About two months after the federal price transparency rule went into effect, a new analysis shows that compliance among hospitals is severely lacking.
On Jan. 1, the Centers for Medicare and Medicaid Services rule requiring hospitals to make pricing information — including prices they negotiate with health insurers — publicly available went into effect.
At ViVE 2024, Panelists Share Prior Authorization Progress and Frustration in Payer Insights Program
At the Payer Insights sessions on Day 1 of ViVE 2024, a panel on prior authorization offered compelling insights from speakers who shared the positive developments in this area after years of mounting frustration. Speakers also shared challenges as they work with providers to figure out how policy developments and technology will work in practice.
Researchers from the Hilltop Institute set out to assess compliance with the rule. Their findings, published in Health Affairs, are not encouraging.
Of the 100 hospitals in the researchers’ sample, 65 were “unambiguously noncompliant.”
The rule requires hospitals to present prices in two ways: as a machine-readable file with all items and services, and as a display of shoppable services in a consumer-friendly format.
Of the 65 that were found to be non-compliant, 12 (18%) either did not post any files or they provided links to searchable databases that were not downloadable.
The Impact Brands: Empowering Wellness Through Natural and Holistic Solutions
In an era of escalating healthcare costs and a growing preference for natural, holistic approaches to health, The Impact Brands emerges as a collective of diverse brands dedicated to supporting overall wellness through natural means.
In addition, 53 (82%) either did not include the payer-specific negotiated rates, with the name of payer and plan clearly associated with the charges, or they were in some other way non-compliant.
Of the remaining 35 hospitals in the sample, 22 appeared to be compliant. Some hospitals even exceeded expectations, like Massachusetts General Hospital in Boston. Its file covers more than 65,000 items and services for 19 payers and 54 plans — with 54 unique payer-plan-contract combinations.
To assess compliance, the researchers collected price transparency files for the 100 largest hospitals in the U.S. — by certified bed count — from late January to early February. They checked the files for the following:
- Whether the dataset included all the variables necessary to be compliant
- Whether these variables complied with all necessary requirements
If the files did not contain the required variables or did not cover all items and services, the researchers noted the hospital as being non-compliant.
The researchers said they “suspected that compliance might be less than perfect,” given the pushback the price transparency rule received from providers.
In 2019, the American Hospital Association and other hospital groups filed a lawsuit challenging the rule after it was finalized. They lost the legal challenge, and their emergency motion to block the enforcement of the rule because of the Covid-19 pandemic was dismissed in December.
While examining compliance, the researchers did make allowances for the fact that some hospitals are under strain due to the pandemic.
But non-compliance should not be such a widespread issue, the researchers wrote, as hospitals already have all the required price information in their EHRs and claims processing systems, and they were previously granted a one-year extension.
“We urge CMS to actively monitor compliance and to use their considerable leverage to incentivize hospitals to comply,” they wrote.
Photo: adventtr, Getty Images
