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Payer-Negotiated Price Variation and Relationship to Surgical Outcomes for the Most Common Cancers at NCI-Designated Cancer Centers

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Federal rules mandate that hospitals publish payer-specific negotiated prices for all services. Little is known about variation in payer-negotiated prices for surgical oncology services or their relationship to clinical outcomes. We assessed variation in payer-negotiated prices associated with surgical care for common cancers at National Cancer Institute (NCI)-designated cancer centers and determined the effect of increasing payer-negotiated prices on the odds of morbidity and mortality.

Materials and Methods

A cross-sectional analysis of 63 NCI-designated cancer center websites was employed to assess variation in payer-negotiated prices. A retrospective cohort study of 15,013 Medicare beneficiaries undergoing surgery for colon, pancreas, or lung cancers at an NCI-designated cancer center between 2014 and 2018 was conducted to determine the relationship between payer-negotiated prices and clinical outcomes. The primary outcome was the effect of median payer-negotiated price on odds of a composite outcome of 30 days mortality and serious postoperative complications for each cancer cohort.

Results

Within-center prices differed by up to 48.8-fold, and between-center prices differed by up to 675-fold after accounting for geographic variation in costs of providing care. Among the 15,013 patients discharged from 20 different NCI-designated cancer centers, the effect of normalized median payer-negotiated price on the composite outcome was clinically negligible, but statistically significantly positive for colon [aOR 1.0094 (95% CI 1.0051–1.0138)], lung [aOR 1.0145 (1.0083–1.0206)], and pancreas [aOR 1.0080 (1.0040–1.0120)] cancer cohorts.

Conclusions

Payer-negotiated prices are statistically significantly but not clinically meaningfully related to morbidity and mortality for the surgical treatment of common cancers. Higher payer-negotiated prices are likely due to factors other than clinical quality.

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Authors and Affiliations

  1. University of Michigan Medical School, Ann Arbor, MI, USA

    Roshun Sankaran MD, MPH

  2. Department of Radiology, University of California San Diego, San Diego, CA, USA

    Roshun Sankaran MD, MPH

  3. School of Public Health, University of Michigan, Ann Arbor, MI, USA

    John O’Connor BS

  4. Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA

    Ushapoorna Nuliyalu MPH, Adrian Diaz MD, MPH & Hari Nathan MD, PhD

  5. IHPI Clinician Scholars Program, Ann Arbor, MI, USA

    Adrian Diaz MD, MPH

  6. Department of Surgery, The Ohio State University, Columbus, OH, USA

    Adrian Diaz MD, MPH

  7. Department of Surgery, University of Michigan, Ann Arbor, MI, USA

    Hari Nathan MD, PhD

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Sankaran, R., O’Connor, J., Nuliyalu, U. et al. Payer-Negotiated Price Variation and Relationship to Surgical Outcomes for the Most Common Cancers at NCI-Designated Cancer Centers. Ann Surg Oncol 31, 4339–4348 (2024). https://doi.org/10.1245/s10434-024-15150-x

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