2023 Called ‘Pivotal’ for Healthcare Price Transparency

This past year was “pivotal” for healthcare price transparency, according to a new report from the consulting firm Turquoise Health.

More than 90% of hospitals required by CMS to post a machine-readable file (MRF) of price information have done so, the report stated. And more than 83% have included a “substantial amount” of negotiated rates.

Furthermore, when comparing 2023 to 2022, 562 new hospitals have posted files. Overall, Turquoise Health, which tracks pricing information, has logged more than 1.1 billion negotiated rates.

There have also been milestones in terms of federal movement on healthcare price transparency, according to the report.

A November update from CMS included a required schema for hospital MRFs as well as new required fields and accountability parameters, Turquoise Health said.

“Momentum continues to build surrounding hospitals’ publication of MRFs,” the report concluded.

In addition to the original Hospital Final Rule that took effect at the beginning of 2021, CMS recommended schemas hospitals could use to “templatize” their MRFs earlier this year, and subsequently finalized those requirements. Changes are set to take in effect in three phases, beginning this month.

The first phase includes a requirement that hospitals post a text file pointing to a download link of their current MRF. Additionally, compliance actions or assessments may now be publicized on the CMS website, among other measures.

The second phase, set to take effect in July, is “largely focused on MRF standardization and additional reported fields,” the report continued. Recommended schemas “benefit consumers and innovators because the new required fields bring much-needed clarity and context to the dollar values for each item and service,” it added.

The final phase, slated for January 2025, includes average expected allow amount rates and additional Part B drug reporting.

As for payer MRF trends, Turquoise Health indicated that, based on a year-and-a-half worth of data, the number of payers posting data has increased from 67 to more than 200.

Yet another trend that has emerged in healthcare price transparency this past year is consolidation. Turquoise Health noted that, across the Hospital Final Rules, Transparency in Coverage (TiC) Rule, and the No Surprises Act, the government has implemented “various requirements for patient estimate tools, shoppable services, and data publication.”

In a related development, the U.S. House of Representatives on December 11 passed the Lower Costs, More Transparency Act, which seeks “to codify price transparency reporting for hospitals, payers, non-hospital entities, and pharmacy benefit managers into law,” according to Turquoise Health.

“While we wait for Senate debate and additional voting, all three current rules and laws remain in effect,” the report stressed.