Have hospitals really taken a step backward along their march toward price transparency? Or is the watchdog outfit making the claim playing fast and loose with the facts?
One watchdog watcher says it’s the latter.
Picking apart last week’s alarming report from Patient Rights Advocate (PRA) point by point, the Healthcare Financial Management Association (HFMA) calls PRA’s transparency scorecards “an irresponsible mix of misleading, incomplete and incorrect” information.
The PRA report in question, “Sixth Semi-Annual Hospital Price Transparency Report: February 2024,” presented numerous findings that HFMA is now irately challenging.
Among the most bothersome to HFMA is PRA’s assertion that only 34.5% of the 2,000 hospitals it scored are complying with federal regulations that went live in January 2021.
HFMA notes that this figure flies in the face of the scorecard maintained by HHS’s Centers for Medicare & Medicaid Services, whose most recent update had hospital compliance on transparency at 70%.
A question of reporting quality
As recounted in Health Exec last week, the 2021 Hospital Price Transparency Rule requires hospitals to post all prices online—and in an easily accessible and searchable format. More:
It’s the latter point that’s become an issue, with the majority of the noncompliant hospitals posting some kind of data, just with incomplete info or unwieldy formatting. Only 4.4% of hospitals reviewed [by PRA] failed to post any usable pricing file.
Qualifying clauses notwithstanding, HFMA suggests PRA’s contradiction of CMS’s own policing data represents a glaring example of how PRA “consistently misinterpret[s] federal rules in each of its reports.”
Also called out by HFMA for amplified criticism is PRA’s accusing of many hospitals for not including all their standard charge files related to accepted insurance plans.
On this point, HFMA says, PRA “assumes that when a hospital negotiates rates with a payer, it secures negotiated rates with all plans and products under that umbrella. This is incorrect and leads to PRA’s overstatement of noncompliance.”
To this HFMA director of policy and analysis Shawn Stack adds:
“This is reckless as it may misrepresent hospital compliance and unfairly impact a provider’s reputation and the patient’s comfort in seeking care.”
PRA pushed to operate with transparency of its own
Other points of contention raised and described by HFMA include:
- PRA penalizes hospitals for not including plan-specific names in machine-readable files.
- PRA does not demonstrate an understanding of the definition of machine-readable files, leading to additional confusion and misinterpretation of federal requirements.
- PRA disregards the nuances of utilizing a patient-friendly price estimator tool as authorized by CMS.
HFMA senior VP of professional practice Richard Gundling calls on PRA founder Cynthia Fisher to “carefully consider her organization’s expertise, accuracy and role in the serious business of assessing hospital compliance and federal regulations.”
More:
“It’s important for PRA to operate with a level of transparency itself when it comes to the ambiguous nature of its sampling, analysis and validation processes.”
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.