Price Transparency for Primary Hip & Knee Arthroplasty: An Overview of the Top 50 US News and World Report Orthopedic Hospitals

• Published in: The Journal of arthroplasty Vol. 37; no. 8; pp. 1514 - 1519
• Main Authors: Cale, John B., Stambough, Jeffrey B., Mears, Simon C., Hutchinson, Johnny D., Barnes, C. Lowry, Stronach, Benjamin M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2022
• Subjects: Centers for Medicare and Medicaid Services; cost; CPT code; DRG code; price transparency; total hip arthroplasty; total knee arthroplasty; total hip arthroplasty; total knee arthroplasty; cost; Centers for Medicare and Medicaid Services; price transparency; DRG code; CPT code
• ISSN: 0883-5403; 1532-8406
• DOI: 10.1016/j.arth.2022.03.070

The Centers for Medicare and Medicaid Services (CMS) has mandated all hospitals to publish the charges of 300 common procedures to provide price transparency. The aims of our study are to evaluate 50 top orthopedic hospitals to determine compliance with this mandate and to assess the ease of finding cost information for arthroplasty procedures. The websites of the top 50 US News and World Report (USNWR) orthopedic hospitals were searched to find publicly accessible procedural charges. Data included the number of clicks to locate pricing documents, number of files provided, and number of data rows pertaining to arthroplasty. Charge data was queried based on Diagnosis related group (DRG) codes (469, 470), Current Procedural Technology (CPT) codes (27130, 27477), and keyword searches (“arthroplasty”, “total hip”, and “total knee”). Forty-four (88%) of the top 50 USNWR Orthopedic institutions had publicly accessible files containing cost information. Thirty three of the 44 institutions provided results with DRG search while less than 10 institutions used CPT and keyword searches. There was an average of 226,190 (range 304-1,121,876) rows of data per file. Average charges varied depending on the use of DRG, CPT or keyword searches ($6,663-$117,072). The majority of compliant hospitals published large data files requiring the use of DRG codes to find cost information with extreme variation in resultant charges provided. These findings underscore the lack of direct patient benefit afforded by the current mandate, as pricing determinations require expert knowledge in medical coding and have a high variability in the reported charges.