2f:I[703058,["/_next/static/immutable/chunks/3bhq_5eh1d760.js","/_next/static/immutable/chunks/1855-ogyi8eh4.js","/_next/static/immutable/chunks/2pfsjpn6k6zlg.js","/_next/static/immutable/chunks/26c7v3_3uwnwu.js","/_next/static/immutable/chunks/25a3ozcrvi1ff.js","/_next/static/immutable/chunks/2r4wx50nvjh_4.js","/_next/static/immutable/chunks/23fsw06hsi5b1.js","/_next/static/immutable/chunks/06_yt270h41rg.js","/_next/static/immutable/chunks/3ezsiz-7shkna.js","/_next/static/immutable/chunks/20x2y96ldu5wx.js","/_next/static/immutable/chunks/2lxntcm3pd1_h.js","/_next/static/immutable/chunks/00dgco8irq3jw.js","/_next/static/immutable/chunks/00nwe-kq0rboc.js","/_next/static/immutable/chunks/2051ffx3xzio9.js"],"PaperListPageClient"] 30:T93a,Hospital prices are currently not subject to regulation, yet have profound financial implications for patients, taxpayers, and governments. While significant for the contemporary era of value-based care, US national variation in hospital price markup has not been delineated. To characterize national variation in the hospital price markup for major elective operations and to assess the association of markup with perioperative outcomes and overall quality of care. This national cross-sectional study evaluated institutional markup ratios (MRs) across 1960 US hospitals performing 4 major elective operations (abdominal aortic aneurysm repair, colectomy, coronary artery bypass grafting, and hip replacement) among patients aged 18 years and older within the 2022 Nationwide Readmissions Database. MR was defined as the ratio of charges to costs. Centers with MRs in the top decile were considered high-markup hospitals (HMH), with others categorized as non-HMH. Data were analyzed from September 2024 to March 2025. The primary outcome was institutional MR, with secondary consideration of perioperative outcomes. Of 1960 unique institutions, 194 were HMH. The median (IQR) hospital price markup factor was 3.0 (1.9-4.4). Considering only HMH, the median (IQR) MR was 8.5 (7.1-10.8); the top 50 most expensive hospitals marked up the true costs of care by a median factor of 13. On average, HMH were more commonly investor-owned, for-profit hospitals located in metropolitan areas. Of 362 367 patients, 42 620 (11.8%) were treated at HMH. Overall mean (SD) patient age was 65.1 (12.7) years, and 174 067 patients (48.0%) were female. Following risk adjustment, care at HMH was associated with significantly greater odds of major morbidity (adjusted odds ratio [AOR], 1.45; 95% CI, 1.14-1.84), including higher adjusted risk of cardiac, respiratory, infectious, and kidney sequelae. Moreover, treatment at HMH was associated with increased likelihood of nonelective readmission within 30 days (AOR, 1.33; 95% CI, 1.24-1.42). This cross-sectional study found that considerable variation in price markup exists across hospitals and that HMHs demonstrated both lower quality and value of care. These findings underscore that HMHs represent a key initial target for national policy efforts targeting pricing regulation, transparency, and quality improvement.31:Td60, Importance Hospital prices are currently not subject to regulation, yet have profound financial implications for patients, taxpayers, and governments. While significant for the contemporary era of value-based care, US national variation in hospital price markup has not been delineated. Objective To characterize national variation in the hospital price markup for major elective operations and to assess the association of markup with perioperative outcomes and overall quality of care. Design, Setting, and Participants This national cross-sectional study evaluated institutional markup ratios (MRs) across 1960 US hospitals performing 4 major elective operations (abdominal aortic aneurysm repair, colectomy, coronary artery bypass grafting, and hip replacement) among patients aged 18 years and older within the 2022 Nationwide Readmissions Database. MR was defined as the ratio of charges to costs. Centers with MRs in the top decile were considered high-markup hospitals (HMH), with others categorized as non-HMH. Data were analyzed from September 2024 to March 2025. Main Outcome and Measure The primary outcome was institutional MR, with secondary consideration of perioperative outcomes. Results Of 1960 unique institutions, 194 were HMH. The median (IQR) hospital price markup factor was 3.0 (1.9-4.4). Considering only HMH, the median (IQR) MR was 8.5 (7.1-10.8); the top 50 most expensive hospitals marked up the true costs of care by a median factor of 13. On average, HMH were more commonly investor-owned, for-profit hospitals located in metropolitan areas. Of 362 367 patients, 42 620 (11.8%) were treated at HMH. Overall mean (SD) patient age was 65.1 (12.7) years, and 174 067 patients (48.0%) were female. Following risk adjustment, care at HMH was associated with significantly greater odds of major morbidity (adjusted odds ratio [AOR], 1.45; 95% CI, 1.14-1.84), including higher adjusted risk of cardiac, respiratory, infectious, and kidney sequelae. Moreover, treatment at HMH was associated with increased likelihood of nonelective readmission within 30 days (AOR, 1.33; 95% CI, 1.24-1.42). Conclusions and Relevance This cross-sectional study found that considerable variation in price markup exists across hospitals and that HMHs demonstrated both lower quality and value of care. These findings underscore that HMHs represent a key initial target for national policy efforts targeting pricing regulation, transparency, and quality improvement. 25:[[["$","script","0",{"type":"application/ld+json","dangerouslySetInnerHTML":{"__html":"{\"@context\":\"https://schema.org\",\"@type\":\"CollectionPage\",\"name\":\"Major Elective Surgery: condition Research & Clinical Takeaways\",\"description\":\"Explore peer-reviewed papers on Major Elective Surgery (condition). Clinician-written summaries and actionable practice insights. 