The Influence of Hospital Owner and Urban/ Rural Status on Chargemaster Rates for Skin Graft and Flap Procedures
Gwendolyn Daly, BA, Sonika Reddy, BS, Silvi Dore, BA, Kavita Patel, BS, Nadera Rahman, BA, Saman Baban, MHS, Elizabeth Zellner, MD, Cara L. Grimes, MD.
New York Medical College, Valhalla, NY, USA.
Background: Price transparency has become an important topic in light of the skyrocketing cost of healthcare in the United States. A central part of this discussion is the hospital chargemaster, a compilation of prices for every billable item provided by a hospital. In January 2019, the Trump administration mandated that hospital chargemasters be made accessible to the public. There is a paucity of research investigating price variation in these chargemasters and factors that influence these prices. In this study, we investigated the influence of hospital owner and urban/ rural status on chargemaster rates for skin graft and flap procedures at New York State hospitals.
Methods: Institutional chargemasters were downloaded and prices for skin graft and flap procedures were extracted with a Python script using the openpyxl and pandas libraries. These procedures were identified with the following CPT codes: 64893, 64901, 15277, 15278, 15860, 15757, 34530, 64708, 15574, 15271, 14301, 14302, 15100, 15101, 15272. Hospital urban/rural status was obtained from the U.S. Department of Agriculture. Hospital owner was obtained from the Homeland Infrastructure Foundation. Data were analyzed with a 2-way ANOVA in GraphPad Prism.
Results: Out of 217 total hospitals in New York, 29 (13.4%) included CPT codes in their chargemasters. 23 (79.3%) of these hospitals were designated as urban and 6 (20.7%) as rural. Urban hospitals listed significantly higher prices than rural hospitals (p<0.0001). Furthermore, government owned hospitals listed significantly higher prices than did non-profit hospitals (p<0.0001). Post hoc analysis revealed that prices were significantly different between the government owned and non-profit hospitals for CPT codes representing: neurorrhaphy with nerve graft (p<0.0001), skin substitute grafts (p=0.001), adjacent tissue transfer (p<0.0001), and skin substitute graft (p=0.0002).
Conclusions: Hospitals in urban regions with government ownership have higher list prices for skin graft and flap procedures than non-profit hospitals in rural regions. There are many limitations to this work including a low number of hospitals publishing CPT codes, unequal distribution of metropolitan versus non-metropolitan hospitals reporting CPT codes, and the inability to link CPT codes to ICD-10 codes. These limitations may reflect deficits in the Trump Administration's chargemaster mandate and further suggest that it does not take into account quality, complication rates, hospital volume, surgeon training, and designations such as centers of excellence. Future research should investigate the impact of these quality measures on pricing.
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