Mandated Price Transparency: Should Those in Glass Houses Throw Stones?

[elementaryschooleconomics]

Alright Ivory Tower academics, with your palliative radiation networks and your Choosing Wisely campaigns. This gentleman just started Tweeting this:

He's compiling Radiation Oncology CPT codes (among others) across different institutions. High res versions:

I don't have access to all the CPT codes at my fingertips, but ASTRO has their chart: LINK

Salient codes:

77385, 77386 - IMRT treatment delivery

77307 - Teletherapy isodose plan

77301 - IMRT dose planning

77470 - Special treatment procedure

Some highlights (apologies if I'm wording this wrong, still trying to digest this):

1) Einstein's IMRT dose planning charge clocking in 471% above average

2) MedStar hitting 554% above average for teletherapy isodose planning

3) Fox Chase with their 439% above average for IMRT treatment delivery

4) While Florida sports the relatively frugal 260% above average IMRT treatment delivery charge

Awesome.

---

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[Chartreuse Wombat]

I don't have a Twitter account but the tweeter is an interesting character. Google him.

 

[medgator]

I don't have a Twitter account but the tweeter is an interesting character. Google him.

He's a compliance/billing speaker?

 

[Chartreuse Wombat]

He is a radiation therapist with an Master's in Health Admin. Interesting career path.

 

[kimplera]

knowing these numbers, imho, is worse than not knowing them for patients. what is important is what their costs are - these are all negotiated in bundles so lower costs for one code may be offset by higher costs for another and then are often discounted in non-transparent ways.

 

[DoctwoB]

How did he get this data? Isn’t the negotiated rate between healthcare systems and insurers proprietary and closely guarded?

 

[elementaryschooleconomics]

How did he get this data? Isn’t the negotiated rate between healthcare systems and insurers proprietary and closely guarded?

As I recall, this was some sort of legislation passed at the Federal level mandating all hospitals release this info in sort of an "informed consumer" argument.

From the CMS Website:

 

[elementaryschooleconomics]

Oh this is fun.

Let's see, who's someone who says the RadOnc job market is fine and we're all misanthropic loons? Hmm, oh that's right Dr Randall, Chair of Kentucky RadOnc.

Let's Google "university of kentucky medical center price transparency".

And you find this website.

If you download the "UK HealthCare Rates" Excel file, you can search for CPT codes. I searched for "77385". Many RadOnc codes pop up, with their corresponding charge:

Of note:

77371 MSRADIOSURG DELIVERY $79,422.00
77373 STEREOTACTIC BODY TX DEL $9,659.00
77385 TOMO (IMRT&CT) BRST/PRST SIMP $4,028.00
77386 TOM0(IMRT & CT)ALL OTHER SITES $4,198.00

So they're charging $4,198 for 77386? "Medicare Allowable" appears to be $542. That's 675% beyond Medicare!

Lemme tell you, at these prices, I'd certainly try to fill my department with Radiation Oncology residents, pay them $50-$70k/year, and demand "MORE DATA" if anyone tells me there's job market issues.

(looking at this, I'm not sure if this is the same type of data that Jordan Johnson was working with, and he says there's only 60% compliance with this CMS rule currently, so perhaps we'll get better data in the future)

 

[fiji128]

How did he get this data? Isn’t the negotiated rate between healthcare systems and insurers proprietary and closely guarded?

It was an executive order through the Trump administration. It was fought in the courts but the health systems and insurance companies lost.

 

[deleted941485]

It was an executive order through the Trump administration. It was fought in the courts but the health systems and insurance companies lost.

Trump is out. And GA will go Dem. banking on nonenforcement.

Besides these numbers are a fantasy anyway. If these were really being paid FCCC would have bought the Ritz Carlton and put patients up with their own chauffeur.

 

[RickyScott]

Trump is out. And GA will go Dem. banking on nonenforcement.

Besides these numbers are a fantasy anyway. If these were really being paid FCCC would have bought the Ritz Carlton and put patients up with their own chauffeur.

