Has anyone found/used a database that has what payors pay for the top 100 (or whatever) procedures? I thought that was a thing recently. Google not very helpful (nor is my state DOI/BOI)
I don’t think you’ll find that in a public place.
I don’t think any company wants that info out. It just raises more questions (“why is MY procedure so expensive??”) that do not solve anything.
I get it.
But I swear payor had to publish that.
I’ve been asked that question so much in my career. Never, NEVEtR, did I say “yup, I got this!!!”
My understanding is the hospitals have to publish it, and list what each payer is contracted at for those top procedures as part of the price transparency act of 2021. But compliance is abysmal and there isn’t an easy aggregated source (at least not a free one I know about).
Interesting article on it
Regulation-
https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
2 Likes
Well, thanks gang! I didn’t think there would be a usable file. Cool article as well @MayanActuary. Thanks for that!
1 Like
Payors were required to provide data starting July 1st, 2022 (Plans And Issuers | CMS).
There is a lot of data, to the point where most individuals probably cannot ingest and analyze the data on their own. There are some companies who are trying to standardize the data across entities, such as Turquoise Health. It looks like you can request a free dataset here: Hospital Price Transparency Research Datasets | Turquoise Health