The Hospital Price Transparency Rule requires hospitals to publish payer-specific negotiated charges and cash prices. Given differences in insurance coverage for screening vs diagnostic mammography, Kristin Hsieh, Icahn School of Medicine at Mount Sinai, New York, NY, and colleagues evaluated factors associated with these payer-negotiated charges in a study presented at the 2022 ASCO Annual Meeting.

The authors conducted a cross-sectional study of US. acute care and critical access hospitals in CMS’ Care Compare linked to Turquoise Health (payer-negotiated charges), Healthcare Cost Report Information System (hospital characteristics) and Social Vulnerability Indices by county. Negotiated charges for mammography (CPT: screening 77067; diagnostic unilateral 77065, bilateral 77066) were estimated by payer type (self-pay, managed Medicare/Medicaid, or commercial). Adjusted models estimated commercial charges accounting for hospital factors.

Most hospitals included in the study (N=4212) were non-profits (61%) and acute care hospitals (69%). Median operating margin was .03 (IQR:-.03, .09), asset-to-liability ratio was 1.79 (1.06, 2.96), and social vulnerability index was .53 (.29, .74). Between 48% and 50% reported mammography charges. Charges were greater for commercial insurance when compared with Medicare/Medicaid (+$55-$82 screening, +$122-$132 bilateral diagnostic; P<.001, all tests). Charges for commercial insurance were similar to those of self-pay for bilateral screening (P=.41) and diagnostic (P=.08) mammography.

“Our analysis showed US negotiated mammography charges are similar for self-pay and commercial payers,” wrote Hsieh and colleagues. “Commercial charges are higher at private hospitals and those with higher operating margins for diagnostic exams, and lower in socially vulnerable areas," they concluded, adding, "Price transparency may promote competition to lower health care prices and highlight any financial toxicity associated with self-pay charges.”

Source:

Hsieh K, Huang H, Tarras ES, et al. Factors associated with U.S. hospital payer-specific negotiated mammography charges.. Abstract presented at: ASCO Annual Meeting; June 3-7, 2022; Chicago, IL, and virtual. Abstract e13633.