# One-Tenth of the Top 50 Pediatric Orthopedic Hospitals Provide Compliant Price Transparency Information for 15 Common Pediatric Orthopedic Procedures

## TL;DR

Only 10% of the top 50 U.S. pediatric orthopedic hospitals fully comply with federal price transparency rules, and procedure costs vary widely.

## Contribution

This study evaluates compliance with CMS price transparency mandates among top pediatric orthopedic hospitals and quantifies pricing variation.

## Key findings

- Only 10% of the top 50 hospitals fully complied with CMS price transparency guidelines.
- Pricing for procedures like arthroscopic Bankart repair varied from $3,012 to $109,320.
- Most hospitals failed to provide all required price types (cash, gross, and payer-negotiated charges).

## Abstract

Introduction

In 2019, Centers for Medicare and Medicaid Services (CMS) mandated hospitals to provide publicly available chargemasters to aid in transparency of pricing for hospital procedures. Despite the mandate, many orthopedic hospitals do not comply with CMS guidelines. The goals of this study are to (1) assess the compliance of the top 50 U.S. children’s orthopedic hospitals with the CMS mandate and (2) analyze variation in pricing for common orthopedic procedures among these hospitals.

Methods

The top 50 pediatric orthopedic hospitals within the United States were selected based on U.S. News and World Report. Fifteen common pediatric orthopedic procedures were then selected based on literature and internal institutional volume. The website of each hospital was searched for the required downloadable chargemaster and/or a user-friendly online tool to provide pricing for each procedure. Compliance was assessed by the ability to find payer-negotiated charges, gross charges, and cash-based cost for each procedure. Hospitals were deemed compliant if they met all guidelines, pseudo-compliant if they met any of the above guidelines, and noncompliant if they met no guidelines.

Results

Only 10% (five of 50) of the hospitals complied with all 15 procedures, while an additional 32% (16 of 50) were pseudo-compliant for at least one of the specific procedures searched. A total of seven hospitals listed cash prices, 10 hospitals listed gross charges, and 12 hospitals listed payer-negotiated charges. The widest range for gross charge was Current Procedural Terminology (CPT) code 23462 (arthroscopic Bankart repair), ranging from $3,012 to $109,320. The range of charges dramatically differed from the gross price for all procedures.

Conclusions

Only 10% of the top 50 pediatric orthopedic hospitals in the United States are compliant with the CMS mandate for price transparency. Furthermore, the cost of each procedure varied widely depending on hospital and type of price reported (gross, cash, and payer-negotiated). These substantial shortcomings call for an evaluation of the current strategies being employed to improve price transparency in healthcare.