Abstract：
BACKGROUND: Recent mandates from the Center for Medicare and Medicaid Services (CMS) require United States hospitals to disclose healthcare service pricing. Yet, there\'s a gap in understanding how state-level factors affect hospital service pricing, like total shoulder arthroplasty (TSA). Comprehending these influences can help policymakers and healthcare providers manage costs and improve care access for vulnerable populations. The purpose of this study was to examine the effect of state characteristics such as partisan lean, Certificate of Need (CON) status, and Medicaid expansion, on TSA price.
METHODS: TSA price data was extracted from the Turquoise Health Database using CPT code 23472. State partisan lean was determined by evaluating each state during the 2020 election year for its legislature (both senate and house), governor, presidential vote, and Insurance Commissioner affiliation, categorizing states as either \"Republican-leaning\" or \"Democratic-leaning.\" CON status, Medicaid expansion, area deprivation index (ADI), and population density information was obtained from publicly available sources. Multivariable regression models were used to assess the relationship between these factors and TSA price.
RESULTS: The study included 2,068 hospitals nationwide. The median (IQR) price of TSA across these hospitals was $12,607 ($9,185). In the multivariable analysis, hospitals in Republican-leaning states were associated with a significantly greater price of +$210 (p = 0.0151), while Medicaid expansion was also associated with greater price +$1,878 (p < 0.0001). CON status was associated with a significant reduction in TSA prices of -$2,880 (p < 0.0001). In North Carolina an ADI >85 was associated with a reduction in price (p = 0.0045), while urbanization designation did not significantly impact TSA price (p = 0.8457).
CONCLUSIONS: This cross-sectional observational study found that Republican-leaning states and Medicaid expansion were associated with increased TSA prices, while an ADI >85 and CON laws were associated with reduced TSA prices.
METHODS: TSA price data was extracted from the Turquoise Health Database using CPT code 23472. State partisan lean was determined by evaluating each state during the 2020 election year for its legislature (both senate and house), governor, presidential vote, and Insurance Commissioner affiliation, categorizing states as either \"Republican-leaning\" or \"Democratic-leaning.\" CON status, Medicaid expansion, area deprivation index (ADI), and population density information was obtained from publicly available sources. Multivariable regression models were used to assess the relationship between these factors and TSA price.
RESULTS: The study included 2,068 hospitals nationwide. The median (IQR) price of TSA across these hospitals was $12,607 ($9,185). In the multivariable analysis, hospitals in Republican-leaning states were associated with a significantly greater price of +$210 (p = 0.0151), while Medicaid expansion was also associated with greater price +$1,878 (p < 0.0001). CON status was associated with a significant reduction in TSA prices of -$2,880 (p < 0.0001). In North Carolina an ADI >85 was associated with a reduction in price (p = 0.0045), while urbanization designation did not significantly impact TSA price (p = 0.8457).
CONCLUSIONS: This cross-sectional observational study found that Republican-leaning states and Medicaid expansion were associated with increased TSA prices, while an ADI >85 and CON laws were associated with reduced TSA prices.
摘要：
背景：医疗保险和医疗补助服务中心（CMS）最近的授权要求美国医院披露医疗服务定价。然而，在理解州一级因素如何影响医院服务定价方面存在差距，比如全肩关节置换术(TSA).理解这些影响可以帮助政策制定者和医疗保健提供者管理成本并改善弱势群体的护理机会。这项研究的目的是检验国家特征的影响，如党派倾斜，需求证明（CON）状态，和医疗补助扩张，TSA价格。
方法：使用CPT代码23472从绿松石健康数据库中提取TSA价格数据。通过在2020年选举年度对每个州的立法机关（参议院和众议院）进行评估来确定州党派倾斜，州长,总统选举,和保险专员的隶属关系，将各州归类为“共和党倾向”或“民主党倾向”。\"CON状态，医疗补助扩大，面积剥夺指数(ADI)，人口密度信息是从公开来源获得的。使用多元回归模型来评估这些因素与TSA价格之间的关系。
结果：该研究包括全国2,068家医院。这些医院的TSA中位数（IQR）价格为12,607美元（9,185美元）。在多变量分析中，在倾向于共和党的州，医院的价格明显高于210美元(p=0.0151)，而医疗补助扩大也与更高的价格+1,878美元相关（p<0.0001）。CON状态与TSA价格-2,880美元（p<0.0001）的显着降低有关。在北卡罗来纳州，ADI>85与价格下降相关(p=0.0045)，而城市化指定对TSA价格没有显著影响(p=0.8457)。
结论：这项横断面观察研究发现，共和党倾向的州和医疗补助扩张与TSA价格上涨有关，而ADI>85和CON法律与TSA价格下降有关。
方法：使用CPT代码23472从绿松石健康数据库中提取TSA价格数据。通过在2020年选举年度对每个州的立法机关（参议院和众议院）进行评估来确定州党派倾斜，州长,总统选举,和保险专员的隶属关系，将各州归类为“共和党倾向”或“民主党倾向”。\"CON状态，医疗补助扩大，面积剥夺指数(ADI)，人口密度信息是从公开来源获得的。使用多元回归模型来评估这些因素与TSA价格之间的关系。
结果：该研究包括全国2,068家医院。这些医院的TSA中位数（IQR）价格为12,607美元（9,185美元）。在多变量分析中，在倾向于共和党的州，医院的价格明显高于210美元(p=0.0151)，而医疗补助扩大也与更高的价格+1,878美元相关（p<0.0001）。CON状态与TSA价格-2,880美元（p<0.0001）的显着降低有关。在北卡罗来纳州，ADI>85与价格下降相关(p=0.0045)，而城市化指定对TSA价格没有显著影响(p=0.8457)。
结论：这项横断面观察研究发现，共和党倾向的州和医疗补助扩张与TSA价格上涨有关，而ADI>85和CON法律与TSA价格下降有关。
