Large Health Systems Are Being Called Out for Lack of Price Transparency

Missing hospital prices in coverage data shows that hospitals are still violating the price transparency rule.

Once again, research finds that not all hospitals are posting their complete price lists as required by federal price transparency rules, according to the latest analysis by PatientRightsAdvocate.org.

According to the report, newly released health insurance company data files show that there are large hospital systems that are still omitting prices from their required disclosures, which is a violation of the requirement.

The group states that by cross-referencing 20 price disclosures made by hospitals and health insurers in accordance with these two rules, it discovered several instances in which prices were omitted from the hospital files but appeared in the insurance company files.

"The discrepancies indicate that some large hospitals are not posting their complete price lists as required by the hospital price transparency rule," the report said.

The examples of missing hospital pricing data uncovered include prices negotiated with insurers such as Blue Cross Blue Shield, United Healthcare, and Cigna, the report noted.

Since going into effect last year, the price transparency requirement demands hospitals disclose gross charges online through a comprehensive machine-readable file with all items and services they provide, as well as through a display of shoppable services in a consumer-friendly format.

While this study highlights larger systems that are not complying, an earlier study by Northwestern University's Feinberg School of Medicine found a correlation between smaller hospitals with fewer beds with a lack of adherence to the price transparency mandate.

In August, the Semi-Annual Hospital Price Transparency Compliance Report found that hospitals as a whole had made little progress on complying with the price transparency rule. At that time, the report revealed that just 16% of hospitals were adhering to the necessary requirements for providing pricing data for patients.

When first shoring up price transparency processes, there are two main requirements that organizations need to adhere to immediately, Connie Lockhart, director of strategy and operations at Impact Advisors, previously shared with HealthