Lack of Price Transparency in Radiofrequency Ablation Treatments at NCI-Designated Cancer Centers

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Viknesh S. Kasthuri, AB (he/him/his)

Medical Student
Warren Alpert Medical School of Brown University

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

SA

Sun-Ho Ahn, MD

Associate Professor of Radiology
Warren Alpert Medical School of Brown University

Disclosure(s):

Viknesh S. Kasthuri, AB: No financial relationships to disclose

Purpose: As patients’ health care financial burden rises, prices may be a determining factor in patients’ choice of treatment options and institution selection. As of January 1st, 2021, Center for Medicare and Medicaid Services requires all hospitals to "establish, update, and make public a list of their standard charges” for all items and services.{1}. The purpose of this study is to determine the level of price transparency (PT) and the variations in price for Radiofrequency Ablation (RFA) treatments, a mainstay of interventional oncology.

Materials and Methods:

National Cancer Institute (NCI)-Designated Cancer Centers (DCC) were identified. NCI-DCC that do not perform patient care or do not participate in Medicare’s Inpatient Prospective System were excluded. In this cross-sectional analysis, commercial negotiated prices were obtained by a search of each center’s website. CPT codes were identified using the manufacturer’s billing guide.{2} Comparison of prices among centers was performed by normalizing the median price for each service at each center to the estimated local 2022 Medicare reimbursement. “Within-center ratio” and “across center ratio” were defined as the ratio between the lowest and highest median commercially negotiated price within a center and across all centers, respectively. All available prices are current as of June 4, 2022.

Results:

62% (44/71) of NCI-DCC published commercially negotiated rates for any of the RFA CPT codes. Disclosure varied amongst centers, with anywhere from 9-37 centers disclosing any commercial rates. Imaging guidance, bone, liver, lung, and kidney RFA codes had greater price transparency than gynecologic and mouth RFA codes. Needle placement codes had greater PT than RFA codes. Within center ratios ranged from 5.7 to 32 and adjusted across center ratios ranged from 9.5 to 667. Some adjusted across center ratios could not be calculated because Medicare did not publish a reimbursement (experimental or phased-out CPT code).

Conclusion:

PT level at NCI-DCC for RFA treatments is low and limited by heterogeneity in quality and comprehensiveness of disclosures. Some of the minimum median values appear implausible and may inaccurately refer to the cost of an individual component of a treatment. However, the absence of such clarification in the machine-readable file makes accurate price data elusive to patients. Nevertheless, there is significant variation in the commercial negotiated rates of RFA treatments both within institutions and among institutions. If PT is to be successful, further work and wider enforcement may be required.