Presentation Authors: Tyler McClintock*, Cambridge, MA, Matthew Mossanen, Ye Wang, Mahek Shah, Boston, MA, Benjamin Chung, Stanford, CA, Steven Chang, Boston, MA
Introduction: While healthcare expenditures continue to rise within the United States healthcare system, data regarding pricing trends with cost and charge evaluated separately are lacking. Analyzing these values per episode of care over time provides context on how the largely irrational pricing structure of American healthcare relates to escalating spending and how it has responded to cost containment efforts. Here, we utilize the surgical subspeciality of urology as a model for determining procedure-specific charge and cost trends in a large, population-based database.
Methods: We selected all patients who underwent radical prostatectomy, radical nephrectomy, radical cystectomy, partial nephrectomy, extracorporeal shock wave lithotripsy (ESWL), percutaneous nephrolithotomy, ureteroscopy with lithotripsy, and transurethral resection of the prostate from 2005 to 2015 in the Premier Hospital Database. Total charges and costs, as reported by the individual hospitals, were assessed for each unique surgical encounter; median cost and charge were defined for each study year. Additionally, median charge-to-cost ratio (CCR) for each procedure was determined per year. All costs and charges were adjusted to 2016 US dollar.
Results: The reported median cost per encounter for this group of procedures was $6824 in 2005 and gradually trended downward to $5586 in 2015 (p for trend < 0.001). However, with respect to reported charge per encounter, there was a dramatic increase from $20,210 in 2005 to $25,773 in 2015 (p for trend < 0.001). These general trends were observed across subgroup analyses of individual procedures.
Conclusions: These findings demonstrate a stark discordance with respect to trends in cost relative to charge per episode of urologic surgery over the preceding decade, as charges have increased steadily and substantially while hospital reported costs have declined. This could indicate some success in cost containment for surgical episodes of care, though higher hospital charges may be increasingly employed to buttress reimbursement from third party payers and compensate for escalating costs in other areas.