- Almost two years after the Hospital Price Transparency Final Rule laid the foundation for public access to standard charges for medical services, most large U.S. health systems and payers are publishing negotiated prices for all items and services, a new report from Turquoise Health has found.
- Nearly 4,200 hospitals and 80 insurers have published negotiated rates, representing a majority of covered lives in the United States, according to the San Diego-based startup, which has developed a scorecard for rating compliance. "These are promising signs that we are methodically moving in the right direction," Turquoise Health said.
- Despite the progress, significant challenges remain, the report said. To achieve the objectives of helping patients manage their medical costs and reducing U.S. healthcare spending overall, the report said further government action is needed, as well as innovation in software and research, to facilitate a competitive marketplace.
Initial assessments of hospital efforts to meet the new regulation were critical, and the CMS increased fines for noncompliance. An analysis from PatientRightsAdvocate.org released last week suggested problems with hospitals posting incomplete price lists.
The CMS rule, which took effect in January 2021, mandates that hospitals must publish machine-readable price lists and display rates for medical services in a consumer-friendly format. The rule requires publication of prices for 70 shoppable services defined by the CMS and 230 that are at the discretion of the hospital.
In July, transparency requirements were extended to insurers, which must disclose the prices they negotiate with providers.
According to Turquoise Health, the CMS has issued penalties for noncompliance to just one health system. "After seven quarters and with many hospitals still significantly out of compliance, CMS needs to take a more active stance in penalizing non-compliant systems," the report advised. It also recommended the agency publicly recognize compliant hospitals on its website.
In addition, standards should be adopted for shoppable service packages and hospital machine readable files. Adopting standards would make enforcement and innovation easier, the organization said, noting that efforts are underway in those areas.
The report also noted that third-party application developers, researchers and other file users have stepped forward to incorporate the new price transparency data for academic research, patient care navigation, employer healthcare cost and other uses that will ultimately benefit consumers, but such projects will take time.