Hospitals have long since exhausted legal challenges to a federal rule that requires them to post prices online. And hospital pricing transparency has been backed by three administrations, Obama (through the Affordable Care Act), Trump in putting the current pricing rule in place, and Biden through supporting its enforcement. But despite the advance notice and bipartisan support for the measure, a report from finds the hospital compliance rates remain dismal.

That report found that only about 14.3% of the 1,000 hospitals reviewed were complying with the transparency rule. That was up modestly from the 5.6% it found were compliant after reviewing 500 random hospitals for its first report, released in July last year. Those same 500 hospitals (minus one: West Hills Hospital in Reno, Nevada, which closed) were included in the latest sampling; and of that group alone, just 18% are now compliant, according to Patient Rights Advocate.

“We’ve seen progress,” said Cynthia Fisher, founder and chair of the organization.

But she emphasizes that compliance with the law remains low.

Hospitals are required to post all prices online in a manner that’s easy for consumers to access — for example, health systems should not be making people provide personal identifying information to get prices.

They’re also supposed to provide a machine-readable standard charges list for items and services for all payers and all plans along with discounted cash prices. And hospitals are required to provide a standard charges list or a price estimator tool for the 300 most common shoppable services, as the report notes.

“This is making them have to compete and pull back the curtain and shine sunlight on their crazy pricing, and some of this pricing is price gouging,” Fisher said. 

That’s why hospitals have been resistant to transparently showing prices, she contends.

“They have not wanted to compete because they’ve benefited from keeping employers and unions and all consumers of healthcare who pay for healthcare … in the dark,” Fisher said.

The report estimated about 86% of the hospitals it reviewed failed to post a complete machine-readable file of standard charges; 85% didn’t provide the national drug codes and associated prices for each of the drugs and pharmacy items offered; and nearly 59% of hospitals didn’t publish all payer-specific negotiated charges.

What’s more, found that none of the hospitals at the nation’s largest health system, HCA Healthcare, were fully complying with the federal price transparency regulations. And just 1% of hospitals at CommonSpirit Health and Ascension, the second- and third-largest health systems in the U.S., were publishing prices, according to its report.

Perhaps, predictably, the health systems largely dismissed the findings of the report from Patients – can we say what one said as an example.

A spokesperson for the American Hospital Association said only the Centers for Medicare and Medicaid Services was in a position to assess if hospitals were following federal hospital pricing transparency regulations.

In its second semi-annual hospital pricing transparency report, Patient Rights Advocate noted that a team of four research analysts at the organization assessed hospital websites to determine compliance, and that independent healthcare price data company FireLight Health reviewed and validated the report.

Refuting the report’s findings, HCA said its hospitals were complying with federal price transparency regulations.

“Over the last year, we have worked diligently and have completed our implementation of these requirements,” HCA spokesperson Harlow Sumerford said in an email.

But there were indications that this is still a work in progress for hospitals.

Asked for an example of an HCA hospital website providing pricing in compliance with federal regulations, Sumerford offered a link to one. But the hospital’s “Patient Payment Estimator”  required putting in personal identifying information, including first and last name as well as insurance member ID and relationship to the policy holder (if insured), before a patient could see pricing.

Ascension also claimed that it was in full compliance with pricing transparency requirements,

Only CommonSpirit Health acknowledged some hospitals were still working on this.

“A majority of the hospitals we own have posted machine-readable files with our standard charges, cash prices and negotiated rates on their websites,” the health system said in a statement provided by a spokesperson. “This has been a complex and time-intensive process and we expect to have the remainder of the files published by April.”

Photo: JamesBrey, Getty Images


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