Hand Surgery Cost Analysis and Usability Following the CMS Hospital Transparency Rule
Olga A Schuth, MD and Annabel Baek, MD, Virginia Commonwealth University, Richmond, VA
Introduction: The cost of hand surgery is an essential element in assessing quality of care. Furthermore, surveys have found that hand surgery patients are interested in discussing their cost of care, but the information is often not available or easy to access. Effective January 1, 2021, the Centers for Medicare and Medicaid Services' (CMS) Hospital Price Transparency rule requires hospitals to provide a "comprehensive machine-readable file with all items and services," along with a "consumer- friendly list of standard charges for a limited set of shoppable services." Here, we examine if enforcement of the Hospital Price Transparency rule has resulted in consumer-friendly costs related to hand surgery.
Materials & Methods: We assessed the publicly available chargemasters, price estimators, and associated websites of the top 30 ranked hospitals for orthopedics in the 2020-2021 U.S. News and World Report for the cost of a standard three-view hand x-ray (CPT code 73130), and carpal tunnel release hospital fees (CPT code 64721).
Results: All 30 hospitals had publicly available chargemasters, but 9 were machine-readable only. Less than half used CPT codes. We found 25 of the 30 hospitals had the required consumer-friendly price estimator tool for shoppable charges. However, these estimators are only required to list 300 procedures, which generally did not include common hand procedures like carpal tunnel release. All 30 had a charge available for a standard three-view hand x-ray, with a median of $618.5 ($73-$1,164). Only 13 hospitals had a charge for carpal tunnel release hospital fees available, with a median of $13,213 ($1,255-$25,171), excluding physician fees. Other results include cost variation between x-rays of the left and right hands within the same hospital, significant differences in procedure descriptions of a hand x-ray and carpal tunnel release, and the use of unique institutional identifiers instead of CPT codes.
Conclusions: In their current form, the required hospital chargemaster lists and price estimators are confusing and difficult tools for patients and surgeons seeking transparent hand surgery costs. The chargemasters require knowledge of CPT codes or the procedure, and many were difficult to locate on hospital websites. Additionally, the information on procedures illustrated vast price differences between hospitals. Although third-party firms like Turquoise are in the process of aggregating data into a more streamlined process for patients to compare prices, we propose including hand surgery costs as a measured metric within a national hand data registry.
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