In a letter to CMS, senators call for action to improve patients' ability to access and decipher pricing information.
Shortcomings in the payer price transparency rule have caught the attention of two senators who have asked CMS to close "technical loopholes."
Senators Maggie Hassan (D-N.H.) and Mike Braun (R-Ind.), members of the Senate Health, Education, Labor, and Pensions Committee, penned a letter to CMS highlighting the need for reporting standardization, file size limits, and increased enforcement of health insurers that fail to comply with the price transparency requirements.
"While some insurance companies are complying with CMS' rule, others may be relying on gaps to evade accountability," the senators wrote. "According to reports, insurance companies have provided information in an indecipherable structure, omitted important pricing information, and stuffed the information into files too large for anything but a supercomputer to process."
The letter continued: "As a result, employers and researchers have been unable to use the data to assess the drivers of high health care costs and target solutions."
The senators also previously called out lack of compliance with the hospital price transparency rule, which still has a ways to go to be truly effective since it went into effect on January 1, 2021.
Meanwhile, the payer price transparency rule has been around for less than a year after arriving on the scene July 1, 2022, but it has dwarfed its hospital counterpart when it comes to available data.
Research by Turquoise Health found that payer data accounted for 630 terabytes, which was significantly more than the three terabytes of hospital data.
However, in the same way hospital data has varied wildly in size and reporting, so has payer data—Turquoise Health found payer machine-readable files that varied 50-100 times in size.
To combat that, the senators point to experts offering potential solutions to limit file size, in addition to creating a standardized reporting template and requiring an organizational system and standardized labeling.
Finally, the senators ask for more enforcement of insurers, suggesting a random audit to ensure noncompliant plans follow the law.
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
Senators Maggie Hassan (D-N.H.) and Mike Braun (R-Ind.) wrote to CMS asking for changes to improve the payer price transparency rule.
The changes include creating a standardizing reporting template, limiting file sizes, and requiring an organizational system and standardized labeling.