价格透明度存在差距:评估付款人的完整性 覆盖数据的透明度
David B Muhlestein1, Yuvraj Pathak
1Simple Healthcare, 465 N Carolina Run, Sanford, FL 32773.
2025年覆盖率透明度 (TIC) 谈判费率文件为医生和医院门诊服务提供了可用的数据,但对于住院护理缺乏足够的细节. 像Aetna和Cigna这样的支付公司在数据完整性方面表现比UnitedHealthcare更好.
科学领域:
- 卫生经济学 卫生经济学
- 医疗保健政策 医疗保健政策
- 医疗信息学 医疗信息学
背景情况:
- 覆盖的透明度 (TIC) 规则要求付款人披露谈判费率.
- 准确和完整的数据对于市场分析和患者成本估计至关重要.
- 之前的评估强调了数据质量和完整性的变化.
研究的目的:
- 为了评估2025年覆盖率透明度 (TIC) 谈判费率文件的完整性.
- 评估医生,医院门诊和医院住院服务线的数据质量.
主要方法:
- 对Aetna,Cigna和UnitedHealthcare发布的2025 TIC数据的横截面描述性审查.
- 进行了数据清理,解析和复制删除.
- 计算了网络规模和共同计费代码的谈判费率完整性,并与营销材料进行了比较.
主要成果:
- 艾特纳和Cigna通常满足或超过网络规模的要求,而UnitedHealthcare列出了更少的提供者.
- 谈判费率的完整性在医生服务中最高,在住院服务中最低.
- 医生和医院门诊数据大多是可用的,但住院数据不足以进行基准测试.
结论:
- 2025 TIC文件适用于分析医生和医院门诊患者的定价,但不适用于住院患者的基准测试.
- 医疗保险和医疗补助服务中心 (CMS) 应审计TIC文件的完整性,并对不遵守规定实施处罚.
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