Factors Impacting Hospital Charges for Carpal Tunnel Release
Aaron Singh, BA1, Travis Kotzur, BS1, Jordan Carter, MD1, Ralph Zachary Garza, MD2 and Christina Brady, MD2, (1)UT Health San Antonio, San Antonio, TX, (2)Audie L. Murphy Memorial Veterans' Hospital, San Antonio, TX
Introduction: Medical debt is one of the leading causes of bankruptcy in the United States and many patients are forced to forgo necessary care due to lack of funding or insurance. However, costs are highly variable, but factors influencing this variability are poorly characterized. The aim of this study is to identify factors that impact hospital charges to both Medicare and commercial payers in the setting of carpal tunnel release.
Materials and Methods: This retrospective study assesses the cost of carpal tunnel release, queried by CPT code from Turquoise Health, a database of hospital pricing and cost information. A number of factors, including hospital size, teaching or non-teaching, ownership, quality and performance metrics, and geographic setting, were assessed via gamma regression analysis to assess their impact on charges, to Medicare and commercial payers, of carpal tunnel release.
Results: Hospitals owned by investors charged Medicare 24% (p<0.001) more and commercial payers 76.6% (p<0.001) more. Teaching hospitals charged Medicare 7.4% (p<0.001) more, but charged commercial payers 12.6% less (p<0.001). Hospitals with over 300 beds, compared to those with under 100, charged commercial payers 17.8% less (p<0.001); however, no difference was observed with respect to Medicare charges. Hospitals in the West, relative to those in the Northeast, charged Medicare 10.4% more. No significant difference was observed in hospitals in the Midwest or South. With respect to charges to commercial payers, hospitals in the Midwest charged 18.6% less (p<0.001) while those in the West charged 16.4% more (p<0.001).
Conclusion: The price of carpal tunnel release is multifactorial and influenced by factors beyond the true cost of care. Majority investor ownership had the largest effect size of all variables assessed, increasing charges 24% to Medicare up and 76.6% to commercial payers. This study reveals great variability, based on factors unrelated to care, in charges to both Medicare and commercial insurers.
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