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Abstract：
BACKGROUND: Little is known about hospital pricing for coronary artery bypass grafting (CABG). Using new price transparency data, we assessed variation in CABG prices across US hospitals and the association between higher prices and hospital characteristics, including quality of care.
RESULTS: Prices for diagnosis related group code 236 were obtained from the Turquoise database and linked by Medicare Facility ID to publicly available hospital characteristics. Univariate and multivariable analyses were performed to assess factors predictive of higher prices. Across 544 hospitals, median commercial and self-pay rates were 2.01 and 2.64 times the Medicare rate ($57 240 and $75 047, respectively, versus $28 398). Within hospitals, the 90th percentile insurer-negotiated price was 1.83 times the 10th percentile price. Across hospitals, the 90th percentile commercial rate was 2.91 times the 10th percentile hospital rate. Regional median hospital prices ranged from $35 624 in the East South Central to $84 080 in the Pacific. In univariate analysis, higher inpatient revenue, greater annual discharges, and major teaching status were significantly associated with higher prices. In multivariable analysis, major teaching and investor-owned status were associated with significantly higher prices (+$8653 and +$12 200, respectively). CABG prices were not related to death, readmissions, patient ratings, or overall Centers for Medicare and Medicaid Services hospital rating.
CONCLUSIONS: There is significant variation in CABG pricing, with certain characteristics associated with higher rates, including major teaching status and investor ownership. Notably, higher CABG prices were not associated with better-quality care, suggesting a need for further investigation into drivers of pricing variation and the implications for health care spending and access.
RESULTS: Prices for diagnosis related group code 236 were obtained from the Turquoise database and linked by Medicare Facility ID to publicly available hospital characteristics. Univariate and multivariable analyses were performed to assess factors predictive of higher prices. Across 544 hospitals, median commercial and self-pay rates were 2.01 and 2.64 times the Medicare rate ($57 240 and $75 047, respectively, versus $28 398). Within hospitals, the 90th percentile insurer-negotiated price was 1.83 times the 10th percentile price. Across hospitals, the 90th percentile commercial rate was 2.91 times the 10th percentile hospital rate. Regional median hospital prices ranged from $35 624 in the East South Central to $84 080 in the Pacific. In univariate analysis, higher inpatient revenue, greater annual discharges, and major teaching status were significantly associated with higher prices. In multivariable analysis, major teaching and investor-owned status were associated with significantly higher prices (+$8653 and +$12 200, respectively). CABG prices were not related to death, readmissions, patient ratings, or overall Centers for Medicare and Medicaid Services hospital rating.
CONCLUSIONS: There is significant variation in CABG pricing, with certain characteristics associated with higher rates, including major teaching status and investor ownership. Notably, higher CABG prices were not associated with better-quality care, suggesting a need for further investigation into drivers of pricing variation and the implications for health care spending and access.
摘要：
背景：关于冠状动脉旁路移植术（CABG）的医院定价知之甚少。使用新的价格透明度数据，我们评估了美国医院CABG价格的变化以及较高价格与医院特征之间的关联，包括护理质量。
结果：诊断相关组代码236的价格是从绿松石数据库获得的，并通过Medicare设施ID与公共可用的医院特征相关联。进行了单变量和多变量分析以评估预测较高价格的因素。在544家医院中，商业和自费费率中位数是医疗保险费率的2.01和2.64倍(分别为57240美元和75047美元，而$28398）。在医院内,保险公司协商的第90百分位数价格是第10百分位数价格的1.83倍。跨医院，第90百分位率是第10百分位率的2.91倍。地区医院价格中位数从中东部的35624美元到太平洋地区的84080美元不等。在单变量分析中，更高的住院收入，年排放量增加，和主要教学状况与较高的价格显着相关。在多变量分析中，主要教学和投资者拥有的地位与明显更高的价格相关（分别为8653美元和12200美元）。CABG的价格与死亡无关，再入院,患者评级，或医疗保险和医疗补助服务中心的整体医院评级。
结论：CABG定价存在显著差异，具有与较高利率相关的某些特征，包括主要教学地位和投资者所有权。值得注意的是,更高的CABG价格与更好的护理质量无关，建议需要进一步调查定价变化的驱动因素以及对医疗保健支出和获取的影响。
结果：诊断相关组代码236的价格是从绿松石数据库获得的，并通过Medicare设施ID与公共可用的医院特征相关联。进行了单变量和多变量分析以评估预测较高价格的因素。在544家医院中，商业和自费费率中位数是医疗保险费率的2.01和2.64倍(分别为57240美元和75047美元，而$28398）。在医院内,保险公司协商的第90百分位数价格是第10百分位数价格的1.83倍。跨医院，第90百分位率是第10百分位率的2.91倍。地区医院价格中位数从中东部的35624美元到太平洋地区的84080美元不等。在单变量分析中，更高的住院收入，年排放量增加，和主要教学状况与较高的价格显着相关。在多变量分析中，主要教学和投资者拥有的地位与明显更高的价格相关（分别为8653美元和12200美元）。CABG的价格与死亡无关，再入院,患者评级，或医疗保险和医疗补助服务中心的整体医院评级。
结论：CABG定价存在显著差异，具有与较高利率相关的某些特征，包括主要教学地位和投资者所有权。值得注意的是,更高的CABG价格与更好的护理质量无关，建议需要进一步调查定价变化的驱动因素以及对医疗保健支出和获取的影响。
