Association Between Cancer Center Accreditation and Compliance With Price Disclosure of Common Oncologic Surgical Procedures

Authors: Yuqi Zhang MD, MHS1,2,3, Marcelo Cerullo MD, MPH1,3,4, Andrew Esposito MD2, and Vishnukamal Golla MD, MPH1,3,5,6
View More View Less
  • 1 National Clinician Scholars Program, Duke University, Durham, North Carolina;
  • | 2 Department of Surgery, Yale University, New Haven, Connecticut;
  • | 3 Durham Veterans Affairs, Durham, North Carolina;
  • | 4 Department of Surgery, Duke University, Durham, North Carolina;
  • | 5 Department of Surgery, Division of Urology, and
  • | 6 Margolis Center for Health Policy, Duke University, Durham, North Carolina.

Background: Cancer center accreditation status is predicated on several factors that measure high-value healthcare. However, price transparency, which is critical in healthcare decisions, is not a quality measure included for accreditation. We reported the rates of price disclosure of surgical procedures for 5 cancers (breast, lung, cutaneous melanoma, colon, and prostate) among hospitals ranked by the American College of Surgeon’s Commission on Cancer (ACS-CoC). Methods: We identified nonfederal, adult, and noncritical access ACS-CoC accredited hospitals and used the commercial Turquoise Health database to perform a cross-sectional analysis of hospital price disclosures for 5 common oncologic procedures (mastectomy, lobectomy, wide local excision for cutaneous melanoma, partial colectomy, prostatectomy). Publicly available financial reporting data were used to compile facility-specific features, including bed size, teaching status, Centers for Medicare & Medicaid wage index, and patient revenues. Modified Poisson regression evaluated the association between price disclosure and ACS-CoC accreditation after adjusting for hospital financial performance. Results: Of 1,075 total ACS-CoC accredited hospitals, 544 (50.6%) did not disclose prices for any of the surgical procedures and only 313 (29.1%) hospitals reported prices for all 5 procedures. Of the 5 oncologic procedures, prostatectomy and lobectomy had the lowest price disclosure rates. Disclosing and nondisclosing hospitals significantly differed in ACS-CoC accreditation, ownership type, and teaching status. Hospitals that disclosed prices were more likely to receive Medicaid disproportionate share hospital payments, have lower average charge to cost ratios (4.53 vs 5.15; P<.001), and have lower net hospital margins (−2.03 vs 0.44; P=.005). After adjustment, a 1-point increase in markup was associated with a 4.8% (95% CI, 2.2%–7.4%; P<.001) higher likelihood of nondisclosure. Conclusions: More than half of the hospitals did not disclose prices for any of the 5 most common oncologic procedures despite ACS-CoC accreditation. It remains difficult to obtain price transparency for common oncologic procedures even at centers of excellence, signaling a discordance between quality measures visible to patients.

Submitted April 7, 2022; final revision received July 27, 2022; accepted for publication July 27, 2022.

Author contributions: Conceptualization: Zhang, Cerullo, Golla. Data curation: Zhang, Cerullo, Golla. Formal analysis: Cerullo. Funding acquisition: Zhang, Cerullo. Investigation: Zhang, Esposito. Methodology: Zhang, Esposito. Project administration: Zhang. Resources: Zhang, Esposito. Software: Cerullo. Supervision: Golla. Validation: Golla. Writing—original draft: Zhang, Cerullo, Golla. Writing—review and editing: All authors.

Disclosures: The authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.

Funding: Drs. Zhang, Cerullo, and Golla have disclosed receiving grant/research support from the U.S. Department of Veterans Affairs.

Correspondence: Yuqi Zhang, MD, MHS, Yale General Surgery, 330 Cedar Street, FMB 107, New Haven, CT 06520-8062. Email: yuqi.zhang@yale.edu

Supplementary Materials

    • Supplemental Materials (PDF 432 KB)
  • 1.

    Centers for Disease Control and Prevention. Leading causes of death. Accessed October 19, 2021. Available at: https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm

    • Search Google Scholar
    • Export Citation
  • 2.

    Diaz A, Chhabra KR, Dimick JB, et al. Variations in surgical spending within hospital systems for complex cancer surgery. Cancer 2021;127:586597.

  • 3.

    Greenup RA, Rushing C, Fish L, et al. Financial costs and burden related to decisions for breast cancer surgery. J Oncol Pract 2019;15:e666676.

  • 4.

    Ramsey S, Blough D, Kirchhoff A, et al. Washington State cancer patients found to be at greater risk for bankruptcy than people without a cancer diagnosis. Health Aff (Millwood) 2013;32:11431152.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5.

