Dive Brief:
- * An online tool that allows patients in markets across the country to compare prices for hundreds of hospital services before getting treatment has launched in its beta development stage.
- * Turquoise Health’s platform uses cost data from machine-readable files made public by hospitals as part of compliance with a federal price transparency rule that went into effect in January 2021.
- * The San Diego-based startup’s platform includes a scorecard that lets users assess price transparency compliance with the CMS requirements for nearly 6,000 hospitals, Turquoise Health said Monday. Hospitals receive a score based on an algorithm-driven five-star rating system.
Dive Insight:
Noncompliance has been an issue with the government’s price transparency rule, which is designed to make it easier for consumers to comparison shop for medical services with the aim of lowering healthcare costs in the U.S. The nation’s hospital lobby mounted legal challenges but ultimately failed to block requirements that they reveal rates negotiated with insurers for services provided to patients.
Under the new rule, hospitals also must publish price data, including expected out-of-pocket costs, for services such as an MRI or knee replacement that can be scheduled in advance, in an easily understandable format to facilitate shopping across different hospitals.
Several studies, including a report published in May in JAMA Network Open, have found low compliance with the price transparency rule. A recent analysis by the nonprofit group PatientRightsAdvocate.org showed that just 14.3% of the 1,000 hospitals it examined were complying with transparency requirements, and about 38% of hospitals posted a “sufficient amount of negotiated rates” on their websites.
In November, the CMS finalized plans to increase penalties for hospitals that don’t post their prices online to as much as $2 million a year for larger facilities. The agency said its analysis showed sub-optimal compliance with the price transparency requirements.
The CMS said it would also require machine-readable files with pricing information to be accessible to automated searches and direct downloads. That requirement was seen as needed to prevent hospitals from using hard-to-access files to keep information opaque.
Turquoise Health said its beta scorecard identifies transparent providers as well as those with areas for improvement. The system’s search results for hospitals covered under the federal rule show name, location, type, bed count and a transparency score based on the completeness of the hospital’s machine-readable file.
Launched in 2020, Turquoise generates revenue by selling a suite of software to payers and providers to support price transparency compliance. The company expects hospitals will use its price transparency scoring system to assess compliance and compare their machine-readable file attributes to similar facilities. Hospitals that score four or five stars are eligible to become verified by Turquoise through a free program.