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How a software start-up is working to improve healthcare transparency

The Centers for Medicare & Medicaid Services’ (CMS) hospital price transparency rule went into effect at the beginning of last year. The rule is designed to inform patients on the cost of an item or service before receiving it. For some hospitals, the new policy has been a bit of a learning curve.

FingerLakes1.com recently sat down with Marcus Dorstel, head of operations at Turquoise Health, to discuss how people can access hospital service pricing online, the rollout of the company’s Price Transparency Scorecard, and compliance ratings for hospitals in the Finger Lakes region.


CMS regulation requires all U.S. hospitals to list pricing information online in two ways: as a machine-readable file (MRF) with the price of every item and service offered and a list of 300 “shoppable services” that can be scheduled in advance.

“For the good part of 2021, our team has been out there, finding these files,” explained Dorstel. “Searching across the 6,000 U.S. hospital websites for these files, parsing them, cleaning them up, bringing them into a structured database.”


As of this month, over 4,000 U.S. hospitals have posted MRFs. The federal regulation did not designate a standard format for the files, so they often differ in format and content.

“We found that it’s very complex and nuanced in terms of what compliance looks like and what a good file looks like versus another. All of that was the impetus to create a much more robust and comprehensive scorecard,” said Dorstel.

On Monday, March 14, Turquoise Health launched their Price Transparency Scorecard, an algorithm-based beta search tool that uses over sixty pieces of information to evaluate a hospital’s MRF. In the spirit of transparency, anyone can download a PDF scorecard free of charge.


Here are the currently available MRF transparency scores for Finger Lakes region hospitals:

Cayuga County

Auburn Memorial Hospital: 5

Ontario County

Finger Lakes Health: 5

Thompson Health: 5

Clifton Springs Hospital and Clinic: 4

Livingston County

Nicholas H. Noyes Memorial Hospital: 4

Steuben County

Ira Davenport Memorial Hospital: 5

St. James Mercy Hospital: 5

Wayne County

Newark Wayne Community Hospital: 4

Yates

Soldiers & Sailors Memorial Hospital: 4

Finger Lakes Partners (Billboard)

In addition to being a great resource for customers, the Price Transparency Scorecard search tool is valuable to hospitals looking to improve their score.

“What we’re seeing is that everybody’s very interested in this data. It was in a black box, it didn’t exist on this broad of a scale before, or everything was kept secret. There’s a lot of value in being able to benchmark how you compare to other payers or providers in your area and in your markets,” said Dorstel. “We’ve had a lot of interest from both sides, provider and payer, in getting their hands on this data and being able to use it for their contract negotiations and for various elements of their operations. We got quite a few hospitals that reached out to us asking about their scores and asking, ‘Why is my score this?’ and ‘How can I improve it?’ so there’s an appetite for being compliant and and ensuring that you’re compliant to the full extent of the law.”


Will CMS takes measures against hospitals that don’t fully comply with the price transparency rule? CMS sent warning letters to non-compliant hospitals in mid-2021, then again in the fourth quarter of 2021. So far, no fines have been issued.

The hospital price transparency rule is the first part of what Dorstel calls the “triumvirate of price transparency legislation.” The next part is the No Surprises Act, which seeks to protect consumers from surprise medical bills that arise from select out-of-network emergency care.

The third piece is the transparency in coverage requirement, which requires insurance providers to provide consumers with an MRF of all their negotiated rates.

“That’s where you’ll get a much broader scope and coverage for non-hospital settings,” explained Dortsel. “What we’re doing is, with the scores out there, we’re going to hear some feedback from hospitals and different folks in the market. We’re going to use that feedback, and we’re going to keep improving the scoring system, and improving the algorithm so that we’re putting the best product out there.”

A full launch of Turquoise Health’s Price Transparency Scorecard search tool is available this spring. You you can check out the beta search tool- with information on thousands of hospitals throughout the country- available now on the Turquoise Health website.



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