Most hospitals are not complying with price transparency laws
Hospitals aren’t meeting requirements when it comes to price transparency, according to a recent study.
The findings underscore other research that also shows hospitals aren’t complying with recent requirements despite numerous delays on price transparency implementation.
Hospitals have been required to post their prices of their 300 most common procedures since Jan. 1, 2021. However, a year later, less than one-third-–32% of hospitals––were actually compliant with the regulations and transparency for knee and hip replacements, according to researchers from Cleveland Clinic, who published a study in Clinical Orthopaedics and Related Research.
“Although pricing information was generally available, it frequently did not meet requirements established by the [government] and was oftentimes difficult to access,” wrote lead author Atul F. Kamath, MD, MBA, of the Cleveland Clinic Foundation, and colleagues.
Under the price transparency rules, hospitals are required to provide five types of online price information for selected services: the total charge, the charges the hospital privately negotiated with insurers, the minimum and maximum negotiated charges and the amount the hospital is willing to accept in cash. Services must also be identifiable by billing code, with the information available in a machine-readable file, free of charge, without any personal identifying information required for access.
Researchers scoured hospital websites for prices of knee and hip replacements. They chose these procedures because they are common, expensive and also typically priced predictively. Of 400 hospitals sampled between Dec. 1 and Dec. 20, 2021, only 32% provided all five types of information. Just 21% of hospitals provided all five types of information for knee replacement and 18% of hospitals did so for hip replacement.
Researchers also looked at the availability of the total cost of procedures, with just 36% of hospitals offering the price of the total charge for knee replacement. Only 31% did the same for hip replacement. They also found 13% of hospitals violated the requirements by not providing machine-readable files, and 21% violated it by requiring users to provide personal information.
The low level of compliance could be due to hospitals hoping they will receive further delays or even policy changes where they wouldn’t have to meet the new requirements. However, CMS is pushing the rules further, announcing it issued the first two penalties to hospitals for noncompliance with the price transparency rule, with penalties ranging from $300 to $5,500 per day depending on hospital size.
“It is possible that hospitals have delayed compliance with the hope that related requirements may change or that current delays in enforcement may continue,” the authors noted.
Amy joined TriMed Media as a Senior Writer for HealthExec after covering home care for three years. When not writing about all things healthcare, she fulfills her lifelong dream of becoming a pirate by sailing in regattas and enjoying rum. Fun fact: she sailed 333 miles across Lake Michigan in the Chicago Yacht Club "Race to Mackinac."