New research by Turquoise Health examines the state of price transparency for both hospitals and insurers.
"Price transparency has passed a major inflection point" with there now being no shortage of pricing data by both payers and providers, Turquoise Health CEO Chris Severn said in the company's Q1 impact report.
The analysis finds that as of March 2023, 95% of commercially insured lives are now represented by payer data, while 84% of hospitals have posted pricing data. Additionally, Turquoise scored payers on transparency for all payer machine-readable files based on completeness, size, and parsability.
On the payer side, the report notes that pricing data has come in a lot quicker after the insurer price transparency law went into effect in July 2022 than it did for hospitals following their regulation more than two years ago. And the numbers continue to rise, with Turquoise citing 183 payers publishing data as of March, up from 68 in July 2022, 111 in October 2022, and 170 in January 2023.
However, the report highlights that "healthcare pricing is complex" and that the size of payer data requires refinement and necessary context.
"If the government is aiming to require all insurance companies to publish the rates for all items and services, which we at Turquoise fully support, the output will, by nature, be nuanced and quite large," Turquoise stated.
"Due to this unfortunate truth, the data still requires industry expertise and additional reference data to process and create utility for end users. When left in the hands of the inexperienced, as we’ve seen in some articles from industry outsiders, incorrect and hasty conclusions are drawn."
That is less the case with provider pricing data, which now has 5,383 hospitals out of 6,394 (84%) with machine-readable files and 4,703 (73.6%) with significant negotiated rates. Those figures are up from Turquoise's first impact report released in October 2022, when 4,909 hospitals (76%) had posted a machine-readable file and 4,195 (65%) had negotiated rates.
The rise in compliance will "usher in a transformational era where data will be embedded in revenue cycle workflows, contract negotiations, and become an integral part of running a savvy healthcare organization," Turquoise said.
Severn recently shared some price transparency tips for revenue cycle leaders in an exclusive interview with Healthleaders.
"Make sure that you have a good understanding of the laws and requirements," Severn said. "There are a lot of resources out there that can help you get educated and understand where you and your organization can best focus your time.
"Also, keep an eye on the landscape for information. We’re seeing guidance, training, podcasts, and notice of any changes, such as a recent job aid to assist payers and providers with their Independent Dispute Resolution applications, published nearly weekly."
Severn also gave congressional testimony at the March 28th hearing "Lowering Unaffordable Costs: Examining Transparency and Competition in Healthcare," where he spoke for more government action, including the enforcement of standards.
Jay Asser is the CEO editor for HealthLeaders.
KEY TAKEAWAYS
Turquoise Health released its Q1 2023 Price Transparency Impact Report, which takes a look at the state of the price transparency landscape for payers and providers.
The report finds that 183 payers have published pricing data as of March 2023, up significantly from 68 in July 2022.
Meanwhile, 5,383 hospitals (84%) have posted machine-readable files and 4,703 (73.6%) have significant negotiated rates, an increase from 76% and 65%, respectively, in Turquoise's October 2022 report.