In an effort to promote price transparency, the Centers for Medicare and Medicaid Services (CMS) ordered that hospitals post chargemasters and pricing for diagnosis-related groups (DRGs) online beginning January 1, 2019. For a study, researchers evaluated the cost and compliance of the top 50 orthopedic hospitals in the US News rankings for a study.

In the top 50 orthopedic hospitals in the United States, the chargemaster and price of DRG codes linked to total knee arthroplasty (TKA) and total hip arthroplasty (THA) (469, 470, 461, 462, 466, 467, and 468) were analyzed. In addition, Spearman rank correlation coefficients (ρ) were utilized to assess the relationship between DRG 469, 470, and 467 prices and geographic practice cost index (GPCI) work and practice expense values. 

About 36 of the 50 hospitals reported THA and TKA DRG prices. Only 15 of the 36 hospitals submitted pricing for all seven relevant DRGs; only 467, 469, and 470 were reported across the board. Around 12 of the 14 hospitals lacked DRG information, while two had inadequate reporting. DRG 469, 470, and 467 prices were marginally or weakly linked with GPCI work and GPCI practice expenditure. The results of all correlation tests were statistically significant (P<0.05).

Overall, compliance with CMS’s 2019 regulation was inadequate. For example, about 14 of the 50 hospitals failed to disclose any DRG pricing appropriately, and just 15 were entirely compliant with the obligation. In addition to poor compliance, the claimed costs varied in ways that were not adequately explained by documented regional disparities.

Reference:journals.lww.com/jaaos/Abstract/2022/06150/Compliance_and_Variability_of_Hospital_Price.11.aspx