- Some large hospitals are still not posting their complete price lists as required by federal transparency rules, a new analysis by PatientRightsAdvocate.org found. A comparison of price data for seven hospitals in Florida and Texas, owned by two major health systems, to corresponding insurance plan data revealed the omissions in the hospital files, the organization said.
- The analysis looked at price disclosures from two hospitals owned by Ascension Health and five owned by HCA Healthcare. The data was cross-referenced with newly released information on prices negotiated with insurers including Blue Cross Blue Shield, UnitedHealthcare and Cigna.
- Ascension, in an emailed statement, said it is complying with the CMS rule and has gone beyond it by offering consumers tools to estimate costs and provide feedback. "We’re proud to be a leader in price transparency," the health system said. In a statement, HCA Healthcare said that it had implemented federal transparency requirements in January 2021 and currently provides a patient payment estimator on its website in addition to posting third-party contracted rates in machine-readable file formats
The hospital price transparency rule, which took effect in January 2021, requires hospitals to publish machine-readable price lists and display rates for medical services in a format that allows consumers to comparison shop. Insurers are now required to disclose rates they negotiate with providers.
In the first year after the hospital rule, studies evaluating compliance with the regulation, including one by Patient Rights Advocate, found efforts lacking. In February, the nonprofit said only 14.3% of hospitals were compliant with disclosure requirements. CMS itself said its initial analysis "strongly suggests there is sub-optimal compliance" with the rule, and the agency increased fines for non-compliant hospitals.
The flood of information from insurers released in July, 18 months after the hospital rule, gave researchers a much greater pool of data for assessing transparency efforts. Cynthia Fisher, chairman of PatientRightsAdvocate.org, called her group's new report the "tip of the iceberg" of what publicly disclosed data files mandated by the the new regulations will reveal.
The data obtained from machine-readable files showed multiple instances where prices for services were omitted from the hospitals' lists, the advocacy group said. Some prices in insurance company files appear with an “N/A” or are blank in the corresponding hospital price lists. “This concrete evidence from the insurance files demonstrates that real prices exist and hospitals are flouting the hospital price transparency rule,” the report said.
The American Hospital Association has taken issue with outside studies it contends are misrepresenting the price disclosure rules. The group, which fought an unsuccessful legal battle to block the regulation, maintains hospitals are working to implement price transparency policies and develop tools to help patients understand costs.
Compiling large machine-readable files has proven more difficult, but outside assessments have ignored CMS guidance allowing a blank cell to be left when an individual negotiated rate does not exist due to services being bundled, the hospital lobby said.