The Mandated Publication of Individual Hospital Charge Description Masters Does Not Permit the Estimation of Complex Procedure Charges.

BACKGROUND: As healthcare spending continues to rise, price transparency is crucial for patients to calculate a reasonable cost estimate for tests and procedures. Legislative efforts have been successful at mandating increased hospital price transparency, including publishing charge description masters (CDMs), but their usefulness in permitting patients to assess the cost for complex procedures is unclear. We sought to determine CDM and diagnosis-related group (DRG) prevalence and evaluate whether these are effective tools for patients to preemptively ascertain the costs for simple and complex tests and procedures. METHODS: Cross-sectional analysis of publicly available 2019 CDMs and DRGs from 122 hospitals in the United States, including the top-20 as ranked by the US News & World Report Honor Roll and two top-ranked hospitals per state. We first determined the availability of CDMs and DRGs and then determined the ability to estimate the hospital charge for a three-view knee radiograph and a primary total knee arthroplasty (TKA) using CDM and DRG data. RESULTS: One hundred fifteen of 122 (94.3%) hospitals published a CDM, and 78 (63.9%) published a DRG. Top-ranked hospitals published DRGs more frequently than those outside of the Honor Roll designation (P = 0.04). The estimated charge for a three-view knee radiograph could be calculated from 113/115 (98.3%) CDMs. The estimated total charge for a primary TKA could not be obtained from any of the available CDMs. By comparison, the estimated charge for a primary TKA could be obtained from 76/78 (97.4%) of the available DRGs. DISCUSSION: CDMs are available as currently mandated for most hospitals and generally can be used to identify the charges for simple procedures, but they are ineffective tools for patients to estimate the charges associated with a multifaceted healthcare procedure, such as TKA. Although DRGs are less frequently available, they are a more effective resource for patients to estimate charges.

Duke Scholars

Author Christopher David Murawski Orthopaedic Surgery