Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA

Objectives Although demand for price transparency in healthcare is growing, variation in private payors’ payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors’ payments to surgeons for cancer resection using data based on fee-...

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Autores principales:	Tasce Bongiovanni, Simon P Kim, Brigid Killelea, Cary P Gross
Formato:	article
Lenguaje:	EN
Publicado:	BMJ Publishing Group 2020
Materias:	Medicine R
Acceso en línea:	https://doaj.org/article/77af1959c14540c59c6d6194002d9ec1
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spelling	oai:doaj.org-article:77af1959c14540c59c6d6194002d9ec12021-11-08T06:00:07ZIs there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA10.1136/bmjopen-2019-0354382044-6055https://doaj.org/article/77af1959c14540c59c6d6194002d9ec12020-10-01T00:00:00Zhttps://bmjopen.bmj.com/content/10/10/e035438.fullhttps://doaj.org/toc/2044-6055Objectives Although demand for price transparency in healthcare is growing, variation in private payors’ payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors’ payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.Setting Fair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation’s largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.Participants We performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.Primary and secondary outcome measures To assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.Results Median allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842–$1760, for lobectomy $326–$3066, for VATS $317–$3307 and for prostatectomy $1716–$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850–$1620; lobectomy $861–$2767; VATS $1024–$3122; and prostatectomy $2286–$3563.Conclusions There is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.Tasce BongiovanniSimon P KimBrigid KilleleaCary P GrossBMJ Publishing GrouparticleMedicineRENBMJ Open, Vol 10, Iss 10 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R
spellingShingle	Medicine R Tasce Bongiovanni Simon P Kim Brigid Killelea Cary P Gross Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
description	Objectives Although demand for price transparency in healthcare is growing, variation in private payors’ payments to surgeons for oncologic resection has not been well characterised. Our aim was to assess variation of private payors’ payments to surgeons for cancer resection using data based on fee-for-service allowed amounts, billed by a large mix of commercial payors and third-party administrators.Setting Fair Health (FH), an independent, not-for-profit organisation that collects and compiles claims data from payors nationwide. FH maintains the nation’s largest repository of privately billed medical and dental claims representing over 125 million covered lives in the USA.Participants We performed a cross-sectional study assessing private payer data for five common types of cancer surgery: simple mastectomy (SM), modified radical mastectomy (MRM), open lobectomy, video-assisted thoracoscopic surgery (VATS) lobectomy and radical prostatectomy during 2012 and 2013.Primary and secondary outcome measures To assess variation across regions, we compared regional median allowed payments. To assess intraregion variability, we evaluated the distribution of regional IQRs of allowed payments.Results Median allowed payments varied substantially across regions. For SM, median allowed payments ranged from $550 in the least expensive to $1380 in the costliest region. For MRM, the range was $842–$1760, for lobectomy $326–$3066, for VATS $317–$3307 and for prostatectomy $1716–$4867. There was also substantial variation within geographic areas. For example, the mean IQRs in surgeon payment within regions were: SM $577 (25th percentile) to $1132 (75th percentile); MRM $850–$1620; lobectomy $861–$2767; VATS $1024–$3122; and prostatectomy $2286–$3563.Conclusions There is a wide range of variation both across and within geographic regions in allowed amounts of surgeon payments for common oncologic resections. Transparency about these allowed amounts may have a profound impact on patient and employer choice and facilitate future assessments of value in cancer care.
format	article
author	Tasce Bongiovanni Simon P Kim Brigid Killelea Cary P Gross
author_facet	Tasce Bongiovanni Simon P Kim Brigid Killelea Cary P Gross
author_sort	Tasce Bongiovanni
title	Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
title_short	Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
title_full	Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
title_fullStr	Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
title_full_unstemmed	Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA
title_sort	is there variation in private payor payments to cancer surgeons? a cross-sectional study in the usa
publisher	BMJ Publishing Group
publishDate	2020
url	https://doaj.org/article/77af1959c14540c59c6d6194002d9ec1
work_keys_str_mv	AT tascebongiovanni istherevariationinprivatepayorpaymentstocancersurgeonsacrosssectionalstudyintheusa AT simonpkim istherevariationinprivatepayorpaymentstocancersurgeonsacrosssectionalstudyintheusa AT brigidkillelea istherevariationinprivatepayorpaymentstocancersurgeonsacrosssectionalstudyintheusa AT carypgross istherevariationinprivatepayorpaymentstocancersurgeonsacrosssectionalstudyintheusa
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Is there variation in private payor payments to cancer surgeons? A cross-sectional study in the USA

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