Over 75% of Hospitals Still Failing to Comply with Price Transparency Rule

Hospitals are slowly becoming better at adhering to the regulation, but too many facilities are still lagging.

Nearly three out of every four hospitals remain noncompliant with the hospital price transparency rule more than two years after the law was implemented, according to a report by PatientRightsAdvocate.org.

The latest Semi-Annual Hospital Price Transparency Compliance Report analyzed 2,000 of the nation's largest hospitals from December 10, 2022 through January 26, 2023 to determine compliance, based on the inclusion of machine-readable files for all items and services, as well as price display of the 300 most common shoppable services.

The findings reveal a modest increase in compliance percentage since the previous report in August 2022, with 24.5% of hospitals (489) now compliant, compared to 16% last year.

Meanwhile 116 hospitals (5.8%) did not post any standard charges files and were found to be completely noncompliant.

More than half (1,025 or 51.3%) posted negotiated prices clearly associated with payers and plans, but 536 of those still failed compliance because most of their pricing data was incomplete.

"Though the majority of hospitals have posted files, the widescale noncompliance of 75.5% of hospitals is due to most hospitals' files being incomplete, illegible, or not having prices clearly associated with both payer and plan," the report stated. "This noncompliance obstructs the ability of patients, employer and union purchasers, and technology developers to comparatively analyze prices, make informed decisions, and have evidence to remedy errors, overcharges, and fraud."

Some of the largest health systems in the country continue to be some of the biggest perpetrators of the law. None of the hospitals owned by HCA Healthcare, Tenet Healthcare, Christus Health, Providence, Bon Secours Mercy Health, UPMC, Mercy Health, UnityPoint Health, and Average Health were found to be compliant.

On the other end of the spectrum, 58% of CommonSpirit hospitals and 73% of LifePoint Health hospitals were deemed compliant.

Not only did the report find a wide range in pricing information available between hospitals, it also observed variation in data size. There was a significant increase in the number of files that were one to seven gigabytes or larger, although many large hospitals did have files less than 200 megabytes. Making pricing information available is only one aspect of creating more price transparency, made relatively useless without accessibility and user-friendliness.

Payers have also had the same problem displaying data as part of their price transparency rule, but in terms of sheer quantity, hospitals are well behind their counterparts despite a head start. According to Turquoise Health, payer data accounts for 630 terabytes, significantly outpacing the three terabytes of hospital data.

The hospital compliance report also highlights that the lack of enforcement of the law by HHS has given hospitals the leeway to continue disregarding the rule. The two hospitals which HHS has penalized to date—Northside Hospital Atlanta and Northside Hospital Cherokee—were found in the report to now have exemplary and complete pricing files, proving that enforcement is necessary.

Timely enforcement by HHS was one of the recommendations put forward by the authors, along with elimination of price estimates in favor of real prices, clear pricing data file standards, and accountability of hospital executives to attest to the completeness and accuracy of their prices.

The report concluded: "When full compliance with the transparency regulations is achieved, the widespread availability of pricing data systemwide in healthcare will unleash the benefits of competition and consumer choice, lowering the costs of care and coverage to patients, employers, and workers."