A new Peterson-KFF brief focuses on the recently effective hospital price transparency rule to assess hospital compliance and examine how payer-negotiated rates vary. The brief shows how prices can vary for the same service (an MRI of the lower spine) across select hospitals that provide payer-specific negotiated rates.
The major challenges with the implementation of the price transparency rule are described, with an example of an analysis of the websites of two of the largest hospitals in each state and the District of Columbia. In their analysis, researchers found that in practice, price transparency data is neither consistently available nor reliable, with most hospitals not fully compling with the rule. Those that do comply and provide payer-specific negotiated rates vary in what prices they show, how they define price (e.g. does it include both facility and professional fees?), and whether they provide payer-specific negotiated rates for all their participating payers.
The lack of standardization in both the definition of “price” as well as the format of machine-readable files across hospitals makes it impossible to reliably compare prices across hospitals. For price transparency data to be useful in making comparisons across hospitals, data in the files would need to follow a set template, such that all hospitals use consistent file formats, billing codes, service descriptions, and insurer and market naming formats. The results from implementation thus far demonstrate a wide range in interpretation and compliance with the hospital rule and may suggest similar challenges with implementation of the insurer-focused rule in 2022 if standardization is not enforced.
- Early results from federal price transparency rule show difficultly in estimating the cost of care. Peterson-KFF Health System Tracker. 9 April 2021