Discrepancy Between Chargemaster Prices and Hospital Quality for Cataract Surgery

Area of Science:

• Health Economics
• Healthcare Policy
• Ophthalmology

Background:

• The U.S. has one of the world's most expensive healthcare systems, with cataract surgery being a major cost driver.
• Hospital chargemasters were mandated in 2018 to increase price transparency and reduce healthcare spending.
• Cataract surgery is a standardized procedure with predictable costs, making it suitable for price analysis.

Purpose of the Study:

• To analyze pricing variations for cataract surgery across the United States.
• To determine the relationship between listed chargemaster prices and hospital characteristics or quality.

Main Methods:

• A cross-sectional study analyzed 825 downloadable hospital chargemasters from California, Massachusetts, Mississippi, New York, and Ohio in Spring 2019.
• An electronic search algorithm extracted pricing data for cataract procedures using CPT codes (66984, 66982) and specific search terms.
• Hospital characteristics, including CMS Star Quality Rating, type, ownership, and location, were collected.

Main Results:

• Significant price variations for cataract surgery were found across the five states (P < 0.001).
• California hospitals listed the highest median prices ($3,240.0), while Ohio hospitals listed the lowest ($1,268.6), an 87% difference.
• Hospitals with the highest Centers for Medicare & Medicaid Services (CMS) 5-star quality rating had the lowest median listed prices ($1,938.0).

Conclusions:

• Cataract surgery prices demonstrate substantial geographic and hospital-type variability within the U.S. healthcare system.
• The highest quality-rated hospitals surprisingly listed lower cataract surgery prices, indicating a disconnect between cost and quality.
• Further investigation into hospital chargemaster pricing is warranted to identify cost-saving opportunities without impacting care quality.