Study Finds Significant Price Transparency Concerns for Ophthalmologic Procedures

Despite federal legislation on price transparency requirements, a study published recently in JAMA Ophthalmology finds that costs for ophthalmologic procedures remain ambiguous and may disproportionately impact vulnerable, uninsured populations.

The analysis served to assess new price transparency legislation that took effect on January 1, 2021, which established codified policies that require hospitals to publish standard charges.

“The Code of Federal Regulations requires that hospitals publish 5 types of standard charges in 2 formats, including all items and services provided by the hospital to a patient in a machine-readable file,” they explained. “In addition, hospitals must publish 300 shoppable services to be prominently displayed on a publicly available website.”

In regards to ophthalmologic practices, researchers note that their service prices are a significant cost pressure on routine procedures. Specifically, they said that while cataract surgery is cost-effective, reimbursement has decreased by 16.6% for Current Procedural Terminology (CPT) codes 66821 (removal of recurring cataract in lens capsule using laser) and by 41.9% for CPT code 66984 (removal of cataract with insertion of lens) in the past decade.

Amid this substantial reimbursement pressure and the introduction of novel price transparency rules, they sought to explore the extent to which hospitals currently provide standard charges for the required ophthalmologic shoppable services, as well as characterize the variability in these standard charges.

In the multi-center economic evaluation study, they derived publicly available price transparency data from Association of American Medical Colleges affiliated hospitals. Standard prices for CPT codes 66984 and 66821 were evaluated from 247 hospitals who met inclusion criteria, which included geographic practice cost indices for work, practice expense, and malpractice from February 1 to April 30, 2021.

Multiple regression was used to study the geographic influence on standard charges and assess the correlation between standard charges, added researchers.

Of the study cohort, 191 (77.3%) hospitals were indicated to provide consumer-friendly shoppable services, most commonly in the form of a price estimator or online tool.

Discount cash pay estimates for CPT code 66984 (removal of cataract with insertion of lens) were provided by just over half of hospitals (n = 102; 53.4%), with a mean (SD) price of $7,818.86 ($5407.91). Moreover, fewer hospitals provided discount cash pay estimates for CPT code 66821 (n = 71; 37.2%), with a mean (SD) price of $2041.72 ($2106.44).

“The top quartile of hospitals, prices wise, listed included prices higher than $10,400 for CPT code 66984 and $2324 for CPT code 66821,” noted the study authors.

For access to these discount cash pay estimates, usability issues were reported for 36 hospitals (18.8%), including requirements for personal information or web page navigability barriers. In findings of the multiple regression analysis, minimal explanatory value was shown for geographic practice cost indices for cash discount prices of CPT codes 66984 (adjusted R², 0.54; 95% CI, 0.41-0.67; P < .001) and 66821 (adjusted R², 0.64; 95% CI, 0.51-0.77; P < .001).

“Given the potential for ambiguous pricing to burden vulnerable, uninsured patients, additional legislation might consider allowing hospitals to defer price estimates or rigorously define standards for actionable cash discount percentages with provisions for displaying relevant benchmark prices,” concluded researchers.

Reference

Berkowitz ST, Siktberg J, Hamdan SA, Triana AJ, Patel SN. Health care price transparency in ophthalmology. JAMA Ophthalmol. Published online October 7, 2021. doi:10.1001/jamaophthalmol.2021.3951