Only 25% of Hospitals Are Complying with the Price Transparency Rule

Less than a quarter of hospitals are complying with the hospital price transparency rule over two years after the regulation went into effect, according to a report from PatientRightsAdvocate.org.

The Fourth Semi-Annual Hospital Price Transparency Report reflects publicly available data from 2,000 hospitals in the US. Researchers assessed the hospitals’ websites from December 10, 2022, to January 26, 2023.

The price transparency regulation went into effect on January 1, 2021, and requires hospitals to post prices online in a user-friendly format. For complete compliance, facilities must publish a machine-readable file that includes the standard charges and discounted cash prices for all items and services for all health plans and a standard charges display with actual prices or a price estimator tool for the 300 most common shoppable services.

The latest review from PatientRightsAdvocate.org revealed that only 489, or 24.5 percent, of the 2,000 hospitals fully complied with the price transparency rule requirements. This indicates that over 1,500 hospitals were noncompliant. Nearly 6 percent of hospitals (116) were noncompliant and did not post any standard charge files.

Around half of the hospitals (51.3 percent) posted negotiated prices that were associated with payers and health plans, but 49.8 percent of those still were not in compliance because most of their pricing data was missing or incomplete.

Three-quarters of the hospitals (1,506) did not publish a complete machine-readable file of standard charges, 975 (48.8 percent) did not publish all payer-specific negotiated charges, and 923 (46.2 percent) did not post a sufficient amount of negotiated rates.

In addition, 327 hospitals (16.4 percent) did not post any discounted cash prices and 116 (5.8 percent) did not publish any usable standard charges pricing file.

For the shoppable services requirement, 411 hospitals (20.5 percent) presented charges in a consumer-friendly format. However, 362 of those hospitals were noncompliant because their standard charges files were incomplete.

Similarly, 1,716 hospitals (85.8 percent) published a price estimator tool, but 73.4 percent of them were noncompliant due to incomplete standard charges files.

Twenty-one hospitals showed backsliding, meaning they were noncompliant in the most recent report but were compliant in PatientRightsAdvocate.org’s August 2022 report. Meanwhile, 116 of the hospitals that were noncompliant in the August report were deemed compliant in the new report.

Compliance varied among the largest hospital systems included in the report. None of the hospitals owned by HCA Healthcare, Tenet Healthcare, Christus Health, Providence, Bon Secours Mercy Health, UPMC, Mercy Health, UnityPoint Health, and Avera Health complied with the regulation.

Nearly 60 percent of hospitals owned by CommonSpirit Health and 73 percent of hospitals owned by LifePoint Health complied with the price transparency requirements.

The stark noncompliance among hospitals may reflect the lack of enforcement from HHS and CMS. The agencies have only issued two civil monetary penalties on two hospitals since the rule took effect.

“This blatant obfuscation of prices and flouting of the rule demonstrates that implementation and enforcement efforts must be rigorously examined and markedly strengthened to improve compliance, enable technology innovators to parse the pricing data, and empower American consumers with upfront prices,” the report stated.