Price variation for total shoulder arthroplasty in the United States: transparency, variability, and compliance with federal reporting regulations

Current federal regulation requires hospitals to report publicly negotiated prices for surgical procedures to improve transparency and reduce costs. The purpose of this study was to assess pricing variability for total shoulder arthroplasty (TSA) as well as compliance with the federal mandate on reporting. The Centers for Medicare & Medicaid Services Provider of Services data (July 2021) and the standard charge files (current as of September 29, 2021) were analyzed to assess prices for TSA. The median and interquartile price ranges were tabulated for commercial payer rates as well as cash pay rates. Multivariable regression was performed to identify hospital factors associated with higher price variation with the outcome variable of median commercial TSA price at reporting hospitals. All regressions are weighted by the inverse probability of being a reporting hospital. There was a wide variation in pricing for TSA, with median price ranging from $3139 to $41,577 for commercial pricing (interquartile price range from $1930 to $42,128.24). The median price for cash pay ranged from $3437 to $36,378 (interquartile price range from $2256 to $43,469). For-profit hospitals, those in an urban setting, and those in the Pacific region of the United States were associated with the highest commercial price for TSA. There is wide variability in pricing for TSA in the United States for both commercial and cash payers. For-profit hospitals, urban hospital setting, and the Pacific region were associated with higher pricing. Comparison of price variability at different institutions may contribute to costs savings for patients and payers.