Trends in Hospital Charging Practices from 2019-2022 Among Hospitals with and without Chimeric Antigen Receptor (CAR) T-Cell Therapy Utilization

OBJECTIVES: Original Medicare (Fee-for-service, FFS) reimbursement in the inpatient setting of care can be impacted by the hospital cost-to-charge ratio (CCR) used for a given claim. This study evaluated differences and trends in CCRs among hospitals that utilized chimeric antigen receptor (CAR) T-cell therapies compared to hospitals with little to no CAR T utilization between 2019-2022.

METHODS: Medicare FFS research identifiable files (RIF, claims) data were used to identify hospitals with at least 11 CAR T claims in each calendar year (“CAR T providers”). Healthcare Cost Report Information System (HCRIS) data were used to obtain CCRs for all hospitals. Descriptive statistics on the Medicare inpatient CCR were presented for CAR T providers and other hospitals. Repeated measures ANOVA with Bonferroni adjustment tested whether the mean Medicare inpatient CCR was the same between CAR T providers and other hospitals each year. A simple linear regression model with an interaction for being a CAR T provider and the year tested if the annual trend in CCR was different for CAR T providers.

RESULTS: Twenty-four hospitals were identified as CAR T providers, compared to about 3,100 non-CAR T providers. Across the timeframe, the mean CCR for CAR T providers was significantly lower compared to non-CAR T providers (0.26 vs 0.32, p<0.05). There were no significant differences in CCR differences between CAR T providers and non-CAR T providers for individual years, and no significant difference in CCR was observed over time within provider categories. The interaction between provider category and time was non-significant.

CONCLUSIONS: This real-world data revealed that Medicare inpatient CCR patterns for hospitals that have provided CAR T therapies are lower, on average, compared to other hospitals; however, charge practices are not significantly different, charges have not increased for either hospital category during the timeframe, and charge trends have not been different between provider categories.