    Farooq A, Merath K, Hyer JM, et al. Financial toxicity risk among adult patients undergoing cancer surgery in the United States: an analysis of the National Inpatient Sample. J Surg Oncol 2019;120:397406.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6.

    Zafar SY, Peppercorn JM, Schrag D, et al. The financial toxicity of cancer treatment: a pilot study assessing out-of-pocket expenses and the insured cancer patient’s experience. Oncologist 2013;18:381390.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7.

    Bhanvadia SK, Psutka SP, Burg ML, et al. Financial toxicity among patients with prostate, bladder, and kidney cancer: a systematic review and call to action. Eur Urol Oncol 2021;4:396404.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Parikh DA, Ragavan M, Dutta R, et al. Financial toxicity of cancer care: an analysis of financial burden in three distinct health care systems. JCO Oncol Pract 2021;17:e14501459.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    American College of Surgeons. Commission on Cancer. About cancer program categories. Accessed October 19, 2021. Available at: https://www.facs.org/quality-programs/cancer-programs/commission-on-cancer/coc-accreditation/categories/

    • Search Google Scholar
    • Export Citation
  • 10.

    Centers for Medicare & Medicaid Services. Hospital price transparency. Accessed October 19, 2021. Available at: https://www.cms.gov/hospital-price-transparency

    • Search Google Scholar
    • Export Citation
  • 11.

    Ayoub NF, Balakrishnan K. Price transparency and compliance with federal regulation for pediatric tonsillectomy. Otolaryngol Head Neck Surg 2021;167:248252.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 12.

    Gondi S, Beckman AL, Ofoje AA, et al. Early hospital compliance with federal requirements for price transparency. JAMA Intern Med 2021;181:13961397.

  • 13.

    Schultz K, Enterline L, Igboechi O, et al. A review of price transparency policy and evaluation of hospital compliance in orthopedic sports medicine. HSS J 2021;17:138144.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Glied S. Price transparency—promise and peril. JAMA 2021;325:14961497.

  • 15.

    Haque W, Ahmadzada M, Allahrakha H, et al. Transparency, accessibility, and variability of US hospital price data. JAMA Netw Open 2021;4:e2110109.

  • 16.

    Chino F, Johnson J, Moss H. Compliance with price transparency rules at US National Cancer Institute-Designated cancer centers. JAMA Oncol 2021;7:19031904.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 17.

    Jiang JX, Makary MA, Bai G. Commercial negotiated prices for CMS-specified shoppable surgery services in U.S. hospitals [letter]. Int J Surg 2021;95:106107.

  • 18.

    American Cancer Society. Cancer facts & figures 2022. Accessed February 8, 2022. Available at: https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Turquoise Health. Clear Rates Data warehouse. Accessed November 1, 2021. Available at: https://turquoise.health

  • 20.

    Xiao R, Miller LE, Workman AD, et al. Analysis of price transparency for oncologic surgery among National Cancer Institute-designated cancer centers in 2020. JAMA Surg 2021;156:582585.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21.

    Centers for Medicare & Medicaid Services. Cost reports, 2019. Accessed November 1, 2021. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Downloadable-Public-Use-Files/Cost-Reports

    • Search Google Scholar
    • Export Citation
  • 22.

    Cerullo M, Yang KK, Roberts J, et al. Private equity acquisition and responsiveness to service-line profitability at short-term acute care hospitals. Health Aff (Millwood) 2021;40:16971705.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23.

    Offodile AC II, Cerullo M, Bindal M, et al. Private equity investments in health care: an overview of hospital and health system leveraged buyouts, 2003-17. Health Aff (Millwood) 2021;40:719726.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24.

    Ly DP, Jha AK, Epstein AM. The association between hospital margins, quality of care, and closure or other change in operating status. J Gen Intern Med 2011;26:12911296.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25.

    Schmitt M. Do hospital mergers reduce costs? J Health Econ 2017;52:7494.

  • 26.

    Zou GY, Donner A. Extension of the modified Poisson regression model to prospective studies with correlated binary data. Stat Methods Med Res 2013;22:661670.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Yelland LN, Salter AB, Ryan P. Performance of the modified Poisson regression approach for estimating relative risks from clustered prospective data. Am J Epidemiol 2011;174:984992.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 28.

