Patterns of Use of a Price Transparency Tool for Childbirth Among Pregnant Individuals With Commercial Insurance

Association between price transparency and patient decision to complete outpatient imaging

PURPOSE

The impact of price transparency on patients' decisions to receive the recommended care is unclear. This study aimed to assess the utilization rate of hospital price estimator tools for outpatient imaging appointments, and the association between price estimator utilization and subsequent imaging completion.

METHODS

In this retrospective, cross-sectional study, adult patients with scheduled outpatient radiology examinations between August 2022 and 2023 at a single tertiary academic health system were included. Data regarding whether an out-of-pocket cost (OOPC) estimate was generated for the scheduled imaging exam, the estimate generation date, amount, generator (patient vs. staff), the date of first view by patients, appointment status (completed vs. missed appointment), and demographics were extracted. The association between price estimator use and imaging completion was assessed using generalized estimation equation multivariable regression models.

RESULTS

A total of 470,422 imaging encounters (mean age: 55.6 ± 19.1; 57.5 % female; 56.3 % white) were included. Overall, 70,437 (15.0 %) OOPC estimates were generated (99.9 % by hospital staff and 0.1 % by patients). There was a higher number of self-pay patients among those with self-generated (55.8 %) vs. staff-generated (8.9 %) estimates (P < 0.001). The odds of imaging appointment completion were significantly higher when an OOPC estimate was generated (OR,1.91; 95 % CI, 1.87, 1.95), and significantly lower when the estimate was self-generated (OR,0.29; 95%CI, 0.17, 0.51).

CONCLUSION

Price-aware patients with staff-generated cost estimates were more likely to complete imaging. Self-pay patients were more likely to self-generate estimates, which was associated with lower likelihood of completing imaging.

Exploring the Lack of Transparency in Prescription Drug Costs: Contributors and Avenues for Reform

The USA spent $722.5 billion on prescription drugs in 2023. The USA retail prescription drug payment and delivery system is notoriously opaque, which has historically made it nearly impossible for prescribing clinicians and their patients to predict the out-of-pocket cost of a particular drug at the pharmacy. This system involves drug manufacturers (i.e., pharmaceutical companies), insurers, pharmacy benefit managers (PBMs), prescribers (i.e., physicians and advanced practice providers), and consumers (i.e., patients). In this article, we provide a brief overview of the roles of and transactions among each of these entities. We focus in particular on areas where financial transparency is lacking. We then describe several targets for policy reform that gained momentum in the first Trump Administration, the Biden Administration, and the 118th Congress. These targets include increased transparency of pharmacy benefit managers' interactions, improved implementation of clinician-facing out-of-pocket cost estimators such as real-time benefit tools, and disclosure of drug prices to patients via direct-to-consumer pharmacies and direct-to-consumer advertising. Clinicians and their professional societies should use their powerful voices to advocate for increased transparency of a prescription drug system that costs the USA hundreds of billions of dollars each year.

Specialist use among privately insured children with disabilities

OBJECTIVE

To investigate primary care practice ownership and specialist-use patterns for commercially insured children with disabilities.

DATA SOURCES AND STUDY SETTING

A national commercial claims database and the Health Systems and Provider Database from 2012 to 2016 are the data sources for this study.

STUDY DESIGN

This cross-sectional, descriptive study examines: (1) the most visited type of pediatric primary care physician and practice (independent or system-owned); (2) pediatric and non-pediatric specialist-use patterns; and (3) how practice ownership relates to specialist-use patterns.

DATA COLLECTION/EXTRACTION METHODS

This study identifies 133,749 person-years of commercially insured children with disabilities aged 0-18 years with at least 24 months of continuous insurance coverage by linking a national commercial claims data set with the Health Systems and Provider Database and applying the validated Children with Disabilities Algorithm.

PRINCIPAL FINDINGS

Three-quarters (75.9%) of children with disabilities received their pediatric primary care in independent practices. Nearly two thirds (59.6%) used at least one specialist with 45.1% using nonpediatric specialists, 28.8% using pediatric ones, and 17.0% using both. Specialist-use patterns varied by both child age and specialist type. Children with disabilities in independent practices were as likely to see a specialist as those in system-owned ones: 57.1% (95% confidence interval [95% CI] 56.7%-57.4%) versus 57.3% (95% CI 56.6%-58.0%), respectively (p = 0.635). The percent using two or more types of specialists was 46.1% (95% CI 45.4%-46.7%) in independent practices, comparable to that in systems 47.1% (95% CI 46.2%-48.0%) (p = 0.054). However, the mean number of specialist visits was significantly lower in independent practices than in systems-4.0 (95% CI 3.9%-4.0%) versus 4.4 (95% CI 4.3%-4.6%) respectively-reaching statistical significance with p < 0.0001.

CONCLUSIONS

Recognizing how privately insured children with disabilities use pediatric primary care from pediatric and nonpediatric primary care specialists through both independent and system-owned practices is important for improving care quality and value.

Cost communication in cosmetic and reconstructive breast surgery: Public perceptions in the United States

BACKGROUND

There is a need to better understand the financial toxicity of surgery on patients. Recent data demonstrated that plastic surgeons seldom discuss out-of-pocket costs with patients. Not much is known regarding the public perceptions of out-of-pocket cost communication in reconstructive and cosmetic breast surgery.

