Two Years In, Hospital Price Transparency Compliance at 36%

Two and a half years in, most hospitals are still seemingly ignoring the federal Hospital Price Transparency Rule, with only 36 percent of facilities fully complying, according to a report from PatientRightsAdvocate.org. 

The fifth “Semi-Annual Hospital Price Transparency Report” analyzes publicly available data from 2,000 US hospitals. The latest report demonstrates that most hospitals continue to hide prices despite calls from CMS to do the contrary. 

Since January 1, 2021, CMS has required hospitals to publish a machine-readable file that includes standard charges, discounted cash prices for all items and services across health plans, and standard charges displayed with actual prices or a price estimator tool. Hospitals must also provide a "consumer-friendly" display of the 300 most commonly sought-after services.  

However, PatientRightsAdvocate.org's latest review shows that only 721 hospitals are complying with the rule, while a staggering 1,279, or 64 percent, are not complying. 

Even though less than half of hospitals are fully complying with price transparency requirements, researchers noted that compliance rates are improving. A previous report showed that less than a quarter of hospitals were compliant from December 10, 2022, to January 26, 2023. 

The most recent findings reveal that 64 percent of hospitals had files that were either incomplete or listed prices that were not "clearly associated with both payer and plan." Additionally, 69 of the hospitals reviewed had no usable standard charges file at all. 

Interestingly, some hospitals previously found to be non-compliant have since remedied their shortcomings, with 256 hospitals moving from non-compliant to compliant status. However, 40 of the hospitals deemed compliant in the February 2023 report were found to be non-compliant in this report. 

 A few exemplary hospitals stood out for their adherence to transparency regulations, including Rush University Medical Center in Chicago, Illinois, MetroHealth Medical Center in Cleveland, Ohio, and University Hospital in Madison, Wisconsin. The organizations provided easily accessible, downloadable, machine-readable files that included all negotiated rates by payer and plan, according to the report. 

Despite these positive strides, nearly 64 percent of hospitals surveyed did not post a complete machine-readable file of standard charges, and about 39 percent failed to publish all payer-specific negotiated charges clearly associated with each third-party payer and plan, as mandated.  

Another 44 percent also did not publish a sufficient number of negotiated rates, and about 2 percent did not publish any discounted cash prices. Furthermore, 3.5 percent of the hospitals still needed to post usable standard charges pricing files. 

Additionally, 17 percent of the hospitals presented 300 shoppable services in a consumer-friendly display for customary charges. However, most of these hospitals were still not compliant with requirements because their standard charges files were incomplete. While 89 percent of the hospitals published a price estimator tool, over half (about 63 percent) were deemed non-compliant due to incomplete standard charges files. 

Notably, none of the hospitals owned by major health networks, including HCA Healthcare, Tenet Healthcare, Providence, Avera Health, UPMC, Baylor Scott & White Health, and Mercy, were fully compliant. 

However, there were significant improvements from hospitals owned by CommonSpirit Health, Community Health Systems, and Kaiser Permanente, the report states. 

Researchers say lenient enforcement by CMS may be contributing to lagging compliance rates. However, CMS proposes in the Outpatient Prospective Payment (OPPS) rule to intensify enforcement of hospital price transparency requirements.  

For example, under the revised OPPS rule, hospitals would be mandated to authenticate the accuracy and thoroughness of their data, with a high-ranking hospital official certifying the machine-readable file. This would encourage hospitals to be more diligent in their data reporting, as incorrect or misleading information could lead to penalties of up to $2 million. The updated OPPS rule seeks to enforce compliance by requiring an authorized hospital official to certify the data's accuracy and completeness.  

Additionally, hospitals might need to provide more documentation to determine their compliance levels and acknowledge receipt of a warning notice if they're deemed non-compliant. In situations of continued non-compliance, CMS might engage the hospital’s health system leadership to resolve the issues across its network. 

To improve price transparency, PatientRightsAdvocate.org recommends that CMS reform enforcement strategies, publicly share the entire compliance process, and leverage the applicable payers' Transparency in Coverage disclosure to verify the accuracy and completeness of hospitals' price files.