Majority of hospitals remain noncompliant with price transparency requirements

Over three-quarters of hospitals remain noncompliant with federal price transparency regulations, according to PatientRightsAdvocate.org’s fourth semi-annual report on the issue. Focusing on larger health systems, research analysts assessed the websites of 2,000 hospitals between December 10, 2022, and January 26, 2023, for compliance with the Hospital Price Transparency rule.

Effective January 1, 2021, the rule required hospitals to list all prices online in the form of a machine-readable standard charges file, as well as a consumer-friendly display or tool for the 300 most common shoppable services.

The recent report—completed two years after the rule’s implementation—revealed 75.5% of hospitals failed to meet one or more of these requirements. This widespread noncompliance can be boiled down to “files being incomplete, illegible, or not having prices clearly associated with both payer and plan,” said the report.

Of the 51.3% of hospitals who posted negotiated prices clearly associated with payers and plans, nearly half were still found to be noncompliant due to incomplete or missing pricing data, according to the report. Nearly 6% of sampled hospitals did not post any standard charges file and were identified as totally noncompliant in the report. Of the 85.8% of sampled hospitals that published a price estimator tool, nearly three-quarters remained noncompliant due to an incomplete standard charges file.

The third PatientRightsAdvocate.org semi-annual report—published in August of last year—showed 16% of 2,000 sampled hospitals in full compliance. Twenty-one of these compliant hospitals “exhibited backsliding,” and were found to be noncompliant in the latest report. However, 116 previously noncompliant hospitals were compliant in the latest report.

As of now, CMS has only issued civil monetary penalties (CMP) to two hospitals for failing to meet price transparency requirements. The report noted that both hospitals’ pricing files “are now complete and exemplary, demonstrating the efficacy of enforcement.”

CMS’ enforcement of this issue has been minimal thus far, but it will likely intensify as groups continue to put pressure on the agency. The Office of Inspector General is expected to release an audit report on CMS’ monitoring and enforcement of the Hospital Price Transparency rule later this year.

In addition to “robust, timely, transparent” enforcement by CMS, PatientRightsAdvocate.org provided the following recommendations to boost compliance:

• Elimination of price estimates in favor of real prices
• Clear pricing data file standards
• Accountability of hospital executives to attest the completeness and accuracy of their prices

Organizations should prioritize price transparency compliance before CMPs become the norm. Review regulatory guidance to ensure your organization is meeting all requirements for both formats. Add price transparency to internal audit plans and ensure public-facing information is current.

Editor’s note: Find more NAHRI resources on price transparency here.