- Just 16% of hospitals are fully compliant with a federal price transparency law more than a year after it went into effect, a healthcare consumer advocacy group said Tuesday. The CMS regulation requires hospitals to post pricing information for items and services online in a consumer-friendly format to help patients explore options.
- Patient Rights Advocate said nearly 40% of the 2,000 hospitals it reviewed have posted negotiated prices clearly associated with payers and plans, but more than 50% "failed compliance" because most of their pricing data was missing or incomplete.
- The nonprofit, in a report, accused HCA Healthcare and Ascension of continuing to "flout the law with zero compliance." Both hospital operators said they are compliant with the CMS rule and challenged the advocacy group's analysis.
A string of studies, including one by Harvard Medical School researchers, pointed to early noncompliance from hospitals after the price transparency law took effect in January 2021. Supported by the Trump administration for its potential to drive down medical costs, the rule was challenged unsuccessfully in court by hospital groups.
The American Hospital Association, in a June blog post, said health systems have expanded adoption of price transparency tools as technologies have improved, but some requirements, such as compiling large machine-readable files of rates negotiated with insurers, remained a challenge to implement. The hospital lobby also took issue with Patient Rights Advocate's research, saying the group and other organizations are misrepresenting the status of provider efforts to implement the regulation.
Patient Rights Advocate contends that consumers are still unable to benefit from the transparency rule due to the "continued widespread failure of most hospitals to fully publish their prices across all payers and plans." The 16% of hospitals found compliant in the report is up from 14.3% in the organization's February review of 1,000 providers and 5.6% in its July 2021 review of 500 hospitals.
“It’s alarming to see that progress on compliance with federal law on transparency has ground nearly to a stop,” Cynthia Fisher, chairman of Patient Rights Advocate, said in a statement.
The latest report said that 5.1% of hospitals did not post any standard charge files and were in noncompliance.
Among the three largest hospital systems in the country, 45 of 111 hospitals owned by CommonSpirit Health were found to be in compliance, up from just one facility reported in February. But the report said none of the hospitals owned by HCA Healthcare and Ascension were in compliance.
HCA spokeswoman Meghan Stanford disagreed with that assessment, saying the system's hospitals implemented the federal requirements in January 2021.
"For nearly a year and a half, our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured. In addition, we have posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of 'standard charges,'” Stanford said in an emailed statement.
In a separate statement, Ascension said that it is complying with the transparency rule and going beyond it, offering consumers tools to estimate costs and provide feedback.
"We are proud to be a leader in price transparency," Ascension spokesman Nick Ragone said. "We will continue to find ways to make sure consumers and patients have the most current information available to make an informed healthcare decision.”
CMS has singled out only two hospitals — Northside Hospital Atlanta and Northside Hospital Cherokee in Canton, Georgia — for noncompliance and issued fines.