Fantasyland.

The chargemaster is a list of all the “sticker” prices of the services provided at a facility. If you’ve ever asked probing questions of administrators about where the chargemaster prices come from, you’ll realize it should more accurately be called the chargecluster. This study evaluated chargemasters for 52 of 63 (84%) NCI-designated cancer centers to determine the range of listed prices for a 28-fraction course of prostate IMRT. Simple enough, right? They focused only on a single service: the treatment delivery charge for a single fraction of simple IMRT (CPT 77385). First off, only 6% of chargemasters even used a CPT code to identify charges. The rest used a smattering of descriptive terms probably made up in the early 2000’s along with CDO’s, MBS’s, and ARM’s. The average list price of 28 fractions was $111,729 ($3990.32/fx) with a standard deviation of $69,395 ($2,478.39/ fx)—as in a standard dev of 62%. That average is a staggering 10x the standard $11,091 CMS price and well above the typical 1-4 times rate paid by private insurers. The range? $18,368 ($656/fx) to $399,056 ($14,252/fx). As another reference point, the RO Model technical base rate for a course of prostate treatment was $19,852. TBL: The “transparent” prices published in hospital chargemasters have no basis in reality. | Agarwal, JAMA Oncol 2020