President Donald Trump’s latest executive order aims to strengthen enforcement for CMS’ price transparency requirements. Some experts think greater price transparency could reduce healthcare costs by fostering more competition, while others are concerned about the potential effects on hospital-payer negotiations, as well as the practicality of enforcing these requirements.
Come January 1, CMS will begin enforcing new price transparency requirements for hospitals. Experts doubt that these regulations will do much to help patients shop for care, but they are optimistic that increasing the amount of publicly available pricing data will help tech companies develop tools that simplify pricing for patients.
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Most hospitals and payers have publicly posted their pricing information, but experts think that data will remain mostly useless for consumers for at least another five years. Now that the data is available, healthcare software companies must step in and build tools that are personalized and easy to use. That way, consumers can eventually use price transparency data to shop for care.
Turquoise Health closed a $30 million Series B round, which brings its total funding to date to $55 million. The San Diego-based startup, which has more than 160 customers, sells a platform that makes it easier for hospitals and payers to comply with price transparency regulations.
Hospitals markedly improved their compliance with price transparency regulations in 2023, according to a new report. It found that more than 90% of hospitals have posted a machine-readable file containing gross charges, negotiated charges and cash prices for the services and items they provide.
During the first three quarters of 2023, the prices for CMS’ 500 shoppable services increased by 2.0%, according to a new report. This figure is in alignment with the 1.9% U.S. inflation measured by the Personal Consumption Expenditures Price Index and below the overall U.S. inflation rate measured by the Consumer Price Index.
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Payers and providers face different challenges when it comes to compliance. The volume of price transparency data that hospitals must disclose online amounts to about 3 terabytes — compared to the whopping 630 terabytes of data that payers have been tasked with posting.
The healthcare industry is still building software to can handle its complex and vast pricing data, so it still has a few more years to go before price transparency information actually becomes useful. Once software development cycle matures, this data can infiltrate the way providers and payers negotiate contracts and affect the way patients shop for care.
Experts believe CMS’ price transparency rule is flawed in its design because the highly complex billing data it is asking hospitals to post is too confusing for consumers to understand. The complicated structure of the healthcare system — from care variance to deductibles to billing codes — means that producing an accurate price estimate is virtually impossible. To improve compliance, hospitals will need health tech companies to step in.
Pulling back the curtain on healthcare pricing is easier said than done, acknowledged Chris Severn, the company's co-founder and CEO. That's exactly why the investment is so important.
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