The Data Would Like a Word
A big part of eliminating the financial complexity of healthcare involves simplifying convoluted processes that make Pepe Silvia’s mailroom paper trail look like an organized ream of printer paper. And, as the clip above emphasizes, It’s (not yet) Always Sunny in the transparency landscape. In a groundbreaking article, CMS pointed to a promising trend that an increasing number of hospitals are publishing price transparency data. The article also didn’t shy away from highlighting some much-needed areas for improvement for price transparency to have the kind of industry-changing impact the Final Rules set out to accomplish.
We can all agree the data in its current form isn’t perfect, but that doesn’t mean we should throw the entire endeavor out as low impact in the meantime.
So who’s been accessing Turquoise’s hospital and payer pricing data recently? And what are they finding? We thought you’d never ask.
Price Transparency Data in the Wild
Evaluation of Prices for Surgical Procedures Within and Outside Hospital Networks in the US
This study, through the JAMA Network and the University of Michigan, reviewed nearly 3,200 reported prices to evaluate price variations for surgical procedures at network hospitals and independent hospitals.
Insurer Price Transparency Rule: What Has Been Disclosed?
A group of scholars at the Johns Hopkins Bloomberg School of Public Health completed a payer data analysis six months after the Transparency in Coverage go-live date of 7/1/2022. Dr. Ge Bai and her team studied the contents of payer machine-readable files, noted limitations within the data, and shared broad implications of this powerful data in the market.
Ongoing challenges with hospital price transparency
A team from the Kaiser Family Foundation sought to learn if price transparency data is useful as a comparison tool for services across hospitals. The findings lay out challenges within the data and key takeaways associated with hip and knee replacements (DRG 470) and diagnostic colonoscopies (CPT 45378).
Factors Associated With Hospital Commercial Negotiated Price for Magnetic Resonance Imaging of Brain
A team affiliated with the JAMA Network, alongside Dr. Bai, studied brain MRI pricing across hospital types to determine differing characteristics associated with prices nationwide, regionally, within states, and by health system.
Business are jumping on the price transparency train, too
Incorporating Price Transparency Data Into Everyday Business
OneOncology, a national management service organization for independent, community oncology practices, has used price transparency data to improve service offerings, help in negotiations, and break into new markets.
Managed Care sees your per diem and raises you one case rate
Huntsville Hospital, an 800+ bed facility in Alabama, used price transparency data to prepare for an upcoming major payer negotiation.
The Outlook is Transformational
All of this work aims to establish a robust, complete, and useful price transparency dataset.
Legislation nerds who memorized Transparency in Coverage will remember the Final Rule directs the healthcare industry to explore the data:
“... the Departments expect that third-party application developers, researchers, regulators, and other file users will have the expertise to aggregate, standardize, and interpret the pricing information included in the file and translate the pricing information into products, research, and market oversight and reforms that will ultimately benefit consumers.”
Digging into this data and applying it to the real (often bonkers) healthcare landscape is essential for change. The more industry experts research and publicize the data, the more scrutiny it will receive, which will increase CMS guidance, enforcement and compliance, and overall data quality. High-quality, complete transparency data is the foundation of fair pricing, decreased administrative burdens, and price certainty for patients.
Curious to see for yourself? Say hi and request research data here.