Health Services Research
SS 35 - HSR 3- Best of Health Services Research
205 - Price Transparency in Radiation Oncology: A Prostate Cancer Patient Perspective Analysis of NCI Designated Cancer Centers' Chargemasters for Intensity Modulated Radiation Therapy
Wednesday, September 18
11:45 AM - 11:55 AM
Location: Room W175
Ankit Agarwal, MD, MBA
UNC Health Care: Resident Physician: Employee
American Medical Association: Alternate Delegate to the House of Delegates: Voting member in the AMA, representing the residents and fellows section of the AMA and the North Carolina Medical Society;
ASTRO: ASTRO-ARRO Executive Committee: National Elected Resident Representative
Price Transparency in Radiation Oncology: A Prostate Cancer Patient Perspective Analysis of NCI Designated Cancer Centers’ Chargemasters for Intensity Modulated Radiation Therapy
A. Agarwal1, A. Dayal2, S. M. Kircher3, R. C. Chen4, and T. J. Royce5; 1University of North Carolina - Chapel Hill, Chapel Hill, NC, 2Fox Chase Cancer Center, Philadelphia, PA, 3Northwestern Feinberg School of Medicine, Chicago, IL, 4University of North Carolina at Chapel Hill, Chapel Hill, NC, 5University of North Carolina School of Medicine, Chapel Hill, NC
Under the Centers for Medicare and Medicaid Services (CMS) price transparency rule that took effect on January 1, 2019, all hospitals are now required to publicly list their chargemaster—the standard prices for all hospital services and procedures. We investigated the utility of this public information to allow ‘comparison shopping’ among National Cancer Institute (NCI) designated Cancer Centers for a prostate cancer patient getting radiation.
Using a patient perspective, we searched for the publicly published chargemasters for all NCI designated cancer centers in January 2019. We identified 63 hospitals, excluding the 7 basic laboratory cancer centers. We isolated the listing for Current Procedural Terminology (CPT) code 77385 that refers to the charge per fraction of simple intensity modulated radiation therapy (IMRT), the most common and expensive charge for a patient receiving standard of care IMRT prostate radiation. Chargemaster search terms used include: imrt, rad tx, radiation, simple, and intensity modulated. We calculated the average cost for all hospitals and NCI-designated regional subgroups. We extrapolated the cost of a 28-fraction hypo-fractionated prostate cancer radiation treatment.
Of the 63 hospitals, 52 (84%) listed a price for simple IMRT. Of the remaining 11 hospitals, 3 did not have a chargemaster available and 8 did have a chargemaster available but did not list a charge for simple IMRT. The mean cost per fraction is $3,990.31 with a standard deviation of $2,501.76. The median charge is $3,300 (IQR $2,408-$4,453). The charges range from a minimum of $656 to a maximum of $14,252, representing a 21.7x difference. For 28 fractions of IMRT, this would represent a range of prices from $18,368 to $399,056 with a mean of $111,728.80 (median $92,400). By region, the mean cost per fraction in New England is $3,053.00, Mid Atlantic is $4,522.31, East North Central is $4,367.17, West North Central is $3,223.33, South Atlantic is $2,678.60, East South Central is $2,883.00, West South Central is $2,778.50, Mountain is $5,531.84, and Pacific is $5,435.22.
The availability of hospital chargemasters’ and the descriptors used to identify IMRT are not uniform. To reference per fraction cost of simple IMRT, the descriptors ranged “modulated rad tx”, “imrt”, and a variety of other heterogeneous terms. The majority of chargemasters did not list the associated CPT code, making cross comparisons difficult. We found a wide range of listed costs per fraction and regional variation. Further barriers to the CMS initiative include the unclear relationship between chargemaster prices and actual insurance negotiated prices and the uncertainty if the listed price is inclusive of all costs associated with the procedure or test (i.e. physician fee, facility fee). At this point, the CMS initiative does not adequately provide price transparency to patients planning to undergo radiation therapy.
Author Disclosure: A. Agarwal: Alternate Delegate to the House of Delegates; American Medical Association. ASTRO-ARRO Executive Committee; ASTRO. A. Dayal: Vice Chair for RFS and Delegate; Pennsylvania Medical Association. Sectional Delegate; American Medical Association. Government Relations and Economics Nonvoting Member, Membership Committee Voting Member; ACRO. S.M. Kircher: None. R.C. Chen: None. T.J. Royce: None.