They are not fantasy. I have posted for years 3-5x actual prices are being recovered at places like MSKCC ,MDACC, UPENN etc. They essentially are essentially monopolies and can charge what they want, and insurers dont really care, because for most plans, they are middle-men take a cut of the transaction like a real estate agent.

 

[scarbrtj]

Oh this is fun.

Let's see, who's someone who says the RadOnc job market is fine and we're all misanthropic loons? Hmm, oh that's right Dr Randall, Chair of Kentucky RadOnc.

Let's Google "university of kentucky medical center price transparency".

And you find this website.

If you download the "UK HealthCare Rates" Excel file, you can search for CPT codes. I searched for "77385". Many RadOnc codes pop up, with their corresponding charge:

View attachment 326644

Of note:

77371 MSRADIOSURG DELIVERY $79,422.00
77373 STEREOTACTIC BODY TX DEL $9,659.00
77385 TOMO (IMRT&CT) BRST/PRST SIMP $4,028.00
77386 TOM0(IMRT & CT)ALL OTHER SITES $4,198.00

So they're charging $4,198 for 77386? "Medicare Allowable" appears to be $542. That's 675% beyond Medicare!

Lemme tell you, at these prices, I'd certainly try to fill my department with Radiation Oncology residents, pay them $50-$70k/year, and demand "MORE DATA" if anyone tells me there's job market issues.

(looking at this, I'm not sure if this is the same type of data that Jordan Johnson was working with, and he says there's only 60% compliance with this CMS rule currently, so perhaps we'll get better data in the future)

At these prices, if you can get close to that reimbursement (I have no idea if you can).... there is ****zero**** negative ramification from seeing a drop-off in patient numbers and fractions the last ten years. I.e. "oversupply" does not exist. (Ed. note: it's not the case outside academics.) I have been telling stories about a man getting shot with a .357, and it was fake news. I have been information-poor which is one of the worst feelings I really ever have.

 

[RickyScott]

At these prices, if you can get close to that reimbursement (I have no idea if you can).... there is ****zero**** negative ramification from seeing a drop-off in patient numbers and fractions the last ten years. I.e. "oversupply" does not exist. (Ed. note: it's not the case outside academics.) I have been telling stories about a man getting shot with a .357, and it was fake news. I have been information-poor which is one of the worst feelings I really ever have.

Exactly, these centers can hire 3X more faculty and administrators than they need, deliver Protons at IMRT prices (and still make a ---load), and pay their chairmen like Mike Steinberg 1 million dollars per year. We havent seen the big guns yet- MDACC, MSKCC etc!

 

[medgator]

Trump is out. And GA will go Dem. banking on nonenforcement.

Besides these numbers are a fantasy anyway. If these were really being paid FCCC would have bought the Ritz Carlton and put patients up with their own chauffeur.

I think some stuff will stick, hopefully this will

 

[scarbrtj]

Exactly, these centers can hire 3X more faculty and administrators than they need, deliver Protons at IMRT prices (and still make a ---load), and pay their chairmen like Mike Steinberg 1 million dollars per year. We havent seen the big guns yet- MDACC, MSKCC etc!

What really gets me is “we” (not me) fell for it. As in felt a little ashamed with stuff like “private practice over fractionates” or “choose wisely no IMRT for breast.” This would have been like Harvey Weinstein emceeing a Stop The Violence Against Women fundraiser in 2000. And it’s also like going into Stanford and seeing their multimillion dollar artwork collection throughout the hospital. Are people really that gullible. I guess so. Soylent Green!

 

[RadOncDoc21]

What really gets me is “we” (not me) fell for it. As in felt a little ashamed with stuff like “private practice over fractionates” or “choose wisely no IMRT for breast.” This would have been like Harvey Weinstein emceeing a Stop The Violence Against Women fundraiser in 2000. And it’s also like going into Stanford and seeing their multimillion dollar artwork collection throughout the hospital. Are people really that gullible. I guess so. Soylent Green!

