How CMS Can Improve Hospital Price Transparency and Strengthen Enforcement Through Data

Mathematica provided recommendations to the Centers for Medicare & Medicaid Services (CMS) for improving hospital price transparency (HPT) compliance and enforcement processes to ensure that the pricing information publicly disclosed by hospitals is accurate and complete.

“Accurate, complete, and accessible healthcare pricing, backed by meaningful enforcement, empowers consumers to make more informed decisions and supports an efficient, cost-effective market,” said Jonathan Morse, senior vice president and managing director of the Federal Payors, Delivery Transformation, and Life Sciences Division at Mathematica. “CMS’s efforts are critical to driving greater transparency in healthcare pricing and giving consumers greater control over their personal healthcare spending.”

Mathematica submitted its recommendations in response to CMS’s hospital price transparency accuracy and completeness request for information. Among its recommendations to CMS were:

• Leverage both the Transparency in Coverage (TiC) data reported by health plans and the Medicare fee schedules to support assessments of the accuracy and completeness of data in a hospital’s machine-readable file.
• Prioritize a monitoring strategy that focuses on identifying hospitals that exhibit consistent patterns of price discrepancies and incompleteness across payers and billing codes.
• Implement a consistent program of audits to improve compliance. Specifically, leverage findings from validation activities, focus early efforts on addressing missing or incomplete data, and prioritize reviewing price data where the impact is likely to be highest.