House Committee Urges GAO to Examine Hospital Price Transparency Compliance

The House Committee on Energy and Commerce has urged the Government Accountability Office (GAO) to investigate compliance with the hospital price transparency rule following continuous reports of hospital noncompliance.

House Representatives Frank Pallone, Jr. (D-NJ), chairman of the committee, and Cathy McMorris Rodgers (R-WA), ranking member of the committee, sent a letter to Gene L Dodaro, comptroller general of the United States and head of GAO.

The price transparency rule went into effect on January 1, 2021, leading the committee to believe that hospitals have had ample time to prepare and comply with the requirements. The rule requires hospitals to publicly publish a machine-readable file comprising gross charges, discount cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges for all services.

In the 2022 Hospital Outpatient Prospective Payment System (OPPS) Final Rule, CMS announced an increase in civil monetary penalties for hospital noncompliance with the price transparency regulation. As of January 2022, CMS has issued over 300 warning letters and 98 requests for corrective action plans to noncompliant hospitals.

In June 2022, CMS sent the first monetary penalties to two Georgia hospitals for failing to comply with the machine-readable file and shoppable services requirements of the price transparency rule.

The Energy and Finance Committee expressed concerns related to continuous reports of high rates of hospital noncompliance with the rule. The letter cited data from the Johns Hopkins Bloomberg School of Public Health that found that 55 percent of hospitals did not comply with the regulation.

In addition, a report from PatientRightsAdvocate.org found that just 14 percent of hospitals were fully compliant with the rule, while more than half of the 40 percent of hospitals that posted negotiated rates were noncompliant with other aspects of the rule.

An updated PatientRightsAdvocate.org report from August revealed that only 16 percent of hospitals were complying with the rule nearly 20 months after its implementation.

The committee also noted that some hospitals are not publishing prices in a consumer-friendly format.

“We are concerned that some hospitals are making it difficult for consumers to access this information. Some hospitals are requiring consumers to input personally-identifiable information or specific plan information, in clear violation of the final rule,” the letter stated. “Some hospitals are also burying the information deep in their websites or requiring consumers to search through multiple pages and subpages to find the information.”

As a result of these concerns, the committee has asked GAO to examine hospital compliance with the price transparency rule. Specifically, the letter requested that GAO investigate the extent to which hospitals are complying with the machine-readable file requirement, including the requirement to include all charges and a consumer-friendly list of 300 shoppable services and their prices.

GAO should also look at the extent to which price information is easily accessible for consumers and if it is readily displayed. Additionally, the investigation should focus on how CMS monitors and enforces hospital compliance with the rule and to what extent CMS has taken action against noncompliant hospitals.