Hello, my name is Sharada Srivatsa, and today I'll be presenting on cost transparency in neurosurgery. Are we enabling cost-conscious and value-based surgical practice? And listed below are my co-authors. Healthcare costs in the U.S. continue to rise year after year, causing both the consumer's insurance costs and out-of-pocket costs to rise with them. The increased cost-sharing burden placed on the consumer brings into question the public accessibility of information regarding these costs and how detailed and useful this information is to patients. There has been little peer-reviewed literature looking into either the availability or utility of this information for high-cost and specialized procedures such as those in neurosurgery, although recent literature suggests that neurosurgical patients do face increased cost-sharing burdens. In this project, we systematically examined what cost information is available to patients through Google searches for non-emergent neurosurgical procedures in order to determine how readily patients can obtain useful cost information with which to inform their choices regarding surgical care. We performed Google searches on 15 procedures in 8 cities using the phrase cost of insert intervention name and insert city name. We included all non-advertisement websites in the first two pages of search results and categorized them into peer-reviewed publications, cost transparency websites, clinical sites, generic relevant sites, other sites, or unrelated information. We then recorded the following information about each website. Website name and type, did it provide cost information, how was this information presented, were there itemized breakdowns of treatment costs, information about discounts, or cost provider comparisons. We then performed chi-square tests to compare the number of websites with region-specific cost estimates across procedures and locations. Our search resulted in 2,356 included websites, the majority of which were clinical sites followed by peer-reviewed publications and only 386 designated as cost transparency. Cost transparency sites contain the majority of cost information. The number of websites providing cost information was highest in Cleveland and lowest in San Diego and differed significantly by location. The number of websites providing cost information also varied significantly by procedure with more availability for simpler and more common procedures such as MRI, brain, and spine. In terms of the usefulness of cost information, we found that price transparency websites were most likely to provide what they deemed geographically relevant, quote-unquote, fair prices for interventions and ranges for local providers. However, across the board, data sources and analytic methods were not generally disclosed. Additionally, neither clinical nor price websites broke down bundled care costs by included goods and services with a few exceptions each. Lastly, only one website provided information on discounts available to patients. These figures simply show the availability of cost information by city and website type by the percent of websites searched. And as a note, percents correspond to the number of websites providing cost information of the total websites we searched for that city. And secondly, the availability of cost information by intervention of the percent of websites that we searched. In conclusion, increased cost sharing burden felt by the patients underlies the growing importance of patient autonomy and involvement in healthcare decision making. In order for this to happen adequately, patients should have access to publicly available, accurate, and useful cost information. It has been suggested that increased cost transparency could lead to inter-provider competition and the resultant lowering of healthcare and procedure costs. Vague data sources and analytic methodologies limit the usefulness of cost information that is available to patients as shown by the near absence of this information in our searches. The lack of breakdowns or bundled costs may reflect differences in local and state policy on cost transparency. For example, Ohio state law requires that hospitals make only, quote, usual and customary charges for room and board publicly available and does not require disclosure of all involved costs for surgical intervention. Finally, cost transparency is becoming increasingly relevant on the national scale in light of the 2020 Transparency and Coverage Bill finalized by the Department of Health and Human Services. This bill requires outpatient and ambulatory surgical center payment systems to publish itemized cost breakdowns for procedures. As of yet, neurosurgical costs are infrequently made publicly available and in light of these new legislations, this may begin to change. Here's a list of my references and thank you very much.

cost transparency

neurosurgery

healthcare costs

insurance premiums

patient autonomy