It's been nearly two years since the Hospital Transparency Rule went into effect, requiring all hospitals in the U.S. to make their rates for care available to the public. But did they deliver?
According to healthcare pricing platform
In other words, the Hospital Transparency Rule has not been in vain. Alongside the Transparency in Coverage Rule, which went into effect this July and requires health insurers and self-funded plans to share their cost-sharing data, healthcare prices are coming more into the light than ever before, says Marcus Dorstel, head of operations at Turquoise Health.
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"We are letting folks know what we've seen as we dug through the data since the beginning of 2021," he says. "We've been working hard to standardize it and make it more useful."
Turquoise recently launched Simple Extracts, a price transparency tool product that allows anyone to request and receive precise searches from the hospital as well as through insurance rates data. Users can also store, access and refresh any data they have requested from Turquoise. And while hospitals and insurers are still working to be compliant with these laws, every piece of data helps paint a better picture of healthcare costs.
"It's often just a slice or sliver of data needed to really answer the questions that business folks are trying to answer," says Dorstel. "Even if a hospital didn't have a fully compliant file, the file that they put out is still very valuable and has data that is useful for companies."
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Given that healthcare prices are expected to rise by 6.5% in 2023, transparency can be a powerful tool. Dorstel hopes benefit leaders take advantage of the data available to them and reassess their current plans.
"Employers might be looking to switch it up to another carrier for coverage but have no idea what their spend would look like under different coverage," he says. "This data allows you to say, 'Based on our employees' utilization, this what we might expect to spend in 2023 with carrier one versus carrier two.'"
Essentially, if employers know the kinds of
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Still, Dorstel knows there's more work to be done on the transparency front. While the Centers for Medicare and Medicaid have begun slapping fines on hospitals that are not compliant — meaning they have not published a machine-readable file with all items and services as well as displayed their shoppable services in a consumer-friendly format — Dorstel hopes to see more enforcement in 2023. On the other hand, CMS recently released a standard file format, which may make it easier for hospitals to comply and for companies like Turquoise to read their data.
"We have assigned a price transparency score to every file that's out there," says Dorstel. "Ideally, we would love to see everyone at a five-star rating."
Until then, Dorstel encourages employers to look into the data themselves and find out what will work best for their workforce. He emphasizes care navigation benefits as especially useful now that rates have been publicized.
"One of the major questions for employers is how will they control their medical spend," says Dorstel. "Benefit advisers or consultants would try to the answer in the past, but that can now be answered through price transparency data."