METHODS

A cross-sectional survey was administered to adult women in the United States from November 2021 to December 2021 using Amazon Mechanical Turk. Perceptions regarding cost communication in plastic surgery were gathered. Incomplete responses were excluded. Multivariable models were used to identify predictors of responses.

RESULTS

There were 512 complete responses. Respondents had a mean age of 37.4 years. The majority strongly agreed or agreed that plastic surgeons should discuss out-of-pocket costs with patients undergoing implant-based breast reconstruction (85%), plastic surgeons should know the impact of surgery on patients' financial well-being (78%), and discussing costs was the most important aspect of the appointment (70%). Respondents who were unsure of their insurance status had lower odds of strongly agreeing or agreeing that surgeons should discuss out-of-pocket costs for autologous reconstruction (OR 0.12, CI 0.02-0.58, p = 0.01) and cosmetic breast augmentation (OR 0.14, CI 0.03-0.65, p = 0.01). Privately insured respondents had greater odds of strongly agreeing or agreeing to both, respectively (OR 2.21, CI 1.32-3.82, p < 0.01; OR 1.94, CI 1.17-3.31, p = 0.01) CONCLUSION: Many laywomen support the cost communication in plastic surgery and believe that plastic surgeons should know the impact of surgery on the patients' financial well-being, with variability among the sociodemographic groups. Plastic surgeons should strongly consider discussing costs with patients undergoing breast surgery.

Estimating the Impact of New Health Price Transparency Policies

This analysis investigates and scores the impact of new health price transparency rules. Using a set of novel data sources, we estimate substantial savings are possible following the implementation of the insurer price transparency rule. Specifically, we estimate annual savings to consumers, employers, and insurers by 2025, assuming a robust set of tools to allow consumers to purchase medical services. We matched claims with 70 HHS defined shoppable services by CPT and DRG codes and replaced them with an estimated median commercial allowed payment multiplied by a reduced cost of 40% based on estimates found from literature for the difference in cost between negotiated and cash payment for medical services. We consider 40% to be an upper bound estimate of the potential savings based on existing literature. Several databases are used to estimate the potential benefits of insurer price transparency. Two different all-payer claim databases were used, representing the entire insured population in the US. For this analysis, only the private insurer commercial population was examined, comprised of over 200 million covered lives as of 2021. The estimated impact of price transparency will vary significantly by region and income level. The national upper bound estimate is $80.7 billion. The national lower bound estimate is $17.6 billion. For the upper bound, the region with the most significant impact in the US will be the Midwest, with $20 billion in potential savings and an 8% reduction in medical expenditure. The region with the lowest impact will be the South, with only a 5.8% reduction. Concerning income, those at lower levels of income will have the most significant impact with a -7.4% (<100% Federal Poverty Level) to -7.5% (100%-137% Federal Poverty Level) impact. Overall, the total impact could be a 6.9% reduction for the whole privately insured population in the United States. In summary, a unique set of national data resources were used to estimate the cost savings impact medical price transparency. This analysis suggests price transparency for shoppable services may yields significant savings between $17.6 to $80.7 billion by 2025. Consumers may have strong incentives to shop with the rise in the use of high deductibles, health plans, and health savings accounts. How these potential saving are to be shared by consumers, employers and health plans has yet to be determined.

Piloting use of an out-of-pocket cost tracker among gynecologic cancer patients

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Due to lack of cost transparency, an out-of-pocket cost tracker is a tool for patients to manage their costs of care.

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44% of participants in a financial toxicity study voluntarily used an out-of-pocket cost tracker.

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Among users, high rates of satisfaction with ease of use and helpfulness, but lower rates of satisfaction for budgeting.

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Among submitted cost trackers, non-medical costs had the highest monthly out-of-pocket costs (mean $213, max $587).

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User feedback included suggestion to add educational tutorials and reminder systems.

Objective

Our objective was to evaluate uptake and satisfaction with an out-of-pocket (OOP) cost tracker as a means for cancer patients to manage their personalized costs of care and to identify characteristics associated with usage.

Methods

Within a longitudinal survey evaluating financial toxicity among gynecologic cancer patients on active systemic therapy over a 6-month period, we provided paper worksheets for participants to voluntarily track expenses. We assessed usage and satisfaction at 3 and 6 months using frequency and percentage. We used Fisher’s exact test and Wilcoxon rank sum analysis to evaluate patient characteristics based upon usage. Participants were encouraged to submit their completed cost tracker worksheets.

Results

Fifty-three of 121 (44%) participants reported ever using the OOP cost tracker. Most users reported it was easy to use (97%, 100%) and helpful (86%, 72%); however, fewer users rated it as useful for budgeting (42%, 26%) at 3 and 6 months, respectively. More patients who knew their insurance premium were users compared to non-users (74.4% vs. 54.4%, p = 0.04). Among thirteen users who submitted their completed cost tracker worksheets, non-medical costs (i.e., transportation) had the highest monthly out of pocket costs (mean $213, range $0–587). User feedback included suggestions to enhance the cost tracker with educational tutorials or a reminder system.

Conclusions

Future studies should explore if cost tracker uptake and satisfaction are enhanced with the addition of reminders and whether usage decreases financial toxicity or increases patient self-efficacy in managing the costs of cancer care.