UPJ INSIGHT Rural For-Profit Hospitals Are Associated With Higher Commercial Prices for 3 Common Urological Procedures

By: Ian Berger, MD, MSHP, Division of Urology, Duke University Medical Center, Durham, North Carolina; Alexandria Spellman, MD, Division of Urology, Duke University Medical Center, Durham, North Carolina; Vishnukamal Golla, MD, MPH, Division of Urology, Duke University Medical Center, Durham, North Carolina, Durham Veterans Affairs Health Care System, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina; Marcelo Cerullo, MD, MPH, Durham Veterans Affairs Health Care System, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina, Duke University Medical Center, Durham, North Carolina; Yuqi Zhang, MD, MHS, Durham Veterans Affairs Health Care System, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina, Yale New Haven Health System, Connecticut; Michael E. Lipkin, MD, MBA, Division of Urology, Duke University Medical Center, Durham, North Carolina; Gary J. Faerber, MD, Division of Urology, Duke University Medical Center, Durham, North Carolina; Deborah R. Kaye, MD, MS, Division of Urology, Duke University Medical Center, Durham, North Carolina, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, Duke Cancer Institute, Duke University School of Medicine, Durham, North Carolina, Margolis Center for Health Policy, Duke University, Durham, North Carolina; Charles D. Scales Jr, MD, MSHS, Division of Urology, Duke University Medical Center, Durham, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina | Posted on: 15 Dec 2023

Berger I, Spellman A, Golla V, et al. Rural for-profit hospitals are associated with higher commercial prices for 3 common urological procedures. Urol Pract. 2023;10(6):580-585.

Study Need and Importance

With the Centers for Medicare and Medicaid Services 2021 price transparency mandate, urologic prices are publicly accessible. Prices have not been analyzed for common urologic procedures. High prices may dissuade patients from undergoing care. Rural patients are especially vulnerable to high prices due to lack of access to urologic services.

What We Found

For facilities that report prices, rural for-profit hospitals comprised 17% of all rural hospitals in our study. Prices for ureteroscopy, transurethral resection of bladder tumor, and transurethral resection of prostate were higher for rural for-profit hospitals compared to rural nonprofit hospitals and metropolitan for-profit hospitals even after controlling for facility characteristics (Figure).

Figure. Median hospital prices stratified by rural status and hospital ownership for ureteroscopy and laser lithotripsy (A), transurethral resection of bladder tumor (B), and transurethral resection of prostate (C).

Limitations

Our data use publicly available prices and cannot account for hospitals that do not disclose prices. Hospitals that do not disclose data may have reasons for doing so and are not random. It does not include prices at ambulatory surgical centers. Prices include the facility fee, but do not include the professional fee and may not represent the true cost to the patient.

Interpretation for Patient Care

Rural patients face barriers to accessing urologic procedures. Rural patients may only have a single center from which to obtain urologic care. If that center is for-profit, they may face high prices. The effect of publicly available pricing on consumer behavior is still under investigation; however, patients facing high prices may forgo surgery, leading to poor outcomes. The number of for-profit hospitals is increasing across the country. While these hospitals may use high urologic prices to support less profitable service lines, such as emergency care, the high prices may burden those who require urologic surgery.