Hospital price transparency dips: report
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The percentage of hospitals fully complying with federal price transparency rules fell since February, making it harder for patients and consumers to obtain meaningful data on how much common services cost, Patient Rights Advocate said in a new review shared first with Axios.
Why it matters: Lax enforcement by the Centers for Medicare and Medicaid Services could be contributing to the backsliding, the advocacy group suggests in its report.
What they found: Just 21% of 2,000 hospitals reviewed were in full compliance with requirements to publicly post a list of prices for common treatments and services, the report found.
- Patient Rights Advocate found 34.5% of hospitals complied with the regulations in February.
- Nearly 450 hospitals previously found compliant with the regulations become noncompliant since the last report.
Yes, but: All 2,000 hospitals reviewed by Patient Rights Advocate for the report posted machine-readable files.
- Still, 532 hospitals in the sample posted files that didn't pass CMS' validation tool.
- Additionally, 415 hospitals didn't include all payer and plan names in their files, and 231 hospitals didn't post accurate minimum and maximum negotiated charges for items and services.
- The vast majority of hospitals (97%) also presented the required 300 shoppable services in a way that consumers could access. But PRA deemed 78% of those hospitals noncompliant because of insufficient machine-readable files, the report said.
Catch up quick: Since 2021, hospitals have had to provide comprehensive machine-readable files with all of their offered items and services, as well as consumer-friendly lists of services that would let patients compare prices across hospitals.
- The Biden administration has fined 15 hospitals for noncompliance so far. Only one hospital has been penalized in 2024.
- As of Oct. 31, CMS has also issued about 1,596 warning notices to hospitals about compliance issues and 918 requests for corrective action to hospitals that previously received warning notices, a spokesperson told Axios.
- "CMS is committed to ensuring hospitals make public their standard charges in accordance with the law. ... Enforcement is a process," a spokesperson said in a statement.
Between the lines: Prime Healthcare had the highest percent (90%) of fully compliant hospitals of any health system in the sample. PRA also found that 68% of Baylor Scott & White hospitals and 59% of Sanford Health hospitals met all transparency requirements.
- More than half (56%) of HCA Healthcare hospitals in the sample met all the price transparency requirements — a big improvement from February 2023, when Patient Rights Advocate deemed none of HCA Healthcare's hospitals compliant.
- None of the hospitals in PRA's review owned by Ascension, AdventHealth, Kaiser Permanente or Bon Secours Mercy were in full compliance.
Reality check: The Health and Human Services Inspector General published an audit earlier this month that estimated 46% of hospitals nationwide are not in full compliance with the rules, a significantly higher projection of compliance than PRA's review found.
What we're watching: The Trump administration, which spearheaded passage of the price transparency requirements in its first term, will take over enforcement next year.
- "On behalf of all American healthcare consumers, please prioritize strengthening and enforcing the hospital price transparency rule immediately upon taking office," Patient Rights Advocate founder Cynthia Fisher wrote in a letter sent to President-elect Trump alongside the report.
- Fisher's letter also asks Trump to toss out Biden administration adjustments to the price transparency requirements that allow hospitals to post percentages and algorithms in lieu of specific prices.
