NEW REPORT: Just 21% of U.S. hospitals complying with federal price transparency rule

News provided by

Nov 20, 2024, 08:30 ET

WASHINGTON, Nov. 20, 2024 /PRNewswire/ -- Today, PatientRightsAdvocate.org (PRA) released a new report examining hospital compliance with the federal Hospital Price Transparency Rule, which went into effect nearly four years ago, requiring all hospitals to publicly post all prices online.

PRA's seventh Semi-Annual Hospital Price Transparency Report revealed that only 21.1% of the 2,000 hospitals reviewed nationwide were in full compliance with the federal rule, a substantial decline from the 34.5% compliance found in PRA's last report released in February 2024. The Centers for Medicare & Medicaid Services (CMS) has issued penalty notices to only 15 hospitals in four years and only one notice in 2024. PRA found that hospitals that were previously in compliance in the February report have rolled back transparency measures that were in place to protect consumers.

After years of lackluster enforcement measures, effective July 1, 2024, CMS lowered transparency standards, which created the illusion that many hospitals made strides in consumer protections under the new rule. These standards included the option to omit actual, dollars-and-cents prices, which consumers need to assess and compare actual prices. Therefore, in this new report, in addition to measuring compliance, PRA also assessed each hospital for its "Pricing Data Sufficiency" based on the availability of actual prices found in the files.

"Unfortunately, our Seventh Hospital Price Transparency Compliance Report reveals that after nearly four years, the overwhelming majority of hospitals reviewed are still not complying with the rule requiring them to publish their discounted cash prices and all negotiated rates," said PRA Founder and Chairman Cynthia Fisher. "By keeping their prices hidden, hospitals continue to block American consumers from their right to compare prices and protect themselves from overcharges. On behalf of all American healthcare consumers, PatientRightsAdvocate.org strongly urges policymakers to strengthen and enforce the hospital price transparency rule immediately."

The latest review of 2,000 hospitals across the United States found:

Only 421 (21.1%) hospitals were fully complying with the rule.
Only 335 (16.8%) hospitals were found to be sufficient in their disclosure of dollars-and-cents prices.
Only 133 (6.7%) hospitals were found to be both fully complying and posting sufficient pricing data.
Most hospitals -- 1,579 (78.9%) -- were found in total noncompliance, failing to pass the CMS Validator Tool, not following the CMS-mandated file name format, and missing significant pricing data by payer and plan names or not posting a compliant TXT file.
Hospital systems with the highest compliance rate (fully compliant):
- 78% of hospitals owned by Christus Health
- 58% of hospitals owned by Baylor Scott & White
- 56% of hospitals owned by HCA Health
Compliance and pricing sufficiency varied widely among the largest hospital systems:
- 56% of hospitals owned by HCA Healthcare were found to be fully compliant, but none (0%) of them met our price sufficiency rating.
- 45% of hospitals owned by CommonSpiritHealth and were found to be fully compliant, but only 32% of them met our price sufficiency rating.
- None (0%) of the hospitals owned by Ascension, AdventHealth, Kaiser Permanente, Bon Secours Mercy, and Mercy were found to be fully compliant.
The hospital systems with the highest number of hospitals meeting PRA's price sufficiency rating were: Prime Healthcare (90%), Baylor Scott & White (68%), and Sanford Health (59%).
449 hospitals exhibited 'backsliding,' with an assessment of "Noncompliant" in the current report after having been assessed as "Compliant" in PRA's February report.

You can view the full PRA price transparency compliance report here.

PatientRightsAdvocate.org is a nonprofit organization fighting for systemwide healthcare price transparency. We seek to empower patients and consumers with actual, upfront prices, greatly reducing healthcare costs through a functional, competitive market.

SOURCE Patient Rights Advocate