    Agarwal A, Dayal A, Kircher SM, et al. Analysis of price transparency via National Cancer Institute-Designated Cancer Centers’ chargemasters for prostate cancer radiation therapy. JAMA Oncol 2020;6:409412.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Jiang JX, Makary MA, Bai G. Where are the high-price hospitals? With the Transparency Rule in effect, colonoscopy prices suggest they’re all over the place. Accessed November 1, 2021. Available at: https://www.healthaffairs.org/do/10.1377/forefront.20210805.748571/full/

    • Search Google Scholar
    • Export Citation
  • 30.

    Nierengarten MB. Greater price transparency needed for thyroid cancer treatment among US cancer centres. Lancet Oncol 2021;22:914.

  • 31.

    Berkowitz ST, Siktberg J, Hamdan SA, et al. Health care price transparency in ophthalmology. JAMA Ophthalmol 2021;139:12101216.

  • 32.

    Xiao R, Rathi VK, Gross CP, et al. Payer-negotiated prices in the diagnosis and management of thyroid cancer in 2021. JAMA 2021;326:184.

  • 33.

    Zurfley FE, Shifflet K, Hossler EW. Chargemasters and price transparency in dermatology. J Am Acad Dermatol 2021;85:247249.

  • 34.

    American Hospital Association. In OPPS rule, CMS boosts payment rates by 2%, makes modifications to price transparency rule. Accessed January 10, 2022. Available at: https://www.aha.org/news/headline/2021-11-02-opps-rule-cms-boosts-payment-rates-2-makes-modifications-price

    • Search Google Scholar
    • Export Citation
  • 35.

    Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020;70:730.

  • 36.

    Jiang JX, Polsky D, Littlejohn J, et al. Factors associated with compliance to the hospital price transparency final rule: a national landscape study. J Gen Intern Med. Published online December 13, 2021. doi: 10.1007/s11606-021-07237-y

    • Search Google Scholar
    • Export Citation
  • 37.

    Vaidya A. Top 10 states with the most hospitals. Accessed January 24, 2022. Available at: https://www.beckershospitalreview.com/finance/top-10-states-with-the-most-hospitals.html

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38.

    Bai G, Anderson GF. A more detailed understanding of factors associated with hospital Profitability. Health Aff (Millwood) 2016;35:889897.

  • 39.

    Bai G, Anderson GF. Extreme markup: the fifty US hospitals with the highest charge-to-cost ratios. Health Aff (Millwood) 2015;34:922928.

  • 40.

    Xiao R, Ross JS, Gross CP, et al. Hospital-administered cancer therapy prices for patients with private health insurance. JAMA Intern Med 2022;182:603611.

  • 41.

    Burke LG, Frakt AB, Khullar D, et al. Association between teaching status and mortality in US hospitals. JAMA 2017;317:21052113.

  • 42.

    Frakt A. Teaching hospitals cost more, but could save your life. The New York Times. June 5, 2017. Accessed January 21, 2022. Available at: https://www.nytimes.com/2017/06/05/upshot/teaching-hospitals-cost-more-but-could-save-your-life.html

    • Search Google Scholar
    • Export Citation
  • 43.

    Mariotto AB, Enewold L, Zhao J, et al. Medical care costs associated with cancer survivorship in the United States. Cancer Epidemiol Biomarkers Prev 2020;29:13041312.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44.

    Emanuel EJ, Diana A. Considering the future of price transparency initiatives-information alone is not sufficient. JAMA Netw Open 2021;4:e2137566.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 45.

    Mathew AT, Jain B, Dee EC, et al. Assessment of compliance with Centers for Medicare & Medicaid Services Price Transparency Final Rule. JAMA Oncol 2022;8:12121213.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 46.

    Riley GF, Lubitz JD. Long-term trends in Medicare payments in the last year of life. Health Serv Res 2010;45:565576.

  • 47.

    Riley GF. Administrative and claims records as sources of health care cost data. Med Care 2009;47(Suppl 1):S5155.

  • 48.

    Cutler DM, Summers LH. The COVID-19 pandemic and the $16 trillion virus. JAMA 2020;324:14951496.

  • 49.

    Mathew AT, Jain B, Dee EC, et al. Payer-negotiated prices for breast cancer treatment at NCI-designated cancer treatment centers. Ann Surg Oncol 2022;29:33813383.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 50.

    Centers for Medicare & Medicaid Services. CMS OPPS/ASC Final Rule increases price transparency. patient safety and access to quality care. Accessed January 21, 2022. Available at: https://www.cms.gov/newsroom/press-releases/cms-oppsasc-final-rule-increases-price-transparency-patient-safety-and-access-quality-care

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 0 0 0
Full Text Views 830 830 830
PDF Downloads 442 442 442
EPUB Downloads 0 0 0