Hospitals Finally Reached Widespread Price Transparency Compliance in 2023
Hospitals across the country have made significant strides in complying with price transparency regulations, according to a report released Thursday by Turquoise Health. The report reveals that hospitals have seen substantial improvements in meeting the requirements set by the Centers for Medicare and Medicaid Services (CMS) for price transparency.
Starting on January 1, 2021, CMS implemented a rule mandating hospitals to publish their gross charges, negotiated charges with payers, minimum and maximum negotiated charges (de-identified), and cash prices on their websites using a machine-readable file (MRF). Additionally, hospitals were required to publish pricing information for the 300 most commonly used services in a consumer-friendly manner.
Turquoise Health, a startup specializing in price transparency software, examined data from 6,357 hospitals nationwide. The analysis found that an impressive 90.7% of these hospitals had successfully uploaded an MRF by December 15. This marks a significant improvement compared to previous years, as a study published in the Journal of the American Medical Association in June 2022 revealed that fewer than 6% of hospitals had fully complied with CMS’ regulations.
The challenge of complying with the price transparency rule stems from the intricate nature of healthcare billing data. The complexity of the U.S. healthcare system, including care variations, deductibles, and billing codes, makes it challenging to accurately estimate the price of specific services. Furthermore, at the time CMS began enforcing the regulations, most hospitals lacked the technical expertise and staff necessary to develop tools that present billing information in a user-friendly manner.
Turquoise’s report not only highlights the significant progress made in MRF postings, but it also indicates that 83.1% of hospitals have disclosed a substantial amount of negotiated rates. Moreover, 81.3% of hospitals have published rates from major insurance companies such as Blue Cross Blue Shield, United Healthcare, Cigna, Aetna, and Humana, known as BUCAH rates. Additional rates, including imaging, surgery, and cash rates, have also seen substantial compliance, with 80.8%, 80.4%, and 77.3% of hospitals respectively posting this information.
The report further reveals that the quality of hospitals’ MRFs has improved. Over half of the hospitals surveyed received a five-star rating from Turquoise for their MRFs. To be awarded a five-star rating, hospitals must provide an MRF that includes negotiated, cash, and list rates for a significant number of items and services.
The improved compliance with price transparency regulations brings long-awaited benefits for consumers. Patients can now access vital pricing information for a wide range of services, empowering them to make informed decisions about their healthcare and potentially reduce their out-of-pocket expenses.
The road to achieving widespread price transparency compliance has been a challenging one for hospitals. However, their efforts to overcome the complexities of healthcare billing data have proven fruitful. The results of Turquoise’s report indicate a significant and commendable accomplishment in meeting CMS’ price transparency requirements.
This progress will undoubtedly contribute to greater transparency in the healthcare system, enabling patients to make well-informed choices and promoting a more accessible and equitable healthcare experience for all.
