title: Association of Hospital Prices for Coronary Artery Bypass Grafting With Hospital Quality and Reimbursement.
abstract: Although prices for medical services are known to vary markedly between hospitals, it remains unknown whether variation in hospital prices is explained by differences in hospital quality or reimbursement from major insurers. We obtained "out-of-pocket" price estimates for coronary artery bypass grafting (CABG) from a random sample of US hospitals for a hypothetical patient without medical insurance. We compared hospital CABG price to (1) "fair price" estimate from Healthcare Bluebook data using each hospital's zip code and (2) Society of Thoracic Surgeons composite CABG quality score and risk-adjusted mortality rate. Of 101 study hospitals, 53 (52.5%) were able to provide a complete price estimate for CABG. The mean price for CABG was $151,271 and ranged from $44,824 to $448,038. Except for geographic census region, which was weakly associated with price, hospital CABG price was not associated with other structural characteristics or CABG volume (p >0.10 for all). Likewise, there was no association between a hospital's price for CABG with average reimbursement from major insurers within the same zip code (ρ = 0.07, p value = 0.6), Society of Thoracic Surgeoncomposite quality score (ρ = 0.08, p value = 0.71), or risk-adjusted CABG mortality (ρ = -0.03 p value = 0.89). In conclusion, the price of CABG varied more than 10-fold across US hospitals. There was no correlation between price information obtained from hospitals and the average reimbursement from major insurers in the same market. We also found no evidence to suggest that hospitals that charge higher prices provide better quality of care.
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa. Electronic address: bria-giacomino@uiowa.edu.
authors.forename: Bria D
authors.initials: BD
authors.lastname: Giacomino
authors.affiliation: Division of General Internal Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario.
authors.forename: Peter
authors.initials: P
authors.lastname: Cram
authors.affiliation: Department of Comprehensive Access and Delivery Research and Evaluation Center, Iowa City Veterans Affairs Medical Center, Iowa City, Iowa; Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa.
authors.forename: Mary
authors.initials: M
authors.lastname: Vaughan-Sarrazin
authors.affiliation: Department of Internal Medicine, Institute of Clinical & Translational Science, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Yunshu
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Division of Cardiovascular Medicine, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
authors.forename: Saket
authors.initials: S
authors.lastname: Girotra
mesh_terms: D001026:Coronary Artery Bypass / Q000191:economics* / Q000706:statistics & numerical data; D017722:Hospital Charges / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D011787:Quality of Health Care / Q000191:economics*; D014481:United States