Abstract：
The Price Transparency Rule of 2021 forced payors and hospitals to publicly disclose negotiated prices to foster competition and reduce cost. Burn care is costly and concentrated at less than 130 centers in the US. We aimed to analyze geographic price variations for inpatient burn care and measure the effects of American Burn Association (ABA) verification status and market concentration on prices. All available commercial rates for 2021-2022 for burn-related Diagnosis Related Groups (DRG) 927, 928, 929, 933, 934, and 935 were merged with hospital-level variables, ABA verification status, and Herfindahl-Hirschman Index (HHI) data. For the DRG 927 (most intensive burn admission) a linear mixed effects model was fit with cost as the outcome and the following variables as covariates: HHI, plan type, safety net status, profit status, verification status, rural status, teaching hospital status. Random intercepts allowed for individual burn centers. There were 170,738 rates published from 1541 unique hospitals. Commercial reimbursement rates for the same DRG varied by a factor of approximately three within hospitals for all DRGs. Similarly, rates across different hospitals varied by a factor of three for all DRGs, with DRG 927 having the most variation. Burn center status was independently associated with higher reimbursement rates adjusting for facility-level factors for all DRGs except for 935. Notably, HHI was the largest predictor of commercial rates (p<0.001). Negotiated prices for inpatient burn care vary widely. ABA-verified centers garner higher rates along with burn centers in more concentrated/monopolistic markets.
摘要：
2021年的价格透明度规则迫使付款人和医院公开披露谈判价格，以促进竞争并降低成本。烧伤护理费用昂贵，集中在美国不到130个中心。我们旨在分析住院烧伤护理的地理价格变化，并衡量美国烧伤协会（ABA）验证状态和市场集中度对价格的影响。2021-2022年烧伤相关诊断相关组（DRG）927、928、929、933、934和935的所有可用商业费率与医院一级变量合并，ABA验证状态,和赫芬达尔-赫希曼指数(HHI)数据。对于DRG927（最严重的烧伤入院），线性混合效应模型以成本为结果，以下变量为协变量：HHI，计划类型,安全网状态，利润状况，验证状态,农村地位,教学医院地位。允许对各个烧伤中心进行随机拦截。1541家独特医院公布了170,738个比率。对于所有DRG，同一DRG的商业报销率在医院内的差异约为三倍。同样，对于所有DRG，不同医院的费率相差三倍，DRG927的变化最大。烧伤中心的状态与较高的偿还率独立相关，该偿还率根据所有DRG的设施水平因素进行调整，935除外。值得注意的是,HHI是商业率的最大预测因子(p<0.001)。住院烧伤护理的谈判价格差异很大。经过ABA验证的中心在更集中/垄断的市场中与燃烧中心一起获得更高的费率。
