The federal Transparency in Coverage (TiC) regulations and the Hospital Price Transparency (HPT) rule have required the publication of machine-readable files (MRFs), providing policymakers with verifiable, large-scale data to make hospital prices more transparent and empower patients as “healthcare shoppers” thereby subjecting healthcare system to market economic forces.

We are just now starting to be able to use those files to actually show hospital prices and comparison shop procedures in a way that is accessible on a normal computer or mobile device.

The Advocacy Challenge: Moving Past Anecdote

For policymakers, advocacy requires more than anecdotes or broad cost averages. To successfully challenge large health systems in a political arena, a clear articulation of market malfunction, quantifiable by objective data points, is necessary. The sheer volume of raw disclosure files can be overwhelming, but converting this data into three specific, trackable metrics provides the leverage needed to secure legislative wins and prove that high local costs are a systemic public health burden.

Metric 1: The Negotiated Rate Spread

The Negotiated Rate Spread is the difference between the maximum and minimum in-network negotiated rate for the exact same medical service (CPT code) within a single county or metro area, irrespective of the payer.

This metric instantly quantifies the arbitrary nature of pricing and the massive financial risk citizens face. Analyses of newly available data demonstrate that prices for the same procedure can vary by an average range of more than ten times within the same hospital depending on the specific insurance plan.

This wide dispersion indicates a severe lack of price discipline, suggesting that prices are a function of market power, not clinical quality or the cost of service delivery.

Metric 2: The Insurance Penalty Rate

The Insurance Penalty Rate measures the percentage of local providers who charge a patient more when they use their insurance than if they had simply paid the publicly disclosed Cash Price for the same service. This metric exposes a clear-cut failure of the system where the benefit of having insurance is undercut.

A Johns Hopkins study found that for nearly half of common shoppable services, hospital cash prices were lower than or equal to the median price negotiated with private insurers.

This phenomenon occurs when discounted cash rates, offered to uninsured patients, are lower than the rates established between powerful insurers and providers. Policymakers can leverage this data point to advocate for better consumer protection laws that address unexpected patient responsibility and reduce the risk of surprise billing, even for technically in-network care.

Metric 3: The Compliance Deficit Score

The Compliance Deficit Score is an audit of local hospital systems’ adherence to federal price transparency rules. It measures missing, obscured, or non-machine-readable rates, demonstrating a lack of transparency and compliance with the law.

Early reports showed that many hospitals were initially not fully compliant with the 2021 Hospital Price Transparency Rule. By transforming vast, complex in-network negotiated rate data into three simple, authoritative, and actionable metrics—the Rate Spread, the Penalty Rate, and the Compliance Deficit Score—government officials and policy researchers gain the essential tools to force market accountability. The systematic use of this evidence is the most effective path toward legislative and budgetary wins that protect the public from the ongoing financial burdens of opaque, arbitrary healthcare pricing.