- CMS is currently auditing a sample of hospitals to see if those facilities are in compliance with the price transparency policy that went into effect Jan. 1. The agency is also probing complaints, a spokesperson said Friday. CMS did not provide any further details about the complaints or sampling of hospitals.
- If hospitals fail to post the prices they negotiate with insurers they could face a corrective action plan or a fine of $300 per day, CMS said. The agency did not say whether any hospitals had so far faced a financial penalty.
- Researchers closely following the issue said it appears noncompliance is common in their spot checking of hospitals' websites.
A landmark shift occurred in the nation's healthcare system at the start of the year: hospitals across the country are required to post online the negotiated rates they reach with insurers for services. Those figures previously were largely kept out of view from consumers.
Yet, some researchers expressed frustration over the lack of compliance and that there is no single repository for the information, causing them to hunt and peck around thousands of hospital websites.
It's "frustratingly incomplete," said Niall Brennan, president and CEO of the Health Care Cost Institute, which compiles claims data from big payers including Aetna and Kaiser Permanente.
"There is no real mechanism to figure out how many hospitals complied with the regulations," Brennan said, causing him and other researchers to "laboriously" search thousands of websites. He described it as the biggest drawback to the rule and wished the information had to be sent to CMS, as well.
Ge Bai, a researcher and associate professor at John Hopkins, agreed. "I have to say, I look at some hospitals, and the noncompliance is very common," Bai said.
Even still, it's definitely important, Brennan said, noting this information has never been available to the public before. However, in its current form, he cautions it won't be of much use to consumers.
The pricing information Brennan has seen so far largely validates what he was expecting to see: large variation in reimbursement for a single service even among commercial payers.
This is why the hospital lobby fiercely opposed the requirement, Brennan argues.
"It's just not a good look to say, 'depending on who you are and what health insurance coverage you have, the cost of the C-section can range from $5,000 to $55,000,'" Brennan said.
The hospital lobby continued its legal battle right up until it went into effect.
Arguing that hospitals were overwhelmed by both the novel coronavirus and the rollout of vaccines, the hospital lobby attempted a last ditch effort to block the law by filing an emergency motion for a stay during the second to last week of the year.
Ultimately, it failed.
A federal appeals court declined to intervene, allowing the policy to go into effect. Judge David Tatel said AHA's arguments, including that some rates are unknowable, "miss the mark."
It did not come as a surprise following opening arguments in October in which at least two of the three-judge panel were highly skeptical of the lobby's claims.