Study: Half of hospitals not in compliance with price transparency requirements

Wednesday, June 29, 2022

Roughly half of hospitals did not adhere to provisions of the Hospital Price Transparency rule that require them to post five types of standard charges for all services in a machine-readable file and a separate consumer-friendly file or price estimator for at least 300 shoppable services, according to a recent JAMA study.

The study evaluated compliance with these requirements across 5,239 hospitals six to nine months after the requirements went into effect January 1, 2021. Two thousand six hundred sixty-eight hospitals (51%) of hospitals in the study did not have a compliant machine-readable file or a list of or estimator for 300 shoppable services. Approximately 14% had a machine-readable file but no shoppable display while 30% of hospitals had a shoppable display but not a machine-readable file. The study also found fewer than 6% of hospitals were compliant with both requirements.

Researchers also found that hospitals located in moderately concentrated or highly concentrated healthcare markets were significantly less likely to be transparent with their prices. Concluding their findings, the researchers noted that greater scrutiny of organizations within these areas may be needed to ensure adherence to price transparency.

Other hospital characteristics such as total gross revenue, size, emergency service capabilities, and ownership type were not associated with a facility's adherence to the mandate, they wrote.

The team acknowledged that their count of adherent hospitals could be an underestimate as some may have updated their websites within the study's three-month data collection window.

This study doesn't come as much of a surprise as earlier research showed similar results in the adherence to price transparency.

For example, a study published earlier this year by showed that most organizations were not fully complying with the hospital price transparency rule.

The report assessed the compliance with the law by reviewing 1,000 U.S. hospitals out of the over 6,000 accredited hospitals in the country.

Of the 1,000 total hospitals reviewed in the study, only 14.3% were fully complying with the rule. The study also found that only 37.9% of the hospitals posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria of the rule, such as rates by each insurer and named plan.

Some of the largest hospital systems in the country fell short in this study.

In early June, CMS issued its first penalties for violations of the Hospital Price Transparency rule. Two Georgia hospitals in the same health system, Northside Hospital Atlanta and Northside Hospital Cherokee, received fines totaling approximately $1.1 million.

Editor’s note: Some information in this article originally appeared on HealthLeaders. Find more NAHRI resources on price transparency here.

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Compliance, News, Revenue Integrity