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The median (IQR) hospital price markup factor was 3.0 (1.9-4.4). Considering only HMH, the median (IQR) MR was 8.5 (7.1-10.8); the top 50 most expensive hospitals marked up the true costs of care by a median factor of 13. On average, HMH were more commonly investor-owned, for-profit hospitals located in metropolitan areas. Of 362 367 patients, 42 620 (11.8%) were treated at HMH. Overall mean (SD) patient age was 65.1 (12.7) years, and 174 067 patients (48.0%) were female. Following risk adjustment, care at HMH was associated with significantly greater odds of major morbidity (adjusted odds ratio [AOR], 1.45; 95% CI, 1.14-1.84), including higher adjusted risk of cardiac, respiratory, infectious, and kidney sequelae. 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Accessed March 15, 2022. https://www.hcup-us.ahrq.gov/db/nation/nrd/nrddde.jsp","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"soi250061r26","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Cost reports. Centers for Medicare & Medicaid Services. Accessed April 15, 2025. https://www.cms.gov/data-research/statistics-trends-and-reports/cost-reports","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"soi250061r46","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Hospitals. Centers for Medicare & Medicaid Services. Accessed March 3, 2025. https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency/hospitals","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":null,"key":"soi250061r47","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"H.R.5378 - 118th Congress (2023-2024): Lower Costs, More Transparency Act. Congress.gov. Accessed April 15, 2025. https://www.congress.gov/bill/118th-congress/house-bill/5378","article-title":null,"journal-title":null,"doi-asserted-by":null},{"DOI":"10.1377/forefront.20210311.899634","key":"soi250061r48","year":null,"issue":null,"author":null,"volume":null,"first-page":null,"unstructured":"Henderson? MA, Mouslim? MC. Low compliance from big hospitals on CMS’s Hospital Price Transparency Rule. Health Affairs. doi:10.1377/forefront.20210311.899634","article-title":null,"journal-title":null,"doi-asserted-by":"crossref"}],"short-title":[],"journal-issue":{"issue":"11","published-print":{"date-parts":[[2025,11,1]]}},"content-domain":{"domain":[],"crossmark-restriction":false},"original-title":[],"container-title":["JAMA Surgery"],"published-print":{"date-parts":[[2025,11,1]]},"reference-count":57,"published-online":null,"references-count":57,"short-container-title":["JAMA Surg"],"is-referenced-by-count":1},"unpaywall":{"doi":"10.1001/jamasurg.2025.3647","is_oa":false,"title":"Hospital Price Markup and Outcomes of Major Elective Operations","updated":"2025-09-25T02:42:03+00:00","published_date":"2025-09-24","best_oa_location":null}},"created_at":"2025-12-08T12:24:58.509Z","updated_at":"2025-12-08T12:24:58.509Z","tags":[{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"age_group","value":"adult","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"category","value":"Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"condition","value":"Major Elective Surgery","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"impact_flag","value":"safety_signal","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"level_of_evidence","value":"5","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"sample_size","value":"n=362,367","value_numeric":362367},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"sex","value":"mixed","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"study_design","value":"Cross-Sectional","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"warning","value":"High-markup status was defined as the top decile of markup ratio; thresholds may not generalize across settings.","value_numeric":null},{"paper_doi":"10.1001/jamasurg.2025.3647","tag_type":"warning","value":"Only abstract-level details are available; definitions of major morbidity, specific risk-adjustment variables, and complication criteria are not described.","value_numeric":null}],"summaries":{"what_studied":"A US national cross-sectional study of 1960 hospitals used the 2022 Nationwide Readmissions Database to measure hospital markup ratios (charges-to-costs) for four major elective operations in adults and compared top-decile high-markup hospitals (HMH) with others. Secondary analyses examined perioperative outcomes, including 30-day nonelective readmission.","key_result":"Median markup was 3.0 (IQR 1.9–4.4); among 194 HMH, median markup was 8.5 (IQR 7.1–10.8), and the 50 highest had a median factor of 13. After risk adjustment, HMH care was associated with higher major morbidity (AOR 1.45; 95% CI 1.14–1.84) and higher 30-day nonelective readmission (AOR 1.33; 95% CI 1.24–1.42); 42,620 of 362,367 patients (11.8%) were treated at HMH.","practice_takeaway":"Among adults undergoing major elective surgery, treatment at top-decile markup hospitals was linked to worse adjusted perioperative outcomes and more 30-day readmissions. When discussing hospital choice, consider price transparency and quality signals given the wide variation in markups."}}],"initialOffset":1,"fetchConfig":{"kind":"tags","tags":[{"tag_type":"condition","value":"Major Elective Surgery"}]},"breadcrumbItems":[{"name":"Home","href":"/"},{"name":"Research Hub","href":"/hub"},{"name":"Conditions","href":"/hub/tag/condition"},{"name":"Major Elective Surgery"}],"hrefConfig":{"basePath":"/hub/papers","webViewQueryParams":{"hub_ctx":"tag","hub_tag_type":"condition","hub_tag_value":"Major Elective Surgery"}}}]]

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