Kovid Bhayana, MD, MBA, Farshad Aduli, MD Howard University Hospital, Washington, DC
Introduction: CMS issued the OPPS rule mandating hospitals display online chargemasters with pricing for common procedures, including discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges. This study examined compliance of Washington DC university hospitals with the CMS mandate and compared prices for common endoscopic gastroenterology procedures.
Methods: We reviewed the chargemasters from three Washington DC university hospitals: Georgetown/Medstar Hospital, George Washington University Hospital (GWUH), and Howard University Hospital (HUH). We extracted pricing for CPT codes 43235 (EGD), 43239 (EGD with biopsy), 45378 (colonoscopy), and 45380 (colonoscopy with biopsy), including standard/gross charges, minimum and maximum negotiated charges, and cash discount prices for major insurers (Aetna, Cigna, United Healthcare).
Results: Georgetown/Medstar Hospital's chargemaster was disorganized, making data extraction impossible. GWUH and HUH had organized chargemasters. HUH reported lower prices than GWUH for all major insurers, higher gross charges, and higher cash discount prices for all CPT codes. GWUH had missing data points for gross charges for CPT codes 45378 and 45380 and duplicate pricing for CPT 43235.
Discussion: Washington DC university hospital compliance with the CMS mandate was poor. Georgetown University Hospital's data was unusable, and GWUH and HUH showed unreliable trends. HUH, often a safety net hospital, had lower insurance reimbursement rates but higher gross charges and cash discount prices, questioning its safety net status. The variability in compliance and pricing suggests CMS’s goal of increased consumer control is unmet. Transparent pricing in high-volume, high-cost procedures like colonoscopies could benefit patients significantly.
Figure: Comparison of Washington DC Academic Hospital endoscopy price
Disclosures:
Kovid Bhayana indicated no relevant financial relationships.
Farshad Aduli indicated no relevant financial relationships.
Kovid Bhayana, MD, MBA, Farshad Aduli, MD. P0660 - Washington, DC University Hospitals' Price Compliance and Comparison for Endoscopies, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
