P1213 - Evaluation of Publicly Available Uninsured Costs of Esophagogastroduodenoscopy and Colonoscopy in the US by Hospital Type

Kelsey Anderson, MD¹, Rei Mitsuyama, MD², Shaharyar Zuberi, MD¹, Rachel Porth, MD¹, Joseph D. Feuerstein, MD^1
1Beth Israel Deaconess Medical Center, Boston, MA; ²Brown University, Providence, RI

Introduction: Almost 30 million people in the United States (US) do not have health insurance. In 2021 CMS enacted the Hospital Price Transparency Final Rule to require hospitals to reveal cash pricing of services. Esophagogastroduodenoscopy (EGD) and colonoscopy are essential procedures, but costs are high and unpredictable across systems, limiting access. We therefore aimed to evaluate patterns in the uninsured costs of EGD and colonoscopy among different hospital types.

Methods: Publicly available price estimation data for EGD and colonoscopy was searched for hospital systems in New England. Categories included: academic medical center (AMC), community, for-profit, and teaching, with multiple designations possible. A sample of private practices was included. CPT codes 43239, 45380, or the most similar available equivalent were used. All prices were estimated using online cost estimators or chargemaster costs. Hospital demographics were obtained from the American Hospital Directory. Mean, median, and range prices were calculated.

Results: Fifty six procedural centers (45 hospitals, 11 private practices) were evaluated. Hospitals classifications included 9 AMC, 36 community, 8 for-profit, and 26 teaching. Eight (17.8%) hospitals did not have complete price estimation data available online. Mean EGD prices ranged from $2,400 (for-profit) to $7,278 (AMC). Mean colonoscopy prices ranged from $2,483 (for-profit) to $5,773 (AMC). Figure 1 demonstrates the range of prices for EGD and colonoscopy by hospital type. Table 1 shows hospital characteristics, minimum, and maximum price by hospital type. About half of all hospitals offered discounts, with for-profits offering the highest discounts at an average of 42-50% of the listed cash charge. Only one (9.0%) private practice disclosed cash pricing estimates.

Discussion: There is significant variation in pricing of EGD and colonoscopy among all hospital types, demonstrating non-standardization of costs. Given that this trend persists among all hospital types and within a similar geographic location, it is unlikely that higher expenses are driving costs. Interestingly, for-profit hospitals had the lowest prices and offered the highest discounts, challenging arguments that these centers are driving higher costs. Variations in estimated costs may be a root cause for the rising cost of healthcare throughout the US, and further work is needed at the policy and system level to improve standardization.




Disclosures:


Kelsey Anderson, MD¹, Rei Mitsuyama, MD², Shaharyar Zuberi, MD¹, Rachel Porth, MD¹, Joseph D. Feuerstein, MD¹. P1213 - Evaluation of Publicly Available Uninsured Costs of Esophagogastroduodenoscopy and Colonoscopy in the US by Hospital Type, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.