Hospital Pricing Transparency in Georgia

Abstract

Background

The Hospital Transparency Final Rule, effective on January 1, 2021, requires U.S. hospitals to post a machine-readable file (MRF) listing the payer-specific negotiated prices, discounted cash prices, and standard charges for all services on their website. Hospitals are also required to have a consumer-friendly display of the same price information for 300 shoppable services. Health care price transparency is expected to improve the affordability of hospital care by promoting price competition. Noncompliant hospitals can face daily civil monetary penalties. Compliance is growing, but substantial variation remains. With 40% of hospitals compliant, Georgia ranked 29 out of 51 in 2021.

Objectives

Our objectives were to examine progress in increasing compliance level in Georgia, focusing on differences between rural and urban and system affiliation, and to assess pricing (means and variation) for 10 common procedures across facilities in Georgia.

Methods

This was a descriptive cross-sectional study using Turquoise Health data through 2022 - a current, aggregated source of publicly available data from hospital websites, Turquoise Health Price Transparency Scorecard - a 1-5 ranking of MF completeness, Centers for Medicare and Medicaid Services’ hospital quality scores, and census data.

Expected Results

Georgia hospitals with a 5 price transparency score, in comparison with hospitals with a 1 score, report more rates's insurance plans within the same Current Procedural Terminology (CPT) code, report rates for more CPTs, and report higher mean rate values per CPT. Further analysis of pricing levels and of correlations between compliance and price levels and household income are expected to yield an informative map of pricing across the state and to highlight rural/urban differences.

Conclusion

Our study provides an initial insight into hospital price compliance in Georgia and warrants further research on mechanisms of ensuring operational effectiveness of the regulation.

Keywords

hospital pricing transparency, rural/urban comparison

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Hospital Pricing Transparency in Georgia

Background

The Hospital Transparency Final Rule, effective on January 1, 2021, requires U.S. hospitals to post a machine-readable file (MRF) listing the payer-specific negotiated prices, discounted cash prices, and standard charges for all services on their website. Hospitals are also required to have a consumer-friendly display of the same price information for 300 shoppable services. Health care price transparency is expected to improve the affordability of hospital care by promoting price competition. Noncompliant hospitals can face daily civil monetary penalties. Compliance is growing, but substantial variation remains. With 40% of hospitals compliant, Georgia ranked 29 out of 51 in 2021.

Objectives

Our objectives were to examine progress in increasing compliance level in Georgia, focusing on differences between rural and urban and system affiliation, and to assess pricing (means and variation) for 10 common procedures across facilities in Georgia.

Methods

This was a descriptive cross-sectional study using Turquoise Health data through 2022 - a current, aggregated source of publicly available data from hospital websites, Turquoise Health Price Transparency Scorecard - a 1-5 ranking of MF completeness, Centers for Medicare and Medicaid Services’ hospital quality scores, and census data.

Expected Results

Georgia hospitals with a 5 price transparency score, in comparison with hospitals with a 1 score, report more rates's insurance plans within the same Current Procedural Terminology (CPT) code, report rates for more CPTs, and report higher mean rate values per CPT. Further analysis of pricing levels and of correlations between compliance and price levels and household income are expected to yield an informative map of pricing across the state and to highlight rural/urban differences.

Conclusion

Our study provides an initial insight into hospital price compliance in Georgia and warrants further research on mechanisms of ensuring operational effectiveness of the regulation.