1130 Price Transparency for Decompressive Laminectomy in the United States

INTRODUCTION: The Transparency in Coverage Final Rule issued by the Centers for Medicare and Medicaid Services aimed to promote price transparency for patients for common medical and surgical services, such as lumbar decompression surgery. METHODS: A cross-sectional analysis was conducted using hospital pricing data for laminectomies (CPT 63005) from the Turquoise Health database including commercial, Medicaid/Medicare, and cash prices. Hospitals that reported both commercial and cash prices were cross-referenced with hospital competition data from the Healthy Marketplace Index. Costs were adjusted using the 2023 Practice Expense Geographic Practice Cost Index. A sub-analysis of hospitals with a cash-to-commercial ratio<2 (CCR<2) was performed to filter out hospitals not detailing true cash prices. RESULTS: Out of 887 hospitals reporting any laminectomy expense, 250 (28.2%) provided commercial and cash prices (full cohort). Among those 250, 69 (27.6%) had CCR<2. Hospitals in the full cohort had median commercial prices of $10,039 (IQR:$5,369-15,122) versus $18,390 (IQR:$10,807-22,314) for those with CCR<2 (p<.001). Full cohort median cash prices were $8,268 (IQR:$4,281-12,295) compared to $5,966 (IQR:$3,943-10,442) for CCR<2 (p<.001). Among the CCR subgroup analysis of patients offering a good-faith cash payment, 100% offered a significant cash discount to the median negotiated commercial rate. Unconcentrated hospital markets had higher median commercial and cash prices compared to hospitals with higher market concentration for both the full cohort and CCR<2. CONCLUSIONS: Only 28% of US hospitals performing laminectomies provided complete pricing data, including charges, cash discounts, and commercial negotiated rates. However, among fully participating hospitals, those facing market competition have reimbursement rates closer to Medicare levels, meaning that competition makes spine surgery pricing more efficient. Median cash discounts were below commercial rates, which potentially allow hospitals/insurers to avoid costly delays and negotiations.