Ankit Agarwal1, Anupriya Dayal2, Sheetal M Kircher3, Ronald C Chen1, Trevor J Royce1. 1. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill. 2. Department of Radiation Oncology, Fox Chase Cancer Center, Temple Health, Philadelphia, Pennsylvania. 3. Division of Hematology-Oncology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
Abstract
Importance: 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. Objective: 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. Results: 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.
Importance: 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. Objective: 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 humanparticipants 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. Results: 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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