As a new grad I was gullible and truly preached what I was taught. After experiencing and seeing how the ASTRO leaders practice I realized their goals did not align with mine and were actually negatively impacting me.

 

[RickyScott]

What really gets me is “we” (not me) fell for it. As in felt a little ashamed with stuff like “private practice over fractionates” or “choose wisely no IMRT for breast.” This would have been like Harvey Weinstein emceeing a Stop The Violence Against Women fundraiser in 2000. And it’s also like going into Stanford and seeing their multimillion dollar artwork collection throughout the hospital. Are people really that gullible. I guess so. Soylent Green!

can agree more, and why I obsessively post here.

 

[RickyScott]

The fine for failing to post negotiated prices is 300$/day. Some hospitals- MDACC have stated that under no circumstances will they post! Hopefully they raise the fine soon?

 

[OTN]

Trump is out. And GA will go Dem. banking on nonenforcement.

Besides these numbers are a fantasy anyway. If these were really being paid FCCC would have bought the Ritz Carlton and put patients up with their own chauffeur.

They absolutely are NOT fantasy. I have been in discussion with insurers where they state that MDACC's charges/costs are 5x higher than ours, with equivalent outcomes. (They actually do track cancer outcomes, believe it or not.) They also do care, which is why several insurers do not contract with MDACC and others are investigating the possibility of "incentivizing" their patients to go elsewhere.

Given all this, the hypocrisy of Choosing Wisely is astounding, as is the arrogance of academicians who believe they have some sort of mandate to talk to the rest of us about financial toxicity. Get your own house in order before you start poking around mine.

 

[deleted941485]

They absolutely are NOT fantasy. I have been in discussion with insurers where they state that MDACC's charges/costs are 5x higher than ours, with equivalent outcomes. (They actually do track cancer outcomes, believe it or not.) They also do care, which is why several insurers do not contract with MDACC and others are investigating the possibility of "incentivizing" their patients to go elsewhere.

Given all this, the hypocrisy of Choosing Wisely is astounding, as is the arrogance of academicians who believe they have some sort of mandate to talk to the rest of us about financial toxicity. Get your own house in order before you start poking around mine.

I agree that academic centers have shielded themselves from the policy changes they support.

 

[fiji128]

Maybe choosing wisely should also include something about avoiding unnecessarily high cost care at academic centers when other local options are available.

 

[RickyScott]

Trump is out. And GA will go Dem. banking on nonenforcement.

Besides these numbers are a fantasy anyway. If these were really being paid FCCC would have bought the Ritz Carlton and put patients up with their own chauffeur.

California attorney general replacing azar secured huge settlement against sutter health and exposed how hospital prices in northern ca were double that in southern ca!

 

[scarbrtj]

The fine for failing to post negotiated prices is 300$/day. Some hospitals- MDACC have stated that under no circumstances will they post! Hopefully they raise the fine soon?

They're applying The Formula. If your revenue is $11,200 per minute, $300/day ain't so bad.

 

[Reaganite]

At these prices, if you can get close to that reimbursement (I have no idea if you can).... there is ****zero**** negative ramification from seeing a drop-off in patient numbers and fractions the last ten years. I.e. "oversupply" does not exist. (Ed. note: it's not the case outside academics.) I have been telling stories about a man getting shot with a .357, and it was fake news. I have been information-poor which is one of the worst feelings I really ever have.

Exactly!!! This is why satellite expansion is so easy for these guys. It's almost impossible for them to fail. They get paid sooooo much per patient they can keep a center open with a handful of patients. There are academic satellites that have a NNT to break even of low single-digit patients. I have heard some centers turn a profit on as few as 5 patients on treat. That may sound crazy but it's really not if you're making 2-3k per IMRT fraction or 50 k for SRS. So these guys can literally expand at will and just sit around with low patient volumes turning a profit waiting for their private practice competitor in town to retire or eventually sell out...then boom they expand their monopoly.

 

[RickyScott]

Transparency in Pricing - Penn Medicine

Access the Charge Description Master (CDM), a list of standard charges made available to provide pricing transparency for each of our hospitals

www.pennmedicine.org

Power of a monopoly is staggering. Please dig in- this is just cursory look
Daily delivery charge stereo 77373 (charge per fraction up to 5 fractions!)
1200% X cms.
ex:

STEREOTACTIC BODY RADIATION DELIVERY 77373

$56,291.27 avg​

$1,870.32 cms​

$7,411.73 aetna hmo​

$1,982.54 aetna medicare​

$51,490.00 ibc hmo​

$51,490.00 ibc ppo​

$1,870.32 ibc medicare​

$19,139.03 cigna​

$1,926.43​

$1,012.40​

$2,019.95​

$1,860.00​

$1,982.54​

$1,850.00​

$15,761.56​

$25,331.07​

$1,870.32​

$27,582.72​

$1,982.54​

77338

CHG MLC IMRT DESIGN & CONSTRUCTION PER IMRT PLAN

$8,843.90 avg​

$354.46 cms​

$2,942.29​

$375.73​

$549.80​

$549.80​

$354.46​

$3,006.93​

$365.10​

$150.80​

$382.82​

$4,421.95​

$375.73​

$400.01​

$2,476.29​

$3,979.75​

$354.46​

$4,333.51​

$375.73​

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg​

$1,317.07 cms​

$2,841.95​

$1,396.10​

$12,414.79​

$12,414.79​

$1,317.07​

$9,478.28​

$1,356.59​

$545.42​

$1,422.44​

$597.92​

$1,396.10​

$594.70​

$7,805.64​

$12,544.79​

$1,317.07​

$13,659.88​

$1,396.10​

77386

CHG INTENSITY MODULATED RADIATION TX DLVR COMPLEX

$14,416.11 avg​

$569.87 cms​

$2,399.87​

$604.06​

$3,113.00​

$3,113.00​

$569.87​

$4,901.48​

$586.96​

$309.74​

$615.46​

$529.15​

$604.06​

$526.31​

$4,036.51​

$6,487.25​

$569.87​

$7,063.89​

$604.06​

77385

CHG INTENSITY MODULATED RADIATION TX DLVR SIMPLE

$14,404.39 avg​

$569.87 cms​

$2,392.34​

$604.06​

$3,113.00​

$3,113.00​

$569.87​

$4,897.49​

$586.96​

$309.74​

$615.46​

$499.97​

$604.06​

$497.28​

$4,033.23​

$6,481.98​

$569.87​

$7,058.15​

$604.06​

77523

PROTON TX DELIVERY \INTERMEDIATE

$21,866.80 avg​

$1,318.57 cms​

$13,678.26​

$1,397.69​

$3,115.00​

$3,115.00​

$1,318.57​

$7,434.71​

$1,358.13​

$1,149.64​

$1,424.06​

$548.25​

$1,397.69​

$1,488.01​

$6,122.70​

$9,840.06​

$1,318.57​

$10,714.73​

$1,397.69​

77336

CONTINUING MEDICAL PHYSICS CONSLTJ PR WK

$1,583.54 avg​

$133.89 cms​

$443.80​

$141.92​

$240.29​

$240.29​

$133.89​

$538.40​

$137.90​

$61.53​

$144.60​

$91.14​

$141.92​

$90.65​

$443.39​

$712.59​

$133.89​

$775.94​

$141.92​

77334

TX DEVICES DESIGN & CONSTRUCTION COMPLEX

$3,464.35 avg​

$354.46 cms​

$881.26​

$375.73​

$1,212.87​

$1,212.87​

$354.46​

$1,177.88​

$365.10​

$114.46​

$382.82​

$102.30​

$375.73​

$101.75​

$970.02​

$1,558.96​

$354.46​

$1,697.53​

$375.73​

77280

THER RAD SIMULAJ-AIDED FIELD SETTING SIMPLE

$2,893.81 avg​

$133.89 cms​

$1,602.17​

$141.92​

$1,373.06​

$1,373.06​

$133.89​

$983.90​

$137.90​

$61.53​

$144.60​

$67.89​

$141.92​

$67.53​

$810.27​

$1,302.21​

$133.89​

$1,417.97​

$141.92​

77470

SPECIAL TREATMENT PROCEDURE

$9,598.61 avg​

$569.87 cms​

$903.26​

$604.06​

$4,851.49​

$4,851.49​

$569.87​

$3,263.53​

$586.96​

$225.66​

$615.46​

$39.99​

$604.06​

$39.78​

$2,687.61​

$4,319.37​

$569.87​

$4,703.32​

$604.06​

77301

NTSTY MODUL RADTHX PLN DOSE-VOL HISTOS

$17,078.16 avg​

$1,317.07 cms​

$11,554.66​

$1,396.10​

$12,414.79​

$12,414.79​

$1,317.07​

$5,806.57​

$1,356.59​

$545.42​

$1,422.44​

$1,316.56​

$1,396.10​

