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CMS is now conducting over 200 comprehensive hospital compliance reviews per month — up from 30–40. The April 1, 2026 enforcement date applies to every hospital in the country. Section 1: What Changed and When On November 21, 2025, CMS…
Jeff Davis
The White House released a healthcare reform framework in January 2026 that, if enacted, would expand transparency requirements for both insurers and providers — with direct implications for employer-sponsored plans. Section 1: What the…
CMS phased out “estimated allowed amounts” — a data element it had only added one year earlier — and replaced it with median and percentile figures. The reason why reveals something important about how hospitals have been reporting prices.…
Starting January 1, 2026, every hospital’s machine-readable pricing file must include the name of a C-suite executive personally attesting that the data is accurate and complete. Section 1: Why This Matters For five years, hospitals…
Litigation has strained the No Surprises Act’s IDR process, raising payments far above the median rate and creating a new barrier to enforcing those awards.
Fifth Circuit ruled that providers cannot sue to enforce No Surprises Act IDR awards, exposing an enforceability gap. Analysis shows air ambulance providers win 86% of disputes.
Learn how price transparency is shifting the balance of power, giving patients the information they need to save money and take control of their healthcare journey.
All of the fines issued by Centers for Medicare & Medicaid Services (CMS) to hospitals for non-compliance with hospital rice transparency in accordance with Section 2718 of the PHS Act, titled “Bringing Down the Cost of Health Care…
Analysis of the push for mandating public access to all payer rates. We compare current fragmented transparency data with comprehensive All-Payer Claims Databases (APCDs) and their potential for rigorous policy research.
We explore the arguments from physicians and provider groups who have been critical of price transparency mandates and what their concerns are for patients and the industry.
The U.S. Department of Veterans Affairs (VA) proclaims a commitment to being “the most transparent organization in government”[1]. The official VA Transparency portal hosts public reports on outcomes, quality, and other metrics,…
Unexpected medical bills, often called “surprise bills,” can be a major source of financial stress for American families. These bills typically occur when you receive emergency care or are treated by an out-of-network provider at an…
If you’ve ever received a medical bill that feels like a punch to the gut, you’re not alone. In the U.S., the healthcare system is a labyrinth of hidden fees, surprise charges, and enough fine print to fill a novel. Despite laws like the…
For years, advocates have championed hospital price transparency, which requires hospitals to publicly post the prices of their services. These regulations, designed to empower patients, have faced a fierce and sustained opposition from…
Date Event Description 1963 Economist Kenneth J. Arrow publishes a seminal paper on the economics of medical care, highlighting the lack of price transparency and its implications for consumer vulnerability in healthcare markets. [AEA]…
The New Frontier in Healthcare Transparency: Understanding Executive Order 14221 Most of us are accustomed to knowing the price of a product or service before we commit to buying it. Whether it’s a new car or a gallon of milk, clear…
While it is not incredibly unusual for Presidents to issue Executive Orders (EO) that undo their predecessors partisan decrees, it does seem like Trump and Biden have taken great pleasure in issuing EOs to signify a strong policy shift…
Donald Trump has made health care one of his top political issues since 2016. Trump’s first Executive Order (EO) in his first term was an effort at “repeal and replace” on the Affordable Care Act (ACA). Trump had made several promises to…
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