Sixty-five percent of hospitals have published “robust” negotiated rates that analysts can use to compare prices, according to a study released Tuesday by data company Turquoise Health.
In addition, 80 health insurers have also published negotiated rates, representing the majority of people who are covered with health insurance in the US, according to the report.
Employers and eventually consumers are expected to use the data hospitals, health insurers, and self-insured employers are required to report to compare hospital rates and negotiate lower costs. Turquoise is one of the data companies compiling the data to make it understandable and usable.
Hospitals were required to file their negotiated rates Jan. 1, 2021, and “payers"—health insurers and self-insured employer plans— were required to do so as of July 1, 2022, under government regulations. Hospitals were slow to come up to speed, but insurers were largely compliant in July, Turquoise Health co-founder and CEO Chris Severn said in a webinar sponsored by the American Enterprise Institute on Monday.
For hospitals with more than 30 beds, the minimum civil monetary penalty for failure to comply is $10 per bed per day, capped at $5,500 per day. Insurers face a more significant penalty for noncompliance of around $100 per violation, per day, per affected enrollee.
In early 2021, “you saw some initial reports that said, ‘Hey, hospitals are not complying,’” Severn said in the webinar. “For a lot of folks in the industry that were expecting immediate gratification, there was disappointment.”
But Turquoise, which Severn said checks every hospital every quarter and evaluates what has been posted, has found “a pretty steady uptick.” By the end of the third quarter this year, 4,900 hospitals, “well over 80% of hospitals, now have posted machine-readable file data” that provide “significant or meaningful transparency” that can be analyzed, he said.
As many as 65% of US hospitals “have significantly published transparent data on their website” revealing negotiated rates, Severn said. Reports of low hospital compliance are due to hospitals not meeting specific requirements, such as naming files a certain way and locating the files on certain places on websites, he said.
Hospital compliance “skews mostly towards large hospitals, large health systems,” Severn said. “A lot of the holdouts are now like small critical access hospitals that don’t have resources.”
Severn said the results “may be more reason for optimism.”
Insurers More Compliant
In contrast to slow hospital compliance, for large insurers and self-insured employers, “It was almost Day One” that the data was posted July 1, Severn said. “By the end of the first two months, we saw a bunch of the regional players that were a little late come online.”
More than 90% of commercial covered lives are now represented in the insurer data just three months after the publishing date, Severn said.
But insurers have published “so much data,” that it will take five years for the initial phase of price transparency adoption, he said. He predicted that physicians’ offices will be able to provide consumers good faith estimates of procedure costs by 2024-2025 at the time of referral.
Severn recommended standardization of benefit designs and payer-provider contracts to make it easier for consumers to understand and use the price data.
“The real problem before getting to true consumerism in health care is working your way through the complicated math to give consumers an up-front, all-inclusive price,” he said. The prices of 500 shoppable services will be required to be posted by Jan. 1, 2023 under the regulations.
But drug price disclosures have lagged behind, Severn said. By the end of 2022 drug price data is to be reported to the government by payers.
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