Dive Brief:
- Many hospitals still aren’t complying with price transparency requirements years after regulations mandating they share information with the public went into effect, according to a report published last week by the HHS’ Office of Inspector General.
- In a sample of 100 hospitals, 34 didn’t obey requirements for publishing machine-readable files of their charges, while 14 didn’t comply with rules requiring them to post shoppable services in a consumer-friendly way.
- The “notable level” of noncompliance with the rule stems from inadequate oversight by regulators, as the CMS lacks staff to dedicate to hospital reviews, according to the OIG report.
Dive Insight:
The transparency rule, which first went into effect in 2021, requires hospitals to post information about their prices in a bid to help patients find more affordable care and ultimately drive down healthcare costs.
Under the regulation, facilities have to publish and update a list of standard charges for items and services in a machine-readable format. They also need to post a consumer-friendly list of services that patients can typically schedule in advance, like imaging or lab tests or outpatient clinic visits.
But the regulation has been hindered by lagging compliance among hospitals for years. Only about 46% of the more than 5,800 hospitals that are required to comply with the rule have made their standard charges available to consumers, according to the latest OIG report.
Providers interviewed for the analysis said they are confused about specific requirements of the rule and want more technical assistance from regulators, like a call center that could help them answer questions more quickly or templates for machine-readable files.
Small hospitals, or those with fewer than 100 beds, reported that their limited resources also made it harder to comply with the rule.
Meanwhile, regulators have faced their own resource constraints, according to the report. The CMS is supposed to review hospitals’ compliance, but the agency’s ability to conduct this oversight is “limited, primarily by an inability to devote sufficient staffing resources to its hospital reviews,” the OIG said.
However, the CMS has made progress to strengthen its oversight, including assigning more staff to handle reviews for about 1,800 hospitals facing allegations of noncompliance. The agency has also created an online tool to help facilities determine if their files follow the rule.
Between January 2021 and September 2022, the agency had issued just two civil monetary penalties totaling $1.1 million. But by February this year, the CMS had collected $4 million over the course of 14 penalties, according to the OIG report.
