Sood A, Butaney M, Olson P et al: The impact of the price transparency mandate on cost reporting for common urological services across the U.S. News Top 21 Hospitals. Urol Pract 2021; 8: 657.

More than 500,000 American families file for bankruptcy each year due to illness and medical bills.¹

The “Price Transparency” mandate has been proposed as one of the potential solutions to the daunting problem of high U.S. health care costs and associated financial hardship by the way of empowering patients to strategize ahead to ensure financial security and possibly shop for their treatment. This ruling has 2 discrete, complementary components: first, it requires the hospitals to disclose prices of their services, and second, it obligates the insurers to provide enrollees with individual out-of-pocket costs in a “consumer-friendly” manner. The Centers for Medicare and Medicaid Services’ (CMS) final rule mandating the price transparency ruling went into effect on January 1, 2021.

We undertook a cross-sectional study to evaluate the impact of the CMS ruling on public reporting of out-of-pocket costs for common general and specialist urological services across the U.S. News reported Top 21 hospitals.² We utilized the U.S. News 2019–20 Best Hospitals Ranking to identify the Top 21 U.S. hospitals.³ We focused on the Top 21 hospitals as they represent the flagship centers for patient care across the U.S. Data mining was performed between April and June 2021. Prices of 14 commonly delivered urological services by general and specialist urologists were studied to obtain a comprehensive perspective of the pricing landscape in urological care. Services evaluated included an office visit for lower urinary tract symptoms, clinic ordered lab tests such as the prostate specific antigen and urinalysis, clinic-based procedures including cystoscopy and prostate biopsy, commonly prescribed urological medications including tamsulosin and sildenafil, and urological surgeries (fig. 1). The prices of these services were searched for within the individual institutional chargemasters. The obtained prices were adjusted for geographic cost of living for each individual hospital, with the Mayo Clinic in Rochester, Minnesota as the referent, given its top rank. All statistical analyses were performed using SAS® 9.3. No institutional review board approval or informed consent was required as all information was publicly available and no human participants were involved.

Figure 1. Study design and proportion of hospitals providing prices for 14 common urological services in their chargemasters.

The chargemasters for all 21 hospitals were publicly available. However, not all chargemasters contained information on the 14 commonly utilized urological services that were studied. For example, only 33.3% (7/21) of the hospitals quoted a price for prostate check-up, and between 61.9% and 90.5% (13–19/21) of the hospitals had data on the 5 specialty procedure prices (fig. 1). Overall, only 3 (14.3%) of the 21 hospitals provided information on all 14 commonly delivered urological services that were queried, and only 3 of the 14 (21.4%) urological services studied had a price listed across all 21 hospitals. The listed prices for the studied services varied substantially among the 21 hospitals. The variation was in the range of fivefold to tenfold (figs. 2 and 3). Lastly, and probably most importantly, it was unclear whether the listed prices reflected hospital charges, payer reimbursement or out-of-pocket costs for the patients.⁴

Figure 2. Individual bar plots show availability of and variability in publicly listed prices for 9 common general urological services across 21 hospitals: clinic visit for lower urinary tract symptoms (A), prostate specific antigen test (B), urinalysis (C), office cystoscopy (D), office prostate biopsy (E), tamsulosin (F), sildenafil (G), ureteral stent insertion with cystoscopy (H) and transurethral resection of prostate (I). X-axis represents anonymized 21 top-ranked hospitals based on U.S. News rankings, and the y-axis represents chargemaster listed prices in U.S. dollars.

Figure 3. Individual bar plots show availability of and variability in publicly listed prices for 5 common specialist urological services across 21 hospitals: robot-assisted radical prostatectomy (A), ureteroscopy for stone (B), inflatable penile prosthesis (C), mid urethral sling (D) and circumcision (E). X-axis represents anonymized 21 top-ranked hospitals based on U.S. News rankings, and the y-axis represents chargemaster listed prices in U.S. dollars.

The current study demonstrates that the prices for common urological services are not uniformly reported among the Top 21 U.S. hospitals and, when available, are highly variable. Furthermore, these prices are not consumer friendly, as it is unclear what they represent. A specific example is of the prices listed for 3 of the 8 studied procedures: prostatectomy, ureteroscopy and transurethral resection of the prostate; the prices listed for these procedures in the chargemasters were based on the CMS’ Diagnosis Related Group nomenclature. This is of little value to a patient deciding among hospitals or treatments based on his or her financial constraints, as it does not provide the patient with the vital information that he or she needs, which is the out-of-pocket cost. Neither is it helpful to the physician counseling the patients on cost-effectiveness. Our study therefore highlights an important disconnect at the hospital administration level with regards to providing patients with reliable resources to seek financially informed medical care. A recent article by National Public Radio based on Kaiser Health News analysis found similar results.⁵

Thus, although in theory the Price Transparency ruling sounds like a win for the patients and U.S. health care, in practice much work needs to be done before the merits of this mandate may be realized.