Study Finds 'Selective Compliance' with Price Transparency Rule

The research confirms what has been anecdotally reported for months: That hospitals are choosing which parts of the rule to comply with, and that partial compliance is common.

Hospital compliance with the CMS price transparency rule is spotty and selective, finds a new study.

The research, published in JAMA Internal Medicine, confirms what has been anecdotally reported for months: That hospitals are choosing which parts of the rule to comply with, and that partial compliance is common.

The researchers analyzed two groups of hospitals: A random sample of 100 out of 6,171 hospitals, as well as the 100 hospitals with highest gross revenue in 2017.

Those high-earning hospitals, the researchers reasoned, would have the fewest financial barriers to compliance but the most to lose by revealing privately negotiated rates.

"Selective compliance was especially pronounced for the 100 highest-revenue hospitals," the researchers wrote. "[S]elective compliance may fail to expose abuses of market power, affect price negotiations, or support broad analysis of price variation to the extent intended by the transparency initiative."

Continue Reading: Analysis: CMS Price Transparency Rule Not Working as Intended

The researchers examined data gathered and analyzed from March 1 through 10, 2021 to determine whether:

• A machine-readable file with charge data and a separate tool for shoppable services were available.
   
• Those files included payer-specific negotiated rates and discounted cash prices.
   
• Patients' health insurance information was required to access hospital rates for that insurer within the shoppable services.

For the 100 randomly sampled hospitals, the researchers found that:

• 83 were noncompliant with at least one major requirement.
   
• 33 reported payer-specific negotiated rates.
   
• 30 reported discounted cash prices in a machine-readable file.
   
• 52 hospitals offered a price estimator tool for shoppable services, of which 23 (44.2%) posted payer-specific negotiated rates in a machine-readable file.
   
• All price estimator tools required personal health plan information to access price or cost-sharing information; discounted cash prices could be viewed without plan information since they are not insurer-specific.

Of the 100 highest-revenue hospitals:

• 75 were noncompliant with at least one requirement.
   
• 35 reported payer-specific negotiated rates.
   
• 40 reported discounted cash prices in a machine-readable file.
   
• 86 offered a price estimator tool, of which 34 (39.5%) posted payer-specific negotiated rates in a machine-readable file.

To boost compliance rates, the researchers suggest harsher penalties, public non-compliance reporting, and technical assistance.