The organization stressed that hospitals and health systems are making progress on complying with regulations.
Ahead of a hearing by the House Ways and Means Committee this past week, the American Hospital Association (AHA) submitted to Congress recommendations to strengthen price transparency efforts.
Hospitals have been slow to react to the price transparency law, which went into effect on January 1, 2021, while CMS has been relatively lenient on enforcement. However, AHA said compliance will continue to rise as hospitals put the COVID-19 pandemic in their rearview mirror and pointed to CMS' recently updated enforcement processes for holding hospitals more accountable going forward.
When CMS initially assessed 235 randomly sampled hospitals between January and February 2021, only 27% had both a machine-readable file and consumer-friendly display, with 30% having the former and 66% having the latter.
In CMS' second assessment of 600 hospitals between September and November 2022, those figures improved drastically. The report found that 70% posted a machine-readable file and consumer-friendly display, with 82% having one or the other.
"The lower compliance rate in 2021, however, should not be interpreted as a lack of hospital commitment to transparency," AHA wrote. "Instead, it reflects the incredible challenges hospitals were experiencing in 2020 and 2021 in addressing the most acute phases of the COVID-19 public health emergency, which strained hospitals' staff and required the diversion of personnel and financial resources.
"As the pandemic phase of COVID-19 winds down and hospitals have been able to resume more standard operations, they are able to dedicate the resources necessary to build the full suite of price transparency tools."
Increased enforcement should also, in theory, incentivize hospitals to comply.
As of April 2023, CMS has issued more than 730 warning notices and 269 corrective action plan (CAP) requests, while fining four hospitals for noncompliance: Northside Hospital Atlanta ($883,180), Northside Hospital Cherokee ($214,320), Frisbie Memorial Hospital ($102,660), and Kell West Regional Hospital ($117,260).
More fines could be on the way after CMS recently announced that it will now require CAP completion deadlines, impose civil monetary penalties earlier and automatically, and streamline the compliance process.
To support hospitals and health systems as they work towards improving price transparency, AHA asked Congress and the Biden administration to review and streamline existing transparency policies "with a priority objective of reducing potential patient confusion and unnecessary regulatory burden on providers." These policies include the hospital price transparency rule and the No Surprises Act.
AHA also recommended that lawmakers "refrain from advancing additional legislation or regulations that may further confuse or complicate providers' ability to provide meaningful price estimates while adding unnecessary costs to the health care system." Before additional legislative changes are made to the hospital price transparency rule, recent modifications CMS made to the compliance process should be reviewed.
Finally, the organization stated that Congress should "continue to convene patients, providers and payers to seek input on how to make federal price transparency policies as patient-centered as possible."
Jay Asser is the contributing editor for strategy at HealthLeaders.
KEY TAKEAWAYS
The American Hospital Association asked Congress to take steps to support hospitals and health systems as they work toward improving price transparency.
The recommendations included reviewing and streamlining existing transparency policies, including the hospital price transparency rule and the No Surprises Act.
CMS recently updated its enforcement policy which could result in more monetary penalties for hospitals and health systems.