{"database":"biostudies-literature","file_versions":[],"scores":null,"additional":{"submitter":["Rochlin DH"],"funding":["NCATS NIH HHS","NCI NIH HHS"],"pagination":["476e-487e"],"full_dataset_link":["https://www.ebi.ac.uk/biostudies/studies/S-EPMC11240862"],"repository":["biostudies-literature"],"omics_type":["Unknown"],"volume":["152(3)"],"pubmed_abstract":["<h4>Background</h4>Commercial payer-negotiated rates for cleft lip and palate surgery have not been evaluated on a national scale. The aim of this study was to characterize commercial rates for cleft care, both in terms of nationwide variation and in relation to Medicaid rates.<h4>Methods</h4>A cross-sectional analysis was performed of 2021 hospital pricing data from Turquoise Health, a data service platform that aggregates hospital price disclosures. The data were queried by CPT code to identify 20 cleft surgical services. Within- and across-hospital ratios were calculated per CPT code to quantify commercial rate variation. Generalized linear models were used to assess the relationship between median commercial rate and facility-level variables and between commercial and Medicaid rates.<h4>Results</h4>There were 80,710 unique commercial rates from 792 hospitals. Within-hospital ratios for commercial rates ranged from 2.0 to 2.9 and across-hospital ratios ranged from 5.4 to 13.7. Median commercial rates per facility were higher than Medicaid rates for primary cleft lip and palate repair ($5492.20 versus $1739.00), secondary cleft lip and palate repair ($5429.10 versus $1917.00), and cleft rhinoplasty ($6001.00 versus $1917.00; P < 0.001). Lower commercial rates were associated with hospitals that were smaller ( P < 0.001), safety-net ( P < 0.001), and nonprofit ( P < 0.001). Medicaid rate was positively associated with commercial rate ( P < 0.001).<h4>Conclusions</h4>Commercial rates for cleft surgical care demonstrated marked variation within and across hospitals, and were lower for small, safety-net, or nonprofit hospitals. Lower Medicaid rates were not associated with higher commercial rates, suggesting that hospitals did not use cost-shifting to compensate for budget shortfalls resulting from poor Medicaid reimbursement."],"journal":["Plastic and reconstructive surgery"],"pubmed_title":["The Reality of Commercial Payer-Negotiated Rates in Cleft Lip and Palate Repair."],"pmcid":["PMC11240862"],"funding_grant_id":["P30 CA008748","KL2 TR003143"],"pubmed_authors":["Rochlin DH","Rizk NM","Flores RL","Sheckter CC","Matros E"],"additional_accession":[]},"is_claimable":false,"name":"The Reality of Commercial Payer-Negotiated Rates in Cleft Lip and Palate Repair.","description":"<h4>Background</h4>Commercial payer-negotiated rates for cleft lip and palate surgery have not been evaluated on a national scale. The aim of this study was to characterize commercial rates for cleft care, both in terms of nationwide variation and in relation to Medicaid rates.<h4>Methods</h4>A cross-sectional analysis was performed of 2021 hospital pricing data from Turquoise Health, a data service platform that aggregates hospital price disclosures. The data were queried by CPT code to identify 20 cleft surgical services. Within- and across-hospital ratios were calculated per CPT code to quantify commercial rate variation. Generalized linear models were used to assess the relationship between median commercial rate and facility-level variables and between commercial and Medicaid rates.<h4>Results</h4>There were 80,710 unique commercial rates from 792 hospitals. Within-hospital ratios for commercial rates ranged from 2.0 to 2.9 and across-hospital ratios ranged from 5.4 to 13.7. Median commercial rates per facility were higher than Medicaid rates for primary cleft lip and palate repair ($5492.20 versus $1739.00), secondary cleft lip and palate repair ($5429.10 versus $1917.00), and cleft rhinoplasty ($6001.00 versus $1917.00; P < 0.001). Lower commercial rates were associated with hospitals that were smaller ( P < 0.001), safety-net ( P < 0.001), and nonprofit ( P < 0.001). Medicaid rate was positively associated with commercial rate ( P < 0.001).<h4>Conclusions</h4>Commercial rates for cleft surgical care demonstrated marked variation within and across hospitals, and were lower for small, safety-net, or nonprofit hospitals. Lower Medicaid rates were not associated with higher commercial rates, suggesting that hospitals did not use cost-shifting to compensate for budget shortfalls resulting from poor Medicaid reimbursement.","dates":{"release":"2023-01-01T00:00:00Z","publication":"2023 Sep","modification":"2025-04-19T20:38:56.457Z","creation":"2025-04-19T20:38:56.457Z"},"accession":"S-EPMC11240862","cross_references":{"pubmed":["36847669"],"doi":["10.1097/prs.0000000000010329","10.1097/PRS.0000000000010329"]}}