Price, outcomes of CABG do not appear to be correlated
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Key takeaways:
- The price of CABG was not associated with adverse outcomes or CMS or patient rankings.
- Cost was higher at investor-owned and teaching hospitals and centers in the Pacific region.
The price of coronary artery bypass graft surgery varies widely across the U.S., with investor-owned and major teaching hospitals conferring greater cost, researchers reported.
However, CABG cost was not associated with significant differences in readmission, mortality, CMS ranking or patient rating, according to a study published in the Journal of the American Heart Association.
“Since the enactment of the new price transparency legislation, multiple studies have documented substantial variation in payer-negotiated prices across a broad spectrum of medical services, including diagnostics, procedures and prescription drugs. However, little has been published in the cardiovascular field, despite its contribution to overall U.S. health care spending,” Chen Wei, MD, MBA, internal medicine resident at Stanford University School of Medicine, and colleagues wrote. “Insurer-negotiated prices for inpatient cardiovascular care remains understudied. Furthermore, important questions remain unanswered about the association between price and quality of care.”
Variation of CABG price
Wei and colleagues reported that in 2019, approximately 160,000 CABG procedures were performed, 60,000 of which were paid for by Medicare — totaling more than $12 billion — and approximately 100,000 procedures were reimbursed by commercial insurance.
“CABG is a cornerstone in the management of coronary artery disease,” the researchers wrote. “Because CABG is a common and high-cost procedure, it is important to understand how the price for CABG varies across hospitals and how this variation relates to quality of care.”
Wei and colleagues used the Turquoise Health database of listed hospital prices to assess variation in CABG procedure prices across U.S. hospitals; compared commercial and self-pay prices with Medicare; and investigated the association of CABG cost with hospital characteristics and quality of care metrics.
The present study included 544 U.S. hospitals compliant with the 2021 Hospital Price Transparency Rule, which represents 52.4% of all hospitals that offer CABG.
The researchers observed median commercial ($57,240) and self-pay rates ($75,047) for CABG were up to 2.01 and 2.64 times higher compared with Medicare rates ($28,398), respectively.
Within price-transparent hospitals, 90th percentile insurer-negotiated CABG prices were 1.83 times higher compared with 10th percentile prices, and the 90th percentile commercial rate was 2.91 times higher compared with the 10th percentile hospital rate, according to the study.
Regional hospital prices varied widely, from a median of $35,624 for CABG in the East South Central region to $84,080 in the Pacific region.
After multivariable analysis, Wei and colleagues reported that major teaching (+$8,653) and investor-owned hospital status (+$12,200) were associated with higher CABG cost compared with other kinds of hospitals.
Moreover, CABG price was not associated with CABG-specific 30-day readmission, 30-day mortality or hospital-wide mortality, nor was it associated with Hospital Consumer Assessment of Healthcare Providers and Systems patient ratings or CMS overall hospital ratings, the researchers wrote.
Results ‘raise more questions than answers’
“Economists often relate price and quality, with consumers seeing price as a proxy for quality. In this study, we found that the commercial health plan price for CABG was not significantly associated with the quality of care across several important metrics of hospital quality,” the researchers wrote. “Rather, price was associated with hospital characteristics including major teaching status, investor ownership and hospital-wide volume.
“The policy community has been keen to examine the data provided by the Hospital Price Transparency Rule to gain greater insight into the functioning of this market. These results seem to raise more questions than answers to these larger policy questions,” they wrote. “This variation could be related to underlying negotiation relationships between health plans and hospitals or could represent a significant inefficiency on the part of health plan negotiations. The source of this variation requires further study.”
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