Price Transparency Compliance From US Hospitals Diminishes


It is worth noting that the US hospitals happen to be backsliding when it comes to compliance with the federal price transparency laws are concerned, as per the February analysis from Patient Rights Advocate.

It is well to be noted that 34.5% of the 2,000 hospitals that were reviewed by the nonprofit watchdog organization happened to be deemed fully compliant as far as the price transparency rules were concerned as of January this year. When we take into comparison the July 2023 review, 36% of hospitals happened to be in full compliance.
Significantly, the federal price transparency rule, which happened to be created to aid patients in shopping for care as well as drive down medical costs, went into effect in 2021. Under these requirements, hospitals have to post pricing data in a consumer-friendly display as far as their 300 most common procedures, such as standard charges for all payers as well as plans, are concerned.

Apparently, the price data can as well help patients spot swings in the costs for the same procedure, and that too at the same location, say proponents. Patient Rights Advocate found that the service prices can go on to vary tenfold in the same hospital and even 31fold throughout the hospitals in the same region.

A caesarean section, for instance, could run a patient $6,241 or $60,584 at the same hospital, as per a Wall Street Journal investigation that has been cited by the study.
There are hospitals that have been accused of failing to completely comply with the price transparency guidance since the time of its inception.

It is worth noting that the nonprofit’s most recent analysis, which went out to draw upon information from almost 2,000 hospital websites and that too between Sept. 3, 2023, and Jan. 13, 2024, stated that 65.5% of reviewed hospitals happened to be out of compliance in terms of pricing rules, mostly due to posting files that were incomplete. Eighty-seven hospitals happened to fail to post a standard charge file at all.

Although there happened to be103 hospitals which came into compliance with price transparency rules between July 2023 and January 2024, there were approximately 135 hospitals which fell out of compliance, the report said.

Notably, the other industry reports go on to vary while estimating hospitals’ price transparency compliance.

In January, Turquoise Health found that over 90% of hospitals had posted a machine-readable file in 2023; however, only 53% of reviewed hospitals were fully compliant with the price transparency rule.
The CMS went on to say in a February 2023 blog post that 30% of the hospitals had not fully complied when it came to the transparency standards. One of the spokespersons for the CMS confirmed that other organizations had gone on to report compliance rates ranging from almost 5% to around 85%, depending on the organization’s methodological approach.
Interestingly, the CMS spokesperson said that the agency regularly goes on to review industry reports so as to inform enforcement. Still, as of date, the CMS has gone on to issue just 14 civil monetary penalty notices, confirms the Patient Rights Advocate report.

Patient Rights Advocate went on to suggest that lax enforcement from CMS may as well be to blame for hospitals’ consistent dearth of compliance in terms of price transparency rules and asked for elevated oversight.
Such analyses go on to imply that minimal and lenient enforcement by the CMS has gone on to lead most hospitals to continue and disregard the rule, said the nonprofit.