Dive Brief:
- Hospitals are backsliding on compliance with federal price transparency laws, according to a February analysis from Patient Rights Advocate.
- Only 34.5% of 2,000 hospitals reviewed by the nonprofit watchdog organization were deemed fully compliant with price transparency rules as of January. In comparison, 36% of hospitals were in full compliance as of a July 2023 review.
- None of the hospitals owned by HCA Healthcare, Tenet Healthcare, Kaiser Permanente, Providence, Mercy and UPMC and reviewed by the nonprofit were found to be fully compliant with the price transparency rule.
Dive Insight:
The federal price transparency rule — which was created to help patients shop for care and drive down medical costs — went into effect in 2021. Under the requirements, hospitals must post pricing information in a consumer-friendly display for their 300 most common procedures, including standard charges for all payers and plans.
Price data can help patients spot swings in costs for the same procedure at the same location, proponents say. Patient Rights Advocate found service prices can vary ten-fold within the same hospital and 31-fold across hospitals in the same region. A cesarean section, for example, could run a patient $6,241 or $60,584 at the same hospital, according to a Wall Street Journal investigation cited by the study.
Hospitals have been accused of failing to fully comply with price transparency guidance since its inception.
The nonprofit’s most recent analysis — which drew upon information from 2,000 hospital websites between Sept. 3, 2023 and Jan. 13, 2024 — found 65.5% of reviewed hospitals were out of compliance with pricing rules, primarily due to posting incomplete files. Eighty-seven hospitals failed to post a standard charges file at all.
While 103 hospitals came into compliance with price transparency rules between July 2023 and January 2024, 135 hospitals fell out of compliance, the report found.
Other industry reports vary when estimating hospitals’ price transparency compliance.
In January, Turquoise Health found that over 90% of hospitals had posted a machine-readable file in 2023, however, only 53% of reviewed hospitals were fully compliant with the price transparency rule.
The CMS said in a February 2023 blog post that 30% of hospitals had not fully complied with the transparency standards. A spokesperson for the CMS told Healthcare Dive via email that other organizations had reported compliance rates ranging from approximately 5% to nearly 85%, depending on the organization’s methodological approach.
The CMS spokesperson said the agency regularly reviews industry reports to “inform” enforcement. Yet, to date, the CMS has issued only 14 civil monetary penalty notices, according to the Patient Rights Advocate report.
Patient Rights Advocate suggested that lax enforcement from the CMS may be to blame for hospitals’ continued lack of compliance with price transparency rules and called for increased oversight.
“These analyses imply that minimal, lenient enforcement by CMS has led most hospitals to continue to disregard the rule,” the nonprofit wrote.
The CMS declined to comment on the Patient Rights Advocate report specifically, citing agency policy.
