Inter- and Intrahospital Price Variation for Common Cardiovascular Admission Diagnoses, Diagnostic Tests, and...

The 2021 Price Transparency Rule was implemented to increase market competition, facilitate price shopping, and reduce prices and health care costs. We sought to measure inter- and intrahospital variation in prices, measure price variation across payer types, and identify hospital characteristics associated with increased commercial prices for 16 common cardiovascular admission diagnoses, diagnostic tests, and therapeutic procedures.

Prices were obtained from Turquoise Health, a platform that aggregates hospital prices from publicly available machine-readable files, for each diagnosis, test, and procedure based on Current Procedural Terminology (CPT) and Medicare Severity Diagnosis Related Group (DRG) codes. Hospital characteristics were identified using Dartmouth Atlas data. Inter- and intrahospital price variations were measured using ratios. Multivariate linear mixed-effects models were fit to determine the association between hospital characteristics and hospital-level median commercial negotiated rates. We evaluated 1 020 349 unique rates across all diagnoses, tests, and procedures. The median (interquartile range) ratio of maximum to minimum commercial prices within hospitals ranged from 1.71 (1.14-2.53) for syncope and collapse to 3.1 (2.06-4.58) for cardiac valve surgery. Many hospital referral regions had 90th percentile commercial prices 2 to 3 times larger than 10th percentile commercial prices. Nonprofit status and high hospital market concentration were associated with increased commercial prices across all diagnoses, tests, and procedures.

There is significant price variation for common cardiovascular admission diagnoses, tests, and procedures across and within hospitals as well as across payer types. Increased hospital market concentration is associated with increased commercial prices, so efforts to improve market competition alongside improving transparency compliance are warranted.