Despite the implementation of a price transparency mandate by CMS, published results showed most hospitals either did not provide total joint arthroplasty price estimates or were noncompliant when presenting related information.
Using the CMS Hospital Compare database, Atul F. Kamath, MD, and colleagues searched the websites of a random sample of 400 facilities stratified across practice setting, hospital size, TJA volume, type, ownership and Census region for a machine-readable file providing gross charges, payer-specific negotiated charges, de-identified minimum negotiated charges, de-identified maximum negotiated charges and discounted cash prices. Researchers considered hospitals compliant to CMS price transparency legislation if all five datapoints were provided through a machine-readable file, while hospitals with any gross price information were considered pseudocompliant.
Researchers also assessed consumer friendliness of the website based on whether languages other than English were offered, it took less than 15 minutes to locate pricing information, a phone number or email address was provided for questions, and there was a description of the procedure in common terms. Researchers recorded and compared pricing information for CPT codes 27447 and 27130, and diagnosis-related group codes 469 and 470.
Atul F. Kamath
Results showed 32% of the sampled hospital websites were compliant with all six requirements under the CMS rule for transparency in pricing. Researchers found 21% and 18% of hospitals provided CMS-compliant pricing information for CPT codes 27447 and 27130, respectively, while 18% and 19% of hospitals provided CMS-compliant pricing information for DRG codes 469 and 470. Researchers also noted 36%, 31%, 34% and 50% of hospital websites met pseudocompliance for CMS-compliant pricing information for CPT codes 27447 and 27130 and DRG codes 469 and 470, respectively. At least some pricing data were provided by most included hospitals in a user-friendly format, according to results. Researchers found higher overall prices quoted with a DRG search vs. a procedure-specific CPT code.
“Future analyses are needed to evaluate whether the estimated TJA prices provided by hospitals aligns with the actual charges provided to insurers and patients,” Kamath and colleagues wrote. “Additionally, as penalties begin in July 2022, additional studies will be needed to understand whether they will affect national rates of compliance.”
Burkhart RJ, et al. Clin Orthop Relat Res. 2022;doi:10.1097/CORR.0000000000002288.
Most US hospitals not sharing price information for joint replacement as required. Published June 24, 2022. Accessed July 13, 2022