Progress Report: Vast Majority of Hospitals Still Fail to Comply with Price Transparency Rule

Hospitals have long exhausted legal challenges to a federal rule that requires them to post prices online. And hospital pricing transparency has been supported by three administrations, Obama (through the Affordable Care Act), Trump by implementing the current pricing rule, and Biden by supporting its enforcement. But despite the notice and bipartisan support for the measure, a report by PatientRightsAdvocate.org finds that hospital compliance rates remain dismal.

This report found that only about 14.3% of the 1,000 hospitals surveyed complied with the transparency rule. That was slightly up from the 5.6 per cent it found compliant after surveying 500 random hospitals for its first report, published in July last year. These same 500 hospitals (minus one: West Hills Hospital in Reno, Nevada, which closed) were included in the last sampling; and of that group alone, only 18% are now compliant, according to Patient Rights Advocate.

“We have seen progress,” said Cynthia Fisher, founder and president of the organization.

But she points out that compliance with the law remains weak.

Hospitals are required to display all prices online in a way that is easy for consumers to access – for example, health systems should not require people to provide personally identifiable information to obtain prices.

They’re also supposed to provide a machine-readable list of standard fees for items and services for all payers and plans, as well as discounted spot prices. And hospitals are required to provide a standard fee list or price estimation tool for the 300 most common purchasable services, the report notes.

“It forces them to be competitive and pull back the curtain and shine their crazy prices, and some of those prices are price gouging,” Fisher said.

That’s why hospitals have resisted transparent price displays, she says.

“They didn’t want to be competitive because they took advantage of the fact that employers, unions, and all the health care consumers who pay for health care…were left in the dark,” Fisher said. .

The report estimates that about 86% of the hospitals it examined did not publish a complete machine-readable file of standard charges; 85% did not provide national drug codes and associated prices for each of the drugs and pharmacy items offered; and nearly 59% of hospitals did not publish all payer-specific negotiated fees.

Additionally, PatientRightsAdvocate.org found that none of the hospitals in the nation’s largest healthcare system, HCA Healthcare, fully complied with federal regulations on price transparency. And only 1% of hospitals in CommonSpirit Health and Ascension, the second and third largest health systems in the United States, published prices, according to its report.

Perhaps, predictably, health systems have largely dismissed the findings of Patients’ report — can we say what was said as an example.

A spokesperson for the American Hospital Association said only the Centers for Medicare and Medicaid Services were able to assess whether hospitals were complying with federal regulations on hospital price transparency.

In its semi-annual report on hospital price transparency, Patient Rights Advocate noted that a a team of four research analysts from the organization assessed hospital websites to determine compliance, and this independent health care pricing data company FireLight Health reviewed and validated the report.

Rebutting the report’s findings, HCA said its hospitals are in compliance with federal regulations on price transparency.

“Over the past year, we have worked diligently and completed the implementation of these requirements,” HCA spokesperson Harlow Sumerford said in an email.

But there were indications that it is still a work in progress for hospitals.

Asked for an example of an HCA hospital website providing pricing that complies with federal regulations, Sumerford offered a link to one. But the hospital”Patient Payment Estimatorrequired the entry of personally identifying information, including first and last name as well as insurance member ID and relationship to the policyholder (if insured), before that a patient can see the prices.

Ascension also asserted that it fully complies with the price transparency requirements,

Only CommonSpirit Health has acknowledged that some hospitals are still working on this.

“The majority of hospitals we own have posted machine readable files with our standard fees, cash prices and negotiated rates on their websites,” the health system said in a statement provided by a spokesperson. “This was a complex and time consuming process and we expect to release the rest of the files by April.”

Photo: James Brey, Getty Images

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