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UPJ INSIGHT: Rural Hospital For-Profit Status and Inpatient Hematuria Evaluation With Commercial Insurance
By: Ian Berger, MD, MSHP, Duke University School of Medicine, Durham, North Carolina; Vishnukamal Golla, MD, MPH, Duke University School of Medicine, Durham, North Carolina, Durham Veterans Affairs Health Care System, Durham, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina; Marcelo Cerullo, MD, MPH, Duke University School of Medicine, Durham, North Carolina, Durham Veterans Affairs Health Care System, Durham, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina; Yuqi Zhang, MD, MHS, Durham Veterans Affairs Health Care System, Durham, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina, Yale University School of Medicine, New Haven, Connecticut; Michael E. Lipkin, MD, MBA, Duke University School of Medicine, Durham, North Carolina; Gary J. Faerber, MD, Duke University School of Medicine, Durham, North Carolina; Charles D. Scales Jr, MD, MSHS, Duke University School of Medicine, Durham, North Carolina, Duke University National Clinician Scholars Program, Durham, North Carolina, Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Deborah R. Kaye, MD, MS, Duke University School of Medicine, 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 | Posted on: 17 Mar 2023
Berger I, Golla V, Cerullo M, et al. Association of rural hospital for-profit status with higher publicly reported prices for the components of inpatient hematuria evaluation among commercially insured patients. Urol Pract. 2023;10(2):131-137.
Study Need and Importance
Rural patients have limited access to urological care and are vulnerable to high local prices. However, little is known about inpatient price variation for common urological conditions, such as hematuria.
What We Found
Twenty percent of all hospitals published complete price information for intermediate- and high-risk hematuria evaluation. We found that for-profit hospitals were associated with 88% higher prices for intermediate-risk and 58% higher prices for high-risk evaluation compared to non-profit hospitals. The Figure shows each hospital price by ownership type. Furthermore, rural for-profit status was independently associated with even higher price for both intermediate- and high-risk evaluations which was not explained by rural or for-profit status alone.
Limitations
Our data cannot account for outpatient prices of the components of hematuria evaluation. Additionally, data are likely missing in a nonrandom pattern from hospitals that choose to not report prices. We cannot differentiate between hospitals that do not report prices and hospitals that do not have urological services available.
Interpretation for Patient Care
Prices for the components of inpatient hematuria evaluations are higher at for-profit hospitals compared to not-for-profit hospitals. Rural residents undergoing hematuria evaluations may face particularly high prices at local facilities, especially if they receive care at for-profits. While the effect of price variation on patient behavior remains unknown, high prices may dissuade individuals from undergoing evaluation and contribute to disparities. Though our study shows a difference of inpatient pricing for the components of hematuria evaluation, future research should compare inpatient and outpatient prices for rural residents. This information may further guide patients about where best to receive care.
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