What a month it's been. We've reviewed 6,000+ hospital websites and standardized 1,500 machine readable files into our database, with about 500 more on the way, for nearly 1,000 shoppable services. Here's what the market looks like.
Guidehouse is a big consulting firm that released a study yesterday reviewing 1,000 hospitals in 27 states. The study mentions that it's difficult to make sense of this data and CMS has a "herculean task" to audit it. Both are true - but any problem is solvable if you throw enough engineering at it! We've been frantically writing Python to analyze these files for the past 40 days - we figure we'd pour a coffee and take a moment to blog.
**Disclaimer before we get into it: we've omitted some hospitals from the below graphs & figures that have not yet made it through our final QA.
What's this all about?
At Turquoise, our goal is to reward (and send patients to) transparent, high quality providers. We've had thousands of visitors on our site this week - this is already happening! So, none of this is to chide non-transparent providers (many providers are still working on it, that's fine). This is all with the goal of helping patients know the cost of care.
Our criteria for compliance differs from Guidehouse - we grade on a scale of 1-5 stars. We primarily focus on the machine readable file, as this is the data that can be used to create a transparent market (vs. a multi-step estimate tool that asks patients for PHI and prevents comparison shopping).
We use a combination of algorithms and manual review to assess:
- 5 stars: Provider posts a shoppable service tool (or file) + a machine readable file with negotiated rates (including cash + commercial plans).
- 4 stars: Provider posts a shoppable service tool + the machine readable file is present but missing a key element (such as, codes, key services the provider is known to offer, or cash rates). Commercial insurance rates are present.
- 3 stars: Provider posts a shoppable service tool + multiple key elements listed above are missing. However, meaningful commercial rates and cash rates are still listed.
- 2 stars: Provider posts a shoppable service tool + a machine readable file with cash rates, Medicare Advantage or Managed Medicaid rates only. Or, the machine readable file is not available for download as required by the rule.
- 1 star: Provider may or may not post a shoppable service tool + no machine readable file is present.
Provisionally, we've come across ~2,000 4 and 5 star providers in our scouring of 6,000+ hospital websites.
Here's a snapshot of where our compliance assessments stood for the Eastern Seaboard around the beginning of the month:
You can browse any of these provider's rates at turquoise.health/providers
Can you guys make one of those pie charts?
Great question! Yes: here's the breakdown at the beginning of the month. Important note, we consider it a pretty serious move to assign a "1" or "2" ranking to a provider, so we currently have ~1,000 hospitals in the backlog for manual review to make sure they truly did not post a compliant file.
What the breakdown looks like excluding ~1,000 provisionally non-compliant providers:
But what about quality? It's not just about price, right?
We're with you. If I'm going to get surgery to repair my broken fingers from using this keyboard so much lately, I want to use a high quality provider. For now, we're overlaying this on CMS overall quality score (are you a quality data provider that wants to integrate? firstname.lastname@example.org)
Blue Cross Commercial C-Section rates overlaid on CMS Overall Star Ranking
Cash C-Section rates overlaid on CMS Overall Star Ranking
A look forward to the coming months...
In certain geographies, price competition looks inevitable for commoditized shoppable services. Providers (be it hospitals, ASCs or medical groups offering non-facility based services) can expect new patient volumes to come a knockin'.
With the payer rule only eleven months away, and with it professional rates for more than just hospital services, this map will start to look much more interesting. For now, here's a look at UHC Commercial facility rates for CPT 29881 for a common knee meniscus repair between Erlanger, Covenant and Ascension, all within a short drive of Nashville.
Depending on driving distance, employers, referring physicians, and patients might consider making more cost conscious decisions in regions with several in-network options (the range here is over $3,000 min to max).
Can I use this data too?
Of course! We exist to help organizations (and ultimately the members, patients and users that trust them) make rational, value-based decisions.
We license our data in the following ways:
- Via the Turquoise Health API
- Via data extracts from the Turquoise Health database
- Via data visualizations and reports similar to the ones you see above
Contact email@example.com for more information.
Lastly: We are a startup, and we want to hear from you. How can we make this data more useful to what you're working on? Drop us a line.
Alright - time to get back to the data!
***Disclaimer: our source for this data is primarily the machine readable file disclosure of the 2021 Hospital Price Transparency Final Rule. This data is new and may contain errors and omissions. We are not affiliated with the providers listed in this article. For more about our data, visit the Patients page on turquoise.health