More Hospitals Complying With Price Transparency Rule Requirements

Almost two-thirds of hospitals are complying with hospital price transparency rule requirements and have published machine-readable files with negotiated rates or cash rates, according to Turquoise Health’s Price Transparency Impact Report.

The healthcare technology company assesses hospital compliance with the hospital price transparency rule every quarter and evaluates payer compliance with the Transparency in Coverage regulation every month. The report reflects data from the third quarter of 2022.

For hospitals, the company downloads the machine-readable files on hospital pages; analyzes the files on how they compare to CMS requirements for list price, cash price, and payer-negotiated rates; and generates a transparency score between one and five.

The company downloads all available machine-readable files from payers and assesses whether they include In Network and Allowed Amount files.

The report found that 4,909 hospitals (76 percent) posted a machine-readable file in Q3 2022. Sixty-five percent of hospitals published machine-readable files that included negotiated rates and 63 percent posted machine-readable files with cash rates.

There were more than 60.7 million negotiated rates posted in total, the report noted.

More than half (55 percent) of hospitals received five stars on Turquoise Health’s transparency scorecard. The company launched the online transparency tool in March 2022 to allow consumers to compare hospital costs before seeking care.

A five-star score indicates that a hospital had a complete machine-readable file that included cash, list, and negotiated rates for most items and services.

Several major health systems published complete machine-readable files and received five-star scores, including the Mayo Clinic, Advocate Aurora Health, and Prime Healthcare.

Nearly a quarter of hospitals (970 hospitals) received four stars, meaning they had a mostly complete machine-readable file that showed an apparent effort to meet all the requirements but still had room for improvement.

Around one in five hospitals received two or three stars, indicating that they either had an incomplete machine-readable file with unhelpful information or a partially complete file with some useful information but was still missing key elements.

Regarding payer price transparency practices, 80 insurance carriers published rates. These carriers represent 90 percent of all commercially insured people, according to the report. Aetna, Blue Cross Blue Shield, Cigna, Humana, and United Healthcare were among the payers that posted rates.

A past survey found that 60 percent of consumers who research healthcare prices ahead of time are most likely to turn to their health plan for information.

It is up to each state’s insurance department to evaluate payer compliance with Transparency in Coverage.

Meanwhile, CMS is responsible for assessing hospital compliance and issuing penalties for noncompliance. In June 2022, the agency sent out its first fines to two hospitals in Georgia that failed to comply with the rule’s machine-readable file and shoppable services requirements.

Compliance with the hospital transparency rule has been lagging since the regulation took effect in January 2021. According to Turquoise Health, CMS should take a more active stance in penalizing noncompliant facilities while recognizing compliant hospitals on its website.

Some states have taken legislative action to increase price transparency. For example, Colorado passed a bill prohibiting hospitals from pursuing debt collections against patients if the facility does not comply with the price transparency rule.

The report also suggested that standardizing good faith estimates, increasing patient education, and improving the independent dispute resolution (IDR) process for surprise bills could help facilitate price transparency.