07
影响因子：
8.1
通讯作者：
Patel, Shriji N.
中科院分区：
文献类型：
--
作者：
Berkowitz, Sean T.;Siktberg, Jonathan;Patel, Shriji N.
这项经济评估评估了医院为所需的眼科可购物服务提供标准收费的程度，并表征了这些标准收费的可变性。在新的价格透明立法之后，眼科手术标准报告价格的可用性、可用性和可变性是什么？发现这种价格透明度工具的经济评估发现，当前程序术语代码66984和66821的价格估计存在可用性、可用性和较大的医院间差异问题。这些问题不能用成本的地域差异来解释。这意味着尽管最近的联邦立法机构制定了价格透明度要求，但一些当前的标准收费仍然不明确，这可能会给脆弱和未参保的患者带来不成比例的负担。重要的医疗保健价格透明度立法旨在减少医院收费的模糊性和由此导致的患者面临的经济压力。目的评估学术医院眼科手术标准报告价格的可用性、可用性和可变性。设计、设置和参与这项多项经济评估研究的人员分析了美国医学院协会附属医院公开提供的价格透明度网页，以获得标准费用和可用性指标。价格透明度数据是从符合纳入标准的医院网页中收集的。工作、执业费用和医疗事故的地理执业成本指数来自医疗保险和医疗补助服务中心。数据来源为2021年2月1日至4月30日。采用多元回归方法研究不同地域对标准收费的影响，并评估标准收费之间的相关性。目前程序术语代码66984(白内障摘除人工晶状体植入)和66821(激光摘除晶状体囊内复发性白内障)标准价格的可得性和可变性。对于CPT代码66984,102家医院(53.4%)提供了折扣式现金薪酬估计，平均(SD)价格为7818.86美元(5407.91美元)。对于CPT代码66821，71家医院(37.2%)提供了折扣式现金薪酬估计，平均(SD)价格为2041.72美元(2106.44美元)。就价格而言，排名前四的医院包括CPT代码为66984的价格高于10400美元，以及CPT代码为66821的价格高于2324美元。36家医院(18.8%)注意到可用性问题，包括个人信息要求或网页导航障碍。多元回归分析发现，CPT代码66984(调整后的R-2=0.54；95%CI，0.41-0.67；P<；.001)和66821(调整后的R-2=0.64；95%CI，0.51-0.77；P<；.001)的现金折扣价格的地理实践成本指数的最小解释价值。结论和相关性尽管最近的立法机构制定了价格透明度要求，但一些当前的标准收费仍然不明确，医院间的巨大差异不能用成本的地理差异来解释。考虑到模糊的定价可能会给脆弱的、没有保险的患者带来负担，额外的立法可能会考虑允许医院推迟价格估计，或者严格定义可采取行动的现金折扣百分比的标准，并规定显示相关的基准价格。
This economic evaluation assesses the degree to which hospitals provide standard charges for the required ophthalmologic shoppable services and characterizes the variability in these standard charges.Question Following new price transparency legislation, what are the availability, usability, and variability of standard reported prices for ophthalmologic procedures?Findings This economic evaluation of price transparency tools found issues of usability, availability, and large interhospital variability for price estimates for Current Procedural Terminology codes 66984 and 66821. These issues were not explained by geographic variability in costs.Meaning Despite recent federal legislature that codified price transparency requirements, some current standard charges remain ambiguous, which may disproportionately burden vulnerable and uninsured patients.IMPORTANCE Health care price transparency legislation is intended to reduce the ambiguity of hospital charges and the resultant financial stress faced by patients.OBJECTIVE To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals.DESIGN, SETTING, AND PARTICIPANTS In this multicenter economic evaluation study, publicly available price transparency web pages from Association of American Medical Colleges affiliate hospitals were parsed for standard charges and usability metrics. Price transparency data were collected from hospital web pages that met the inclusion criteria. Geographic practice cost indices for work, practice expense, and malpractice were sourced from the Centers for Medicare & Medicaid Services. Data were sourced from February 1 to April 30, 2021. Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges.MAIN OUTCOMES AND MEASURES Availability and variability of standard prices for Current Procedural Terminology (CPT) codes 66984 (removal of cataract with insertion of lens) and 66821 (removal of recurring cataract in lens capsule using laser).RESULTS Of 247 hospitals included, 191 (77.3%) provided consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool. For CPT code 66984, 102 hospital (53.4%) provided discount cash pay estimates with a mean (SD) price of $7818.86 ($5407.91). For CPT code 66821, 71 hospital (37.2%) provided discount cash pay estimates with a mean (SD) price of $2041.72 ($2106.44). The top quartile of hospitals, prices wise, listed included prices higher than $10 400 for CPT code 66984 and $2324 for CPT code 66821. Usability issues were noted for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. Multiple regression analysis found minimal explanatory value for geographic practice cost indices for cash discount prices for CPT codes 66984 (adjusted R-2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R-2 = 0.64; 95% CI, 0.51-0.77; P < .001).CONCLUSIONS AND RELEVANCE Despite recent legislature that codified price transparency requirements, some current standard charges remain ambiguous, with substantial interhospital variability not explained by geographic variability in costs. Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices.