Do New Hospital Price Transparency Regulations Reflect Value in Arthroplasty?

Taylor D'Amore, MD; Graham S. Goh, MD; P. Maxwell Courtney, MD; Gregg R. Klein, MD


J Am Acad Orthop Surg. 2022;30(8):e658-e663. 

In This Article


The top 101 orthopaedic hospitals per the US News & World Report (USNWR) 2020–2021 rankings were identified from the US News website.[9] Institutional Review Board approval was not required for this study. Before initiating data collection, all history and caches were deleted from the personal computers used. Each hospital website was explored by two independent observers to assess compliance with the new CMS price transparency requirement. Specifically, five variables that were part of the requirement were recorded in a data collection sheet, namely, gross inpatient charge, discounted cash price, payer-specific negotiated charges, and deidentified maximum and minimum payer rates for THA and TKA.[5] Most frequently, THA and TKA information was combined together under Diagnosis Related Group (DRG) 470: Major Joint Replacement or Reattachment of Lower Extremity Without Major Complication or Comorbidity. In addition, as part of the CMS requirement, hospital compliance with posting both a machine-readable file and a consumer-friendly display of the information was assessed. To fulfill the machine-readable file component, a digital file must be posted which is digitally searchable and saved under one of three specific file types (json., xml., and csv). The consumer-friendly display of information must include plain language descriptions of each service and allow a healthcare consumer to estimate the amount they will be obligated to pay the hospital for the shoppable service.[6] In cases where the discounted cash price was not available for a particular hospital, but a patient price estimator tool was available, that value was used as the cash price. All information obtained was publicly available on hospital websites, and data were collected through March 25, 2021. To assess clinical outcomes, the Medicare website was accessed and CMS risk-adjusted complication and readmission rates for THA and TKA were recorded for each hospital.[10] Mean reimbursement was also extracted from the Medicare website, which was used to calculate the charge-to-reimbursement ratio (mean inpatient charge for DRG 470/Medicare reimbursement) for each hospital.

A subanalysis was conducted by dividing the cohort into tiers: top-tier, middle-tier, and bottom-tier hospitals. Price transparency compliance rates, magnitude of charge differences reported, and clinical outcomes were compared among the three groups.

Continuous data were expressed for mean and standard deviation, whereas categorical data were expressed for count number and percentage. Spearman correlation was used to determine the relationship between USNWR hospital rank and average charge, whereas Pearson correlation was used to determine the relationship between charges and clinical outcomes. Statistical analyses were conducted using the SPSS 20.0 (SPSS) software package. A P value of <0.05 was used to define statistical significance.