Expenses and expectations for endocrine surgeries: A national analysis of price transparency and cost of care.

BACKGROUND: The Centers for Medicare and Medicaid Services price transparency rule aims to facilitate cost-conscious consumer decision making. However, factors mediating transparency and real-world prices for endocrine surgeries are not well described. METHODS: Data were obtained from Turquoise Health and Centers for Medicare and Medicaid Services reports. The American Association of Endocrine Surgeons "Find A Surgeon" tool identified endocrine surgeons. Chi-square, Kruskal-Wallis, and Wilcoxon rank-sum tests evaluated associations with price disclosure. Multivariable linear regression models assessed the marginal effects of factors on reimbursements. RESULTS: There were 439 American Association of Endocrine Surgeons-affiliated surgeons identified from 307 unique practice locations, of which 254 (82.7%) disclosed endocrine surgery prices. Locations with an American Association of Endocrine Surgeons-affiliated surgeon that disclosed prices were more likely to be teaching hospitals, nonprofit, large size (200+ beds), with a higher share of Medicare patients, greater patient complexity, higher Medicare star rating, and in markets with more endocrine surgery competition (all P < .05). Factors associated with higher prices included commercial insurance or self-pay, nonprofit health system, larger bed size, and in markets with nearby American Association of Endocrine Surgeons-affiliated surgeons. Lower prices were seen for low Centers for Medicare and Medicaid Services star rating, urban locations, in moderately competitive health care markets, and with 21-80 nearby facilities disclosing endocrine surgery prices. Hospitals with an American Association of Endocrine Surgeons-affiliated surgeon had higher hospitalization and lower procedure prices. CONCLUSION: Facilities with an American Association of Endocrine Surgeons-affiliated surgeon demonstrated excellent price disclosure for endocrine surgeries. Hospital characteristics such as size, ownership, quality, geographic location, and market factors influenced final reimbursements. Further studies are needed to investigate the alignment of reimbursement with quality of care to translate price transparency into increased value for patients.

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