Former CMS chief data officer Niall Brennan said it could take hours to sum up his thoughts on the hospital price transparency rule, but was able to cut that to three words: "laudable, but flawed."
Mr. Brennan worked at CMS from April 2010 to January 2017. During his time at CMS he oversaw a new data office tasked with helping the agency use the data at hand to guide decision-making and create frameworks for using the data to improve care and reduce costs. He also played a role in implementing several ACA provisions, including the Qualified Entity Program and the Physician Payments Sunshine Act. He now serves as the chief analytics and privacy officer at the cloud analytics and value-based payments platform Clarify Health.
"If you go back seven, eight years ago when I was at CMS, the notion of this data existing at all was almost inconceivable to people,'' Mr. Brennan said in an interview with Becker's. "So sometimes I think I and other people who criticize various aspects of the program are being a little bit churlish and not acknowledging the giant steps that have been taken over the last couple of years. All that being said, I'm still going to be a little churlish and describe it as flawed."
Mr. Brennan said that compliance is lacking, civil penalties were initially too low and later increased but not enforced. The price transparency rule went into effect Jan. 1, 2021, but it wasn't until June that the first hospitals received fines. So far, only two hospitals — both in the Atlanta-based Northside Hospital health system — have been fined. Northside Hospital Atlanta, the health system's flagship facility, was fined $883,180, according to CMS. Northside Hospital Cherokee in Canton, Ga., was fined $214,320.
He said the jury is still out on whether the rule is achieving what it intended.
"Philosophically, I think it's difficult to expect consumers to navigate the healthcare system on a transactional basis. Specifically, I think it's unreasonable to expect them to interpret or use at scale the information that the hospitals are releasing. That's not to say that there's no value to this information beyond consumers.
"To me, and others may disagree, the requirements and standards around what is compliance are also a little bit confusing. I would say that with this exercise we sort of asked hospitals to engage in an activity that was new and not something they routinely do as part of their business processes, as opposed to the payer rules, which came out [July 1]."
Mr. Brennan said that because a lot of the negotiated rate information is a natural byproduct of the claim cycle, it's a little easier for payers to pull.
"Whereas in hospitals you may be going through individual spreadsheets that have contract rates and different things like that," he said.