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Health Care Price Transparency in Ophthalmology

Educational Objective
To evaluate the availability, usability, and variability of standard reported prices for ophthalmologic procedures at academic hospitals.
1 Credit CME
Key Points

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.

Abstract

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 R2 = 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R2 = 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.

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: August 15, 2021.

Published Online: October 7, 2021. doi:10.1001/jamaophthalmol.2021.3951

Corresponding Author: Shriji N. Patel, MD, MBA, Department of Ophthalmology, Vanderbilt University Medical Center, 2311 Pierce Ave, Nashville, TN 37232 (shriji.patel@vumc.org).

Author Contributions: Dr Patel had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: Berkowitz, Siktberg, Hamdan, Triana.

Drafting of the manuscript: All authors.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Berkowitz, Patel.

Obtained funding: Berkowitz.

Administrative, technical, or material support: Hamdan, Triana, Patel.

Supervision: Triana, Patel.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported in part by an unrestricted departmental award from Research to Prevent Blindness Inc and Vanderbilt Institute for Clinical and Translational Research Grant Voucher VR54208 (Dr Patel).

Role of the Funder/Sponsor: The sponsors or funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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