Lower Commercial Rates for Breast Surgical Procedures are Associated with Socioeconomic Disadvantage: A Transparency in Coverage Analysis.

Autor: Rochlin DH; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. rochlind@mskcc.org., Wang Y; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Amakiri UO; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Levy J; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Boe L; Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Sheckter CC; Division of Plastic and Reconstructive Surgery, Stanford University Medical Center, Stanford, CA, USA., Anderson G; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA., Mehrara BJ; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Nelson JA; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA., Matros E; Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Jazyk: angličtina
Zdroj: Annals of surgical oncology [Ann Surg Oncol] 2024 Dec 24. Date of Electronic Publication: 2024 Dec 24.
DOI: 10.1245/s10434-024-16738-z
Abstrakt: Background: The Centers for Medicare & Medicaid Services (CMS) implemented the Transparency in Coverage Rule in 2022, which requires payers to disclose commercial rates for the first time in the history of the US healthcare system. The purpose of this study was to characterize payer-disclosed commercial facility rates and examine the relationship with county-level social disadvantage for common breast surgical procedures.
Materials and Methods: We performed a cross-sectional study of 2023 pricing data for 14 ablative and reconstructive breast procedures from Turquoise Health. Socioeconomic disadvantage was quantified using the Social Vulnerability Index (SVI). Within- and across-payer ratios quantified rate variation. Linear regression assessed the relationship between relative value unit (RVU)-adjusted median commercial rates and facility-level variables including SVI quartile.
Results: There were 4,748,074 unique commercial rates disclosed by four payers from negotiations with 10,023 hospitals. Rates varied by a factor of 9.8-15.6 within and 10.0-18.1 across payers. RVU-adjusted commercial rate decreased in a stepwise fashion as SVI quartile increased and varied by payer (p < 0.001). Higher RVU-adjusted rates were associated with hospitals compared with ambulatory facilities (β = 138, 95% CI 138-139, p < 0.001). Lower rates were associated with areas of less healthcare infrastructure (β = - 37, 95% CI - 38 to - 37, p < 0.001).
Conclusions: Facility rates for breast surgical procedures varied significantly within and between payers and were higher for hospitals compared with ambulatory surgery centers. Facilities in areas of higher social vulnerability were associated with lower negotiated rates. The health equity implications of lower payment in areas of higher disadvantage, particularly in terms of access to care, deserve further investigation.
Competing Interests: Disclosures: None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this manuscript. Babak J. Mehrara, MD, is the recipient of investigator-initiated research grants from Pfizer, Integra, and Regeneron and has received royalty payments from Elsevier; he also has served as a consultant for Mediflix Corp. Yang Wang, PhD, and Gerard Anderson, PhD, receive funding from Arnold Ventures LLC. Jonas Nelson has served as a consultant for RTI surgical. This research was supported in part by the Cancer Center Support Grant P30 CA008748 that supports the research infrastructure at Memorial Sloan Kettering Cancer Center. In addition, Clifford C. Sheckter, MD, is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number KL2TR003143. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
(© 2024. Society of Surgical Oncology.)
Databáze: MEDLINE
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