Are hospitals disclosing prostate cancer service costs?

Hospitals aren't necessarily disclosing prostate cancer service costs, despite a 2021 mandate issued by the U.S. Centers for Medicare and Medicaid Services (CMS), a January 30 study published in Prostate Cancer Prostatic Disease has found.

Price transparency for medical care -- including for prostate cancer services such as prostate MRI -- is essential for patients, especially in a time when out-of-pocket payments are increasing, wrote a team led by Dr. Aaron Brant of New York-Presbyterian Hospital in New York City.

"The pricing of prostate cancer-related care is of importance to patients, healthcare providers, and policy makers, with particular interest in self-pay prices that uninsured and underinsured patients may face," the group wrote.

As of January 2021, the CMS has required U.S. hospitals to make public the prices of their services, but it appears that not all hospitals are complying with the mandate, the researchers noted. They conducted a study that assessed publicly disclosed prices of such services as prostate-specific membrane antigen (PSMA) testing, prostate MRI, biopsy, prostatectomy, and intensity-modulated radiation therapy for the month of May 2022; adjusted prices by region; and compared disclosing to nondisclosing hospitals.

The study consisted of data taken from the Turquoise Hospital Price Transparency Dataset, and it included 6,013 hospitals, 64% of which disclosed pricing for at least one prostate cancer-related service. The team found that hospitals that disclosed prostate cancer service prices had higher median gross annual revenue compared to those that did not, and were more likely to be nonprofit, academic, and located in areas with fewer hospitals in general (that is, less than two hospitals per zip code or less than three per city).

It also found that disclosure rates were highest for total prostate-specific antigen testing (61%) and prostate MRI (57%), and lowest for prostate biopsy (35%), intensity-modulated radiation therapy (29%), and radical prostatectomy (17%).

In terms of nondisclosing versus disclosing hospital characteristics, the team discovered the results illustrated in the following table.

Characteristics of hospitals disclosing cost of prostate cancer services compared to nondisclosing hospitals*
Metric	Nondisclosing hospitals	Disclosing hospitals
Median gross annual revenue	$62.9 million	$318.5 million
Nonprofit	30%	56%
Academically affiliated	13%	46%
In a neighborhood with low hospital density	62%	68%

*All results statistically significant

The group also reported that self-pay prices were higher than insurance-negotiated costs for all services except prostate biopsy (p < 0.001). Cost range was widest for self-pay prostatectomy, with a 32-fold difference (self-pay, $47,445; insurer paid, $1,476).

The team had hypothesized that neighborhoods with higher hospital density would have higher rates of price disclosure and lower pricing of services, but this did not turn out to be the case, "suggesting that local competition does not lead to lower prices and may disincentivize disclosure of prices," the group noted.

The team conceded that the study is not the first to show that self-pay costs for healthcare are higher than insurer costs, but the authors claimed that it is "the first to demonstrate higher self-pay prices for prostate cancer care in the era of hospital price transparency."