Does the US Centers for Medicare & Medicaid Services January 2019 price transparency rule allow patients to compare prices of radiation therapy at National Cancer Institute–designated cancer centers?
In this economic evaluation of publicly available chargemasters at 52 hospitals, a 21.7-fold difference in price was found between the least and most expensive hospital. Procedure descriptions were inconsistent, and the mean price was 10.1 times the price paid by Medicare.
There is wide variation in the price of radiation treatment, but the complexity of chargemaster information and the unclear association between price and patient cost make the value of the information for patients questionable.
A January 2019 price transparency mandate by the US Centers for Medicare & Medicaid Services (CMS) allows patients to look up the prices of cancer treatment services at hospitals across the United States.
To investigate the value of the CMS price transparency rule in allowing patients with prostate cancer to comparison shop by price for radiation treatment services among National Cancer Institute–designated cancer centers.
Design, Setting, and Participants
We identified the February 2019 publicly available price-containing chargemasters for National Cancer Institute–designated cancer centers. We isolated the charge per fraction of intensity-modulated radiation therapy used in standard prostate radiation treatment. We then calculated the mean (SD) charges of a 28-fraction course of prostate irradiation at all included hospitals. No human participants were included in this study.
Main Outcomes and Measures
We analyzed the degree of price variation, the association of the mean price to the price paid by Medicare, and the association of the prices with the practice expense geographic practice cost index, as determined by Medicare.
Of the 63 designated hospitals, 52 (84%) listed a price for simple intensity-modulated radiation therapy that is associated with standard prostate cancer radiation treatment. For a standard 28-fraction treatment, the charges ranged from $18 368 to $399 056, with a mean of $111 728.80 (10.1 times the price paid by Medicare). There was a weak positive association between price and geographic practice cost index, with an r2 value of 0.13 (P = .008).
Conclusions and Relevance
The availability of CMS-mandated hospital chargemasters and the descriptors used for simple intensity-modulated radiation therapy are not uniform, and the listed charges are highly variable. The association between listed charges and actual prices paid by patients or insurers is unclear, mitigating the value of the CMS rule for patients with prostate cancer who are receiving radiation therapy. This study suggests that implementation of the CMS price transparency policy may be insufficient to enable patients to estimate or compare prices for prostate cancer radiation treatment.
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Agarwal A, Dayal A, Kircher SM, Chen RC, Royce TJ. Analysis of Price Transparency via National Cancer Institute–Designated Cancer Centers’ Chargemasters for Prostate Cancer Radiation Therapy. JAMA Oncol. Published online January 16, 2020. doi:10.1001/jamaoncol.2019.5690
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