Healthcare Blame Game: Patient Rights Advocate claims its report gets ‘independent review and validation’ – but does it?

Headline: The Sixth Annual Hospital Price Transparency Compliance Report
Source: Patient Rights Advocate
Published: February 2024

PatientRightsAdvocate.org recently issued its sixth report scoring hospital compliance with federal price transparency regulations, and for the sixth time, its assessment conflicts with CMS’s assessment.

I want to focus on a nugget we picked up on in the methodology section of the latest report, which has also appeared in all five previous reports: “… an independent review and validation of the report using a substantial sample of the data was performed … by FireLight Health LLC, an independent healthcare price data company with expertise in hospital price transparency data.”

At the end of the report summary on page 7 of the current report, there’s a note: “Validation by FireLight Health LLC: James Jusko.”

So what is FireLight Health and who is James Jusko?

‘Independent review and validation’

Before I get to FireLight Health, it’s important to establish the concept of an independent review.

Every Blame Game blog post I write is reviewed by HFMA policy directors, HFMA senior editors – subject matter experts – and I send it to an outside reviewer who has no affiliation with HFMA, no personal conflict with the topic and is a credible professional.

I want someone who will challenge me.

I also oversee hfm magazine, which includes peer-reviewed articles. Reviewed articles go through a rigorous validation process of initial reviews from internal editors, followed by three separate reviews from outside subject matter experts. We receive several hundred submissions every year and accept about two dozen.

The idea that a published work is independently reviewed and validated evokes an image of rigor, as described above. Indeed, I’ve seen media stories based on PRA reports that reference its independent validation, meaning some reporters think the idea of an independent review is noteworthy.

But we don’t know what PRA’s review and validation processes look like because there’s no transparency into how these reports are built or reviewed.

Firelight Health LLC and James Jusko

Here’s what we do know: FireLight Health LLC has a website for “searching negotiated insurance company prices and cash prices from only certain parts of California and Texas. Prices are available for up to 70 shoppable hospital procedures and services that are typically scheduled in advance. The FireLight website is labeled as “Beta.” According to Jim Jusko’s LinkedIn page, he is the founder of FireLight Health, 2020 to present. No information about staff – and nothing of any substance, really – can be found on the company’s site.

However, the site’s “About Firelight” blurb is revealing. It’s littered with phrases that reflect an anti-hospital bias. Jusko describes hospital pricing as “arbitrary and unfair” and “deeply dysfunctional,” and says price variation among hospitals is “shocking.”

Jusko wears many hats.

His LinkedIn page includes a position (23 years and counting) as executive producer and cofounder of Base Camp Films LLC, which developed, produced or formed project partnerships for major companies like Fox TV Studios and Sony Pictures Television International. He is also vice president of strategy and general counsel for Excel Health Plans, according to that company’s website. The fine print on the website describes the company as offering health plan services that “enable employers to adopt self-funded, employer-owned health plans … Excel Health Plans is not licensed to sell insurance and is not an insurance company.” The website also lists 10 employees on its “Our Team” page.

Back to Jusko’s LinkedIn page: In the feed, he promoted a recent PRA publication entitled, “Price Variation Report.” In December 2023, Jusko wrote: “Co-authored this report released yesterday. No functioning industry would have 30 different prices for the same things done by the same person at the same location. Except your local hospital, where some patients/plans are charged ten times what others pay. #pricediscrimination.”

This is a post I would expect from the founder of a company like Firelight Health, dedicated to combating “arbitrary and unfair” hospital pricing — but not from an independent reviewer, purportedly someone with research expertise who is charged with validating the methodology and other technical aspects of PRA’s price transparency report. And coauthoring PRA’s price variation report does nothing to bolster Jusko’s credibility as an independent reviewer of the PRA price transparency report. The two reports are closely aligned, to say the least.

I attempted to contact Jusko through two email addresses and LinkedIn InMail, and have not received a response.

Conclusion

So as not to rehash well-covered territory, we extensively broke down how PRA is misinterpreting federal price transparency regulations on a recent Healthcare Blame Game podcast, “Patient Rights Advocate’s distortion of price transparency regulations and data.” Or read this blog post from HFMA Policy Director Shawn Stack that also goes deep on how PRA is misinterpreting data. And HFMA recently released a strong statement picking apart PRA’s flawed reports.

CMS is not doing itself or anyone else any favors by not releasing scorecards on a more regular basis – the last assessment period ended in November 2022, after all. This leaves the door wide open for criticism and misinterpretation of rules, such as what PRA continues to do. I’d like to see CMS fill this extended void with an updated scorecard soon.

But the federal rules are the rules, and if you’re arriving at data in conflict with CMS’s assessment while publicly calling out a majority of hospitals as “noncompliant,” you’d best have someone look over your shoulder.

The idea behind an independent review is to add credibility to your content via a third party. Who is handling your review and how that review is conducted matter. PRA’s independent reviewer didn’t even catch errors that should have been low-hanging fruit – among other things, this sixth report dings hospitals for so-called noncompliance with a rule that isn’t effective until July 1, 2024.

PRA Founder and Chairman Cynthia Fisher ambiguously referenced the review process when she was interviewed for a recent episode of “Closer Look with Rose Scott,” a daily news show from Atlanta-based NPR affiliate WABE. During the live interview, Fisher claimed that PRA had “hired two validation firms outside to do an independent review.” A surprising revelation given FireLight Health is the sole reviewer cited in each of PRA’s six price transparency reports. (My colleague Shawn Stack and I were interviewed separately from Fisher on that show, so we were unable to ask her about the identity of the uncredited second reviewer.)

Despite the red flags, media outlets continue to give these reports undeserved airtime. PRA has somehow managed to project enough credibility that outlets like Healthcare Dive and others readily accept PRA’s flawed analysis and write their stories straight off the organization’s reports. It’s a potentially dangerous message when it affects a community’s trust in its local hospital and therefore a patient’s thought process regarding seeking care.

If media or other key stakeholders were to do their due diligence on PRA, they too may begin to ask key questions, like, what is FireLight Health, who is James Jusko, and is PRA a credible organization?

Brad Dennison is a longtime news industry executive where he led multiple national organizations and thousands of journalists across the U.S. He’s also a past board member of the Associated Press Media Editors, where he was elected national chair in 2013. Dennison joined HFMA to lead content operations in 2019.

This article was reviewed by HFMA senior editors Paul Barr and Erika Grotto, as well as HFMA policy director Shawn Stack and Todd Nelson. An independent review was performed by Jean Hodges, a consultant and former senior news director at Gannett Co. Inc.