Data Transparency
By Dr. Nick van Terheyden aka Dr. Nick
Twitter: @drnic1
Host of Dr. Nick: The Incrementalist – #TheIncrementalist
On this episode I to Morgane Mouslim, PhD (@MorganeMouslim) a Policy analyst at the Hilltop Institute at the University of Maryland Baltimore County and Morgan Henderson, PhD, (@morghend) a Data Scientist at the Hilltop Institute at the University of Maryland Baltimore County (@UMBC).
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Together with Sarah Kliff (@sarahkliff) and Josh Katz (@jshkatz) from the NY Times (@NYTimes) they they carried out a seminal piece of data research using data published by hospitals required by the recent regulations requiring data transparency. The article (Hospitals and Insurers Didn’t Want You to See These Prices. Here’s Why) was published in The Upshot (@UpshotNYT) featuring the details that were surprising and revealing.
Unambiguously Non-Compliant
Their work started with the regulations that announced price transparency was here – something that might have passed unnoticed thanks to all the focus on COVID19 and Pandemic issues. Their early work focused on finding compliant organization and there were quickly able to determine those that were
Unambiguously non-compliant
This is code for organizations that had not published any pricing information. The regulations were fought hard by many interested parties using most of the tactics in the book to fight the release of information and continue to this day with many hospitals still claiming it is very difficult to comply. As noted by Micky Tripathi the push by the regulatory bodies is not for “Minimal Viable Compliance”
Ohhh. @mickytripathi1 talks about not falling into the trap of “minimal viable compliance” with respect to info blocking rules. He implores hospitals and medical groups to not aim for lowest possible information sharing. #HLTH2021 pic.twitter.com/gpxkitgdsm
— Craig Joseph, MD (@CraigJoseph) October 19, 2021
The early work focused on 60-70 hospitals to identify the variation in pricing for everything from basic test like a simple pregnancy test:
- for Blue Cross patients in Pennsylvania $18
- for Blue Cross HMO patients in New Jersey $58
- for Blue Cross PPO patients in New Jersey $93
- and for cash paying patients with no insurance $10
to procedures such as Colonoscopies.
At the University of Mississippi Medical Center:
- Cigna plan $1,463
- Aetna plan $2,144
- With No Insurance $782
We discuss the source data and the “Charge master” and how that relates to pricing and the importance of the data in the analysis that now includes cash based payments that to now have rarely if ever been contained in ay economists healthcare research data
As we discuss this is only the beginning as they work for a better future for everyone that decreases healthcare prices even in some of the currently less competitive marketplaces. As they reveal there remains some validation of this data and confirming that the prices paid, cash or insurance based are the actual prices being paid and importantly if these prices paid are changing over time, especially in response to the price transparency regulations.
There are some additional changes from CMS which now requires hospitals to publish on their website a consumer-friendly list of prices for 300 shoppable services – generally, non-emergency services that patients can choose – in addition to an overall list of prices for every item and service the hospital provides.
Morgane and Morgan continue their work in this area and their focus in the coming months include a desire to see:
- Full compliance by every hospital covered by these regulations
- Full compliance with Insurers to new regulation expected in mid 2022 that demands the same level of transparency from insurers pricing, and
- Importance of Data Standardization across these datasets
Listen in to hear what Morgane and Morgan have seen regarding price transparency changes following the publication of their data analysis and report with some institutions now pulling back and publishing less data.
About the Show
For years Dr. Nick van Terheyden aka Dr. Nick, has served as a voice on the impact of new technologies on healthcare, earning a reputation as a leading authority on where the future of medicine is going. Combining powers of observation and real world experience, Dr. Nick has seen many predictions come true and makes the case that innovations in healthcare can be accomplished incrementally, not just by moonshot events. Tune in to hear Dr. Nick: The Incrementalist and his guests discuss what the future of healthcare looks like, how we will get there, and what it will take to improve healthcare for all.
This article was originally published on the Dr. Nick – The Incrementalist blog and is republished here with permission.