Hospital, Payer Price Transparency Compliance Improves, But New Requirements Are Kicking In This Year

A “pivotal year for price transparency” closed out with most—but not all—of the healthcare industry publishing their data publicly and at a higher quality, price transparency data startup Turquoise Health wrote in a state-of-the-industry report released Thursday.

Across a total of 6,357 hospitals, 5,763 (90.7%) posted a machine-readable file (MRF) with at least some necessary service rates in 2023. This was an increase of 562 hospitals over the end of 2022, with Turquoise noting that most of the additions “were individual hospitals, often with unique MRF formats.”

Turquoise gave 2,634 of the hospitals posting MRFs a five-star rating for publishing “a complete MRF that contains cash, list and negotiated rates for a significant quantity of items and services,” the group wrote. That list of top scorers grew 24% from the end of 2022, and now represent more than half of the total hospital field.

Specifically, Turquoise found that 83.1% of all hospitals have posted negotiated rates, 77.3% cash rates, 80.4% surgery rates, 80.8% imaging rates, 81.3% “BUCAH” rates (those from major insurers BCBS, United Healthcare, Cigna, Aetna and Humana) and 65.1% diagnostic-related group rates.

The number of payers publishing their data has grown from an initial 67 back in July 2022 to 170 in January 2023, and now to 205 as of November 2023, according to the report. Turquoise also noted that “the quality and breadth of their files have also improved” over the past several months — welcome news for researchers and other stakeholders who previously critiqued payers’ unwieldy data releases.

Hospitals and payers’ progress on price transparency comes as new enforcement goes into effect and policymakers weigh tighter requirements for the industry, Turquoise wrote in the report.

2023 already brought its fair share of activity from the Centers for Medicare and Medicaid Services (CMS). The agency said it has issued over 1,000 cumulative warning notices to providers; publicly lists 14 civil monetary penalties issued to noncompliant hospitals; and, in November, finalized additional required schema for hospital MRFs as well as additional required fields and accountability parameters under the 2024 Outpatient Prospective Payment System (OPPS) Final Rule.

The first portion of those new regulations went into effect with the new year, Turquoise warned. Those include a requirement that hospitals add a homepage footer link directing users to their price transparency information as well as the addition of a text file to the site’s root folder that directs to a download link for the hospital’s current MRF (CMS has released an online tool to help hospitals generate such a text file).

Further, as of Jan. 1, CMS may now begin publishing any of the compliance actions or assessments it issues to hospitals on its website, similar to the civil monetary penalties.

Later price transparency updates on the calendar include a July 1 enforcement date for MRF standardization plus the addition of new fields, and a Jan. 1, 2025 enforcement date covering average expected allow amount rates and more Part B drug reporting, per the report.

Meanwhile, momentum has been building in Congress to codify price transparency reporting for hospitals, payers, pharmacy benefit managers and others. The standout here is the Lower Costs, More Transparency Act, which passed through the House of Representatives in December and is being considered in the Senate.

“Congress asserting itself to declare price transparency the law of the land is critical,” House Energy & Commerce health subcommittee chair Cathy McMorris Rodgers, R-Ore., said during a floor statement shortly after the bill’s passage. “It is our intent that the requirements for transparency and coverage should be as comprehensive as possible without limitations.”


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