$1,309.49​

$4,781.89​

$7,685.17​

$1,317.07​

$8,368.30​

$1,396.10​

 

[fiji128]

All this junk academic research that is being pushed out of these departments needs to have a disclaimer explaining how their department, and by extension the authors themselves, benefit finically. I'm thinking specifically of Mayo's 3 fraction breast to name just one.

 

[RickyScott]

you can hire a lot of faculty (to sit around) at these rates...

 

[RickyScott]

knowing these numbers, imho, is worse than not knowing them for patients. what is important is what their costs are - these are all negotiated in bundles so lower costs for one code may be offset by higher costs for another and then are often discounted in non-transparent ways.

lists have all the common charges, so you can quickly see if they are taking a hit somewhere else ... and they dont appear to be.

 

[deleted941485]

Maybe choosing wisely should also include something about avoiding unnecessarily high cost care at academic centers when other local options are available.

But But But...they do pallaitive RT so much better and they should be involved with the treatment decisions.

 

[RickyScott]

But But But...they do pallaitive RT so much better and they should be involved with the treatment decisions.

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg

$1,317.07 cms

How much does penn recover for 8 gy x1? 28k for this one charge alone.

 

[Chartreuse Wombat]

77295

3-D RADIOTHERAPY PLAN DOSE-VOLUME HISTOGRAMS

$27,877.30 avg

$1,317.07 cms

How much does penn recover for 8 gy x1?

8 Gy times one in my practice is 2D

 

[RickyScott]

8 Gy times one in my practice is 2D

Did not see isodose charge listed, but we can safely say it is exorbitant...

 

[Chartreuse Wombat]

Did not see isodose charge listed, but we can safely say it is exorbitant...

Indeed. I think UPenn was in the APM. Reprieve for now but how much longer

 

[RickyScott]

Their apm prices will still be 10x cms

 

[Chartreuse Wombat]

Their apm prices will still be 10x cms

Not sure what you are arguing. CMS will pay them the published rate for the diagnosis (no way around it for a Medicare patient). They could try and negotiate higher rates with private payers but that is becoming less common and payors move to shared risk and full risk capitated models. The dozen or so "exempt" hospitals will be immune but I don't think Penn is one of them (link below)

PPS-Exempt Cancer Hospitals (PCHs) | CMS

Medicare PPS Excluded Cancer Hospitals.

www.cms.gov

 

[RickyScott]

Not sure what you are arguing. CMS will pay them the published rate for the diagnosis (no way around it for a Medicare patient). They could try and negotiate higher rates with private payers but that is becoming less common and payors move to shared risk and full risk capitated models. The dozen or so "exempt" hospitals will be immune but I don't think Penn is one of them (link below)

PPS-Exempt Cancer Hospitals (PCHs) | CMS

Medicare PPS Excluded Cancer Hospitals.

www.cms.gov

Arguing that Private payers will continue to pay them huge multiples of cms prices under apm. Private payers don’t like to take on shared risk- they would much rather take a commission on the transaction. Shared risk/capitated plans often don’t permit pts to be treated at very expensive centers.

