In a cross-sectional analysis reported in a research letter in JAMA Oncology, Chino et al found that a minority of National Cancer Institute (NCI)-designated cancer centers (NCI-CCs) were fully compliant with Centers for Medicare & Medicaid Services (CMS) price transparency rules.
Study Details
The CMS began requiring hospitals to disclose prices negotiated with insurers on January 1, 2021. The current study was a cross-sectional analysis of compliance with mandated release of payer-negotiated prices at NCI-CCs, including Medicare Prospective Payment System–exempt cancer centers (those excluded from standard Medicare fee-for-service limitations based on diagnosis-related group), with assessment of pricing variability of available rates. Compliance with the January 2019 CMS ruling requiring standard prices via chargemaster list was also evaluated. NCI-CCs were considered compliant with the 2021 mandate if they had: (1) a complete machine-readable file with all required items and services; and (2) a display of 300 shoppable services in a consumer-friendly format. Data were collected between March 1 and June 1, 2021. Pricing variability for radiotherapy to bone metastasis and colonoscopy with polyp or tumor removal was assessed.
Key Findings
Among 63 NCI-CCs evaluated, 13 (21%) had a complete machine-readable file and 24 (38%) had at least a partial machine-readable file that had incomplete data or incorrect formatting. A total of 41 (65%) had a patient-facing price transparency tool and 44 (70%) had a chargemaster list.
Among 11 Medicare Prospective Payment System–exempt cancer centers, 3 (27%) had a complete machine-readable file, 5 (45%) had a price transparency tool, and 8 (73%) had a chargemaster list.
Among 11 NCI-CCs with complete pricing for a single fraction of radiotherapy to bone metastasis, the mean minimum negotiated rate was $2,149.84 (range = $297.00–$3,492.42), and the mean maximum negotiated rate was $3,371.19 (range = $1,371.00–$6,316.00); overall, the mean price was 3.78 times the Medicare maximum allowable rate of $2,476.89.
Among seven NCI-CCs with complete pricing for colonoscopy with polyp or tumor removal, the mean minimum negotiated rate was $890.46 (range = $297.00–$1,545.11), and the mean maximum negotiated rate was $13,273.65 (range = $4,304.19–$33,411.34); overall the mean price was 2.05 times the Medicare maximum allowable rate of $1,036.95.
The investigators stated: “Greater price transparency, specifically through better pricing information available to patients on the Internet, may improve affordability via lower and more uniform prices…. This study found that only one-fifth of NCI-CCs are compliant with CMS rules and that variability in negotiated rates is large, with some centers charging up to eight times the Medicare maximum allowable rate. Although patient-facing price transparency tools are available in two-thirds of NCI-CCs, it remains unclear whether these tools will accurately estimate out-of-pocket costs given the complexities of cancer treatment and insurance plan design.”
Fumiko Chino, MD, of the Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, is the corresponding author of the JAMA Oncology article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
