Study finds most large hospitals failing to comply with price transparency rules

Study finds most large hospitals failing to comply with price transparency rules

While many industry experts predicted hospitals may largely choose to skirt new price transparency rules that went into effect this year, a recent study from Health Affairs has unveiled a shockingly low number of the nation’s largest hospitals are in compliance with the requirements.

A review of the 100 largest hospitals in the U.S. by bed count showed just 22 of those facilities in compliance, while 65 were labeled as “unambiguously noncompliant,” according to the study.

Of the 65 noncompliant hospitals, 12 had not posted any pricing files, or provided links to searchable databases. Fifty-three of the noncompliant hospitals either failed to clearly post payer-specific negotiated rates with the name of the payer and plan, or in some other way failed to follow the rule.

Under the requirement, hospitals must publicize their standard charges for both gross charges and commercial charges negotiated with specific payers for “shoppable services”. This information must be made available online in an easily digestible format and include information on billing codes used by the hospital and their corresponding services.

Hospital advocates, meanwhile, have long contended these rules will strip their ability to negotiate effectively with commercial payers by promoting anticompetitive practices. Additionally, there is concern over potential public relations issues that could be caused by posting standard charges, which don’t take into account for potential emergency or acute care scenarios.

CMS has previously said it will enforce the transparency requirements through auditing and by imposing civil monetary penalties of up to $300 a day ($109,500 annual total) against hospitals that don’t comply.