 

[Chartreuse Wombat]

Arguing that Private payers will continue to pay them huge multiples of cms prices under apm. Private payers don’t like to take on shared risk- they would much rather take a commission on the transaction. Shared risk/capitated plans often don’t permit pts to be treated at very expensive centers.

In my part of the world that is changing dramatically (Southeast, Top 20 USNWR Hospital). I am on the contracting committee for the group and private payers are refusing to pay multiples of Medicare and many are "excluding" expensive centers. The commission model is dying and as we move to national coverage (made more likely with the events of the day) this trend will accelerate

 

[RickyScott]

In my part of the world that is changing dramatically (Southeast, Top 20 USNWR Hospital). I am on the contracting committee for the group and private payers are refusing to pay multiples of Medicare and many are "excluding" expensive centers. The commission model is dying and as we move to national coverage (made more likely with the events of the day) this trend will accelerate

I hope that is the future.

 

[Chartreuse Wombat]

I hope that is the future.

It is certainly the future in my part of the world

 

[Reaganite]

Any chance we can find out the members of the committees behind "choosing wisely"? Looked for names but only saw "committees" listed. Would be nice to link their recommendations to their institutional charges. Might make a nice letter to the editor in the red journal.

 

[RickyScott]

Living like a rockstar: disclosure of actual prices begs question: shouldn’t these places be making much more than a billion or so per year. Important to understand hey are not set up like a public or private company and the executives can only earn so much. What’s an administrator to do: spend, over -hire other administrators to do his job, build, and mismanage.

MD Anderson Cancer Center's financial woes deepen

MD Anderson Cancer Center lost another $58 million in December, according to the center's...

www.chron.com

 

[medgator]

 

[evilbooyaa]

Ballsy move for another attending in academics. Wonder if UCSD posted their numbers publicly

 

[medgator]

Ballsy move for another attending in academics. Wonder if UCSD posted their numbers publicly

Can't be worse than the 11 anointed PPS exempt special places

 

[scarbrtj]

Ballsy move for another attending in academics. Wonder if UCSD posted their numbers publicly

Urbanic's a good guy, will always err on side of speaking a truth versus staying silent

 

[scarbrtj]

Any chance we can find out the members of the committees behind "choosing wisely"? Looked for names but only saw "committees" listed. Would be nice to link their recommendations to their institutional charges. Might make a nice letter to the editor in the red journal.

2021's best idea so far

 

[scarbrtj]

Living like a rockstar: disclosure of actual prices begs question: shouldn’t these places be making much more than a billion or so per year. Important to understand hey are not set up like a public or private company and the executives can only earn so much. What’s an administrator to do: spend, over -hire other administrators to do his job, build, and mismanage.

MD Anderson Cancer Center's financial woes deepen

MD Anderson Cancer Center lost another $58 million in December, according to the center's...

www.chron.com

I guess they don't **really** want to make cancer history (the "going away" part of MDACC's trademarked verbal double entendre). It'd make them go bankrupt. There's a young newly minted academic rad onc I follow on Twitter whose byline is something like "trying to put myself out of a job on a daily basis!" What a nice, doubt-you-honestly-have-thought-through-all-the-ramifications-of-that sentiment.

 

[RickyScott]

Wanted to update the thread: Duke posted data that is not very accessible but you can search it for the codes: Maximum charge/price per code is at the far right; they are de-identifying the insurers.

What Duke Health Charges

Download Duke Hospitals’ average charges and average patient payments for inpatient admissions and procedures and frequently used outpatient services.

www.dukehealth.org

​ 77372​ 33300046​ 333​ HC STEREO RADSURG COMPL 1 TX 21,831.00​ - 17,792.27​ 77373​ 33300048​ 333​ HC STEREO RADSURG/SBRT TX UP TO 5FX 16,056.00​ - 13,085.64​

​

​

​

​

 

[DireMoose]

What are those unanswered questions?

 

[OTN]

I have two:
1. What does MSKCC charge and collect for different radiotherapy services?
2. Why does MSKCC think it's ok to hide these prices from everyone?