In 2021, the Centers for Medicare and Medicaid Services (CMS) put into effect the Hospital Price Transparency Rule, a mandate requiring hospitals operating in the United States to publicly disclose a list of their standard charges for items and services as comprehensive machine-readable files (MRF). Despite a financial penalty for noncompliance, certain hospitals continue to release incomplete MRF or no MRF at all—keeping the charges of hospital-related services concealed. Fortunately, hospital compliance, or lack thereof, can be measured. Turquoise Health has released a beta version of their Price Transparency Scorecard—a publicly available search tool which assesses the relative completeness of a hospital’s MRF. Turquoise Health considers over sixty pieces of information in evaluating any hospitals’ MRF transparency score. This score serves as a step toward a consumer-friendly, competitive healthcare market where patients can make informed, economical decisions regarding their care. This begs the question: are hospitals compliant in price transparency the same ones providing high quality healthcare?  

We used CMS-provided healthcare quality data to assess the relationship between price transparency and quality performance of a hospital. CMS Hospital Compare feature provides an overall star rating based on how well a hospital performs across different measures of quality. We focused on hospitals in southeast Wisconsin, where our lab is located at Froedtert & the Medical College of Wisconsin. We found a significant positive correlation between the usability of a hospital’s MRF and a hospital’s overall star rating (r = 0.64). To confirm this association, we looked at two other well-established healthcare quality evaluators: Leapfrog and the Wisconsin Hospital Association (WHA). Similarly, for each, there was a positive correlation seen between MRF transparency score and hospital quality performance. This supports the association between price transparent hospitals and the provision of high-quality healthcare.  

Shown above is a map summarizing these findings. Colored in orange are CMS hospital star ratings by zip code with the darker shades signifying better ratings. In blue are MRF scores by zip code with the darker shades representing greater price transparency. We found several hospitals in SE Wisconsin where there was incongruency between MRF Transparency Score and quality measures. These were more closely examined and all hospitals with high transparency/low quality were large, short-term acute care hospitals. There were no hospitals with a low transparency score and a high quality score. This raises a few questions that require additional work to further understand these relationships. Why are larger hospitals highly price transparent but have difficulty providing the highest quality health care? Do these trends extend beyond SE Wisconsin? Is there a direct link between price transparency and high quality care?  

So, what does this all mean for patients navigating the complex healthcare market? Hospitals which are leading the revolution in price transparency by providing high quality MRF are potentially the same hospitals delivering high quality care.