Despite federal mandates for hospital price transparency dating back to 2021, the latest report by PatientRightsAdvocate.org indicates that only about one-third of hospitals are fully compliant. The analysis, covering 2,000 hospitals, reveals persistent challenges in meeting transparency requirements. While some pricing information is available online, a significant portion of hospitals fail to provide complete, accessible data, hindering consumer decision-making. Compliance rates have shown minimal improvement over three years, with numerous hospitals regressing from previously attained compliance. Encoded and complex data formats further impede transparency efforts. Effective transparency is crucial for empowering consumers, reducing overcharges, and enhancing healthcare affordability. PatientRightsAdvocate.org calls for enhanced enforcement to ensure hospitals adhere to transparency standards.
Since the initiation of federal price transparency requirements in 2021, hospitals have shown sluggish progress in adhering to these regulations, as indicated by the latest findings from PatientRightsAdvocate.org’s semi-annual “Hospital Price Transparency Report.” The report, encompassing 2,000 hospitals, unveiled that merely about one-third—approximately 34.5 percent—of these healthcare facilities were fully compliant with the stipulated price transparency requisites. Full compliance entails the posting of a comprehensive, machine-readable standard charges file covering all services, items, and medications across varied payers and plans. Additionally, hospitals must display prices for 300 of the most commonly sought services in a consumer-friendly format or provide an alternative in the form of a price estimator tool.
Despite these regulations being in effect for three years, the trajectory of compliance has remained disappointingly low. The preceding report from PatientRightsAdvocate.org, unveiled in July 2023, showcased a slightly higher but still underwhelming 36 percent rate of full compliance among the reviewed hospitals.
While it’s true that a majority of hospitals have taken steps to make pricing information available online, a staggering 65.5 percent of them fall short of compliance due to incomplete files or the absence of transparent price associations with both payer and plan. Specifically, the report reveals that 37.2 percent of hospitals failed to publish all payer-specific negotiated charges with clear associations to the respective third-party payers and plans, as mandated by federal regulations. Furthermore, nearly half—48.6 percent—of the hospitals failed to disclose a sufficient quantity of negotiated rates.
In addition to the aforementioned shortcomings, smaller percentages of hospitals failed to provide adequate discounted cash prices (12.0 percent) or any usable standard charges pricing file (4.4 percent). Moreover, only a meager 15.7 percent of hospitals presented pricing information for 300 shoppable services in a consumer-friendly manner, while 90.0 percent claimed to have a price estimator tool, albeit 63.0 percent of these tools were deemed non-compliant due to incomplete standard charge files.
The report further highlights a concerning trend of “backsliding” among some hospitals. Shockingly, 135 hospitals regressed from previously compliant status to non-compliance in the current assessment. This regression not only undermines the intent behind the transparency requirements but also obstructs efforts by researchers and vendors to utilize the data for the creation of consumer-friendly guides and tools.
A notable hindrance to achieving effective transparency is the prevalence of encoded, complex JSON-formatted files lacking user documentation or files with convoluted formats, rendering them unusable in certain instances. Additionally, there’s been a shift towards hospitals posting multiple files instead of the mandated single file, further complicating the accessibility of information for consumers and stakeholders alike.
The report underscores the pivotal role of transparency in empowering consumers to make informed healthcare decisions, protect themselves from overcharges, billing errors, and fraud, and ultimately lower their healthcare costs. Furthermore, transparent pricing data enables employer and union plans to enhance their designs and direct members towards lower-cost, high-quality healthcare facilities.
PatientRightsAdvocate.org advocates for more rigorous and timely enforcement of hospital price transparency requirements, citing the relatively paltry number of only 14 hospitals that have faced civil monetary penalties for noncompliance thus far.
The persistent lack of compliance with hospital price transparency requirements underscores the pressing need for decisive action to address existing challenges. PatientRightsAdvocate.org’s call for more rigorous enforcement is imperative to hold hospitals accountable and promote transparency in healthcare pricing. While some progress has been made, the prevalence of incomplete data and regression among previously compliant hospitals indicate a systemic issue that demands attention. Effective transparency not only empowers consumers to make informed healthcare decisions but also serves as a vital tool in combating overcharges and improving affordability. It is incumbent upon regulatory bodies, healthcare stakeholders, and policymakers to prioritize transparency initiatives, ensuring that all patients have access to clear and comprehensive pricing information.
