Why hospital price transparency's shortcomings aren't from a lack of compliance

The challenges facing federal hospital price transparency aren't necessarily a result of lack of compliance, but a lack of standardization and specification in reporting requirements, a Feb. 10 analysis from the Kaiser Family Foundation and Peterson Center on Healthcare's Health System Tracker found. 

For the analysis, researchers looked at how well hospital price transparency disclosures facilitate comparison of prices for services across hospitals. The report addressed the machine-readable files and not shoppable services. The researchers primarily accessed information using a database compiled by Turquoise Health and also evaluated data through the hospitals' websites. 

Researchers focused on payer-specific negotiated rates for two types of care associated with common procedure codes: hip and knee replacement (MS-DRG 470) and diagnostic colonoscopy (CPT 45378). 

The analysis found: 

  • Specification of what services prices correspond with is inconsistent, especially for episodes of care. 
  • Data quality can vary widely, with "questionably low and high values" for negotiated rates.  
  • Crucial pieces of information for interpreting the applicability of price are missing, such as contracting method and payer class.

Consistent specification of the following would improve the reliability and usability of the data, according to the report: 

  • The charge's applicable hospital setting (inpatient or outpatient)
  • Charge type (facility or professional)
  • Associated charge modifiers that affect pricing or payment of a service
  • The time period covered
  • Any bundles the charge is a part of 
  • The health plan type
  • How the charge differs from the base rate. 

"Until there is more standardization in how machine-readable files are organized and made available, analysis of these data will be challenging," the report stated. "More fundamental issues surrounding what is included in a negotiated charge remain."

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