Introduction: Price negotiation between hospitals and insurers is influenced by market competition factors. For rural hospitals, decreased inter-hospital competition may favor hospital negotiating power. However, price differences between rural and metropolitan hospitals for urologic surgeries have not been studied. Our objective was to evaluate prices for ureteroscopy with laser lithotripsy (URS) between rural and metropolitan hospitals in the context of urologist density.
Methods: The Turquoise Health Price Transparency dataset contains publicly available prices from reporting hospitals. We abstracted prices for commercial payers for URS (CPT 52356). We averaged prices across payers by hospital. County level urologist and population density were obtained from the 2019 Area Health Resource File and aggregated into Health Service Areas (HSA) defined by the National Center of Health Statistics. Rural-Urban Commuting Area (RUCA) codes were used to classify each hospital as rural versus metropolitan. Facility features were obtained from the 2019 Centers for Medicare and Medicaid Services Healthcare Cost Reporting Information System and Wage Index. A generalized linear model with gamma distribution and log link evaluated the association of mean price of URS with RUCA classification, controlling for urologist density and facility features.
Results: A total of 659 hospitals reported prices for URS with a median rate of $6,161 (interquartile range $3,836 – $10,338). Rural hospitals comprised 24% (158/659) of facilities. Among HSA with a hospital reporting a URS price, 25th percentile of urologist density was 1.6 per 100,000 persons, 50th was 2.5, and 75th was 3.6. Controlling for hospital factors and urologist density, the price for URS was 26% higher (p=0.004) at rural versus metropolitan hospitals and for profit hospital price was 34% higher versus non-profit (p < 0.001) [Table 1]. Price was 32% lower in the Northeast compared to West region (p < 0.001).
Conclusions: URS prices are higher at rural hospitals. Rural hospitals may face decreased competition for negotiating prices with insurance companies. Higher prices in these areas may exacerbate disparities for rural patients who may struggle to afford health care.
Source of Funding: Duke University Bass Connections
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