Association Between Cancer Center Accreditation and Compliance With Price Disclosure of Common Oncologic Surgical Procedures
Department of Surgery, Yale University, New Haven, Connecticut;
Durham Veterans Affairs, Durham, North Carolina;
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Durham Veterans Affairs, Durham, North Carolina;
Department of Surgery, Duke University, Durham, North Carolina;
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Durham Veterans Affairs, Durham, North Carolina;
Department of Surgery, Division of Urology, and
Margolis Center for Health Policy, Duke University, Durham, North Carolina.
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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.
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