Assessment of price variation in colorectal cancer screening procedures at US hospitals.

Authors

null

Ishan Paranjpe

Stanford, Stanford, CA

Ishan Paranjpe , Pranav Sharma , Chen Wei , Vikram Puram , Samir Kamat , Ali Raza Khaki

Organizations

Stanford, Stanford, CA, Drexel University College of Medicine, Philadelphia, PA, Stanford Health Care, Palo Alto, CA, Icahn School of Medicine at Mount Sinai, New York, NJ, Stanford University, Stanford, CA

Research Funding

No funding received
None.

Background: Following the 2021 Hospital Price Transparency Final Rule, US hospitals were mandated to publish their insurer-negotiated prices. We identified factors contributing to price variability of colorectal cancer (CRC) screening procedures across the US. Methods: We compared prices of colonoscopy, flexible sigmoidoscopy, CT colonography, fecal occult blood test, fecal immunochemical test, and Cologuard across U.S. hospitals using the Turquoise dataset (N = 6,378). Psychiatric, rehabilitation, and pediatric hospitals were excluded. Prices in the top and bottom 1% were also excluded to minimize the effect of outliers. Prices were adjusted by the Medicare Geographic Price Index to account for regional variability. We then compared prices across several subgroups, including National Cancer Institute (NCI) designated hospitals, teaching hospitals, and investor owned hospitals. Significance was assessed using the Kruskal-Wallis test. To quantify price variability across insurance plans within a hospital, we defined the within-center-ratio as the 90th percentile rate at a hospital divided by the 10th percentile rate. To quantify variability across hospitals, the across-center-ratio was defined as the 90th percentile median rate across all hospitals divided by the 10th percentile median rate. Results: 1,460 hospitals reported commercial prices for colonoscopy with a median commercial price of $1,867 (IQR: $1,208 - $2,689). For colonoscopy, the within center ratio was 2.5 (IQR: 1.5 – 3.8) and the across-center ratio was 6.2. Prices for other procedures are provided in the table. Compared to non-investor owned hospitals, prices of colonoscopy ($2,082 vs $1,787, P <0.001) and flexible sigmoidoscopy ($2,022 vs $1,289, P <0.001) were significantly higher at investor owned hospitals. Furthermore, across investor classes, hospitals with >5% ownership from private equity firms had the highest median price for both colonoscopy ($2,898), and flexible sigmoidoscopy ($2,697). We did not find significant differences in price by NCI designation, academic teaching center affiliation, overall hospital mortality, overall hospital readmission rate, or urban/rural location. Conclusions: CRC screening procedure prices vary significantly both within and across hospitals. Private equity and other investor owned hospitals had significantly higher prices compared to non-investor owned hospitals.

Code typeCode descriptionNumber of centersMedian commercial price, $ (IQR)Within center ratio (IQR)Across center ratio
45378Colonoscopy1,4601,867 (1208 - 2689)2.5 (1.5 - 3.8)6.2
45330Flexible Sigmoidoscopy1,3321,473 (823 - 2251)2.3 (1.4 - 3.9)15.9
82270Fecal occult blood test (guaiac)1,30016 (7 - 32)3.2 (1.7 - 6.7)13.1
82274Fecal Immunochemical test1,18541 (25 - 65)2.5 (1.6 - 4.3)5.5
74263CT colonography6441,060 (675 - 1621)1.8 (1.1 - 3.3)5.8
81528Cologuard199560 (509 - 1074)1.7 (1 - 2.6)3.4

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Abstract Details

Meeting

2023 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Health Services Research and Quality Improvement

Track

Quality Care/Health Services Research

Sub Track

Value/Cost of Care

Citation

J Clin Oncol 41, 2023 (suppl 16; abstr 6652)

DOI

10.1200/JCO.2023.41.16_suppl.6652

Abstract #

6652

Poster Bd #

144

Abstract Disclosures

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