Negotiated payor rates for femoral neck fracture surgery across U.S. hospitals

Introduction: Femoral neck fractures are an important source of morbidity and mortality worldwide. Due to the need for timely surgical intervention, patients typically have little control over where they are treated, and thus, the costs of their care. Materials and methods: A cross-sectional analysis was performed using 2024 payor rate data from the Turquoise Health Database, using one Current Procedural Terminology code (27236) for femoral neck fracture fixation. Variables of interest were downloaded from publicly available sources, including hospital size, payor class, Area Deprivation Index, and state-level health policies. State-level policies included Medicaid expansion status, Certificate of Need (CoN) status, nurse practitioner (NP) scope-of-practice regulations, and participation in the price-transparency All-Payer Claims Database (APCD). Results: The analysis included 187,183 negotiated payor rates with a median of $5028. Hospitals with over 1500 beds had negotiated rates that were, on average, $4889 higher than hospitals with under 100 beds (p < 0.001). For payor type, compared to commercial insurance, Veterans Affairs rates were nearly $2380 lower, while rates for dual-eligible beneficiaries were over $5254 higher (p < 0.001). Lastly, states with CoN status had rates approximately $709 higher (p < 0.001), and those with restricted NP scope-of-practice had rates over $3500 higher than states with no independent practice (p < 0.001). Conclusions: This study identified significant variation in negotiated payor rates for patients receiving hip fracture care, with large variations by payor class, hospital size, and state health policy status.