Poor Accessibility to Consumer Pricing Exists for Breast Cancer Surgeries
Tina Tian4, Joshua Bloom4, George Youssef1, Kerry Gaffney4, Carly Wareham4, Nishanth Ganeshbabu1, Jason Hall5, Salvatore M. Nardello2, Abhishek Chatterjee3, Natalie Pawlak1
1Tufts University School of Medicine, Boston, Massachusetts, United States, 2Division of Breast Surgery, Department of Surgery, Melrose Wakefield Hospital, Melrose, Massachusetts, United States, 3Division of Plastic and Reconstructive Surgery, Department of Surgery, Tufts Medical Center, Boston, Massachusetts, United States, 4Department of Surgery, Tufts Medical Center, Boston, Massachusetts, United States, 5Department of Surgery, Boston Medical Center, Boston, Massachusetts, United States
Objective: As of January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) mandates that every United States hospital provides publicly available online pricing information for services rendered. This rule of hospital price transparency allows patients to compare prices across hospital systems before choosing where to receive their care, and to comprehend the burden of medical costs they may incur. The goal of this project was to evaluate how major academic hospital systems within Massachusetts were complying with CMS guidelines with regards to breast cancer surgery.
Design: Cross-sectional analysis
Setting: Major academic hospital systems within the state of Massachusetts
Patients: A sample case of a 68-year-old female with a T2 breast cancer was chosen.
Intervention: The sample patient would have the option of undergoing a partial mastectomy or mastectomy, both with sentinel lymph node biopsy.
Main Outcome Measures: Data was collected on time taken to reach the cost estimate tool and time taken to obtain a price estimate for each procedure and hospital system. Price ranges were also recorded for each hospital system. Searches were performed by medical students or surgical residents for each hospital system and procedure with their own health insurance company using the sample case. Success rates for obtaining price estimates were determined for partial mastectomy, mastectomy, and sentinel lymph node biopsy. Statistical analysis was performed with p value < 0.05 indicating significance.
Results: Seven major Massachusetts academic medical centers were included for analysis, of which 100% had a cost estimate calculator on their respective websites. The average success rate of reaching a cost estimate for partial mastectomy, mastectomy, and sentinel lymph node biopsy was 58%, 35%, and 25%, respectively. If successful, the median time to reach the cost calculator tool was 32 seconds (range, 25 - 37 seconds). The median time from cost calculator to obtaining the cost of a partial mastectomy, mastectomy, and sentinel lymph node biopsy was 82 seconds (range, 52.5 - 103 seconds), 63 seconds (range, 40.5 - 81 seconds) and 69.5 seconds (range, 48.8 - 92.5 seconds), respectively. In successful attempts, the median pre-insurance estimated cost of a partial mastectomy was $16,509 (range, $11,776 - $22,169), compared to $24,541 (range, $16,921 - $25,543) for mastectomy and $12,342 (range, $4,034 - $20,644) for sentinel lymph node biopsy. Sentinel lymph node biopsy costs varied significantly across hospitals (p = 0.025), but there was no statistically significantly difference observed for partial mastectomy or mastectomy.
Conclusion: Despite new regulatory requirements by CMS for increased price transparency for surgical procedures, our results demonstrate a need for improved quality of hospital cost estimate calculators for breast cancer patients.
Back to 2022 Abstracts