Kovid Bhayana, MD1, Farshad Aduli, MD2 1Howard Hospital, Washington, DC; 2Howard University Hospital, Washington, DC
Introduction: To improve price transparency, the Centers for Medicare and Medicaid Services (CMS) issued the Hospital Outpatient Prospective Payment System (OPPS) rule that mandates that hospitals to display online chargemasters or access to a machine-readable file of items and services that include pricing for common medical procedures. The pricing should be stratified by hospital standard (gross) charge, discounted cash price (for an individual who pays cash), and the minimum and maximum charge that a hospital has negotiated with a third-party payer. The standard charge is amount billed for each item or service absent any discounts. We examined the compliance of 30 top gastroenterology hospitals with CMS’s mandate and compared pricing of common endoscopic gastroenterology procedures.
Methods: Each of the top 30 gastroenterology center’s (US News) website was visited and chargemaster downloaded. Each hospital’s chargemaster was examined for the pricing of the following Current Procedural Terminology (CPT®) codes. The codes of interest were for esophagogastroduodenoscopy (EGD): 43235, EGD with biopsy: 43239, colonoscopy: 45378, and colonoscopy with biopsy: 45380. The standard or gross charges were obtained and compared.
Results: 14 of 30 hospitals reported some CPT pricing. Of these hospitals, ten had prices for all four CPT codes of interest. The most expensive hospital was the University of Pennsylvania and had an average cost of $49,686. This was the most expensive hospital and was followed by New York Presbyterian Cornell at $13,440. The cheapest hospital with all four CPT codes of interest was University of California San Francisco and had an average cost of $2,562.
Discussion: In summary, compliance with CMS mandate was poor overall. 16 of 30 hospitals did not report any relevant CPT pricing, and only 10 of the hospitals were fully compliant with the mandate. In addition to poor compliance, the reported procedure pricing displayed high variation.
Since the surveyed hospitals demonstrated poor compliance and high-cost variability, CMS’s stated goal of increased consumer control is falling short. A consensus exists that increased hospital price transparency will yield positive outcomes for patients and especially in gastroenterology. Colonoscopies and other endoscopic procedures are outpatient high-volume, high-cost procedures where many patients stand to benefit from increased price transparency.
Disclosures:
Kovid Bhayana indicated no relevant financial relationships.
Farshad Aduli indicated no relevant financial relationships.
Kovid Bhayana, MD1, Farshad Aduli, MD2. P4091 - Compliance and Variability of Common Endoscopic Procedures at Top Gastroenterology Hospitals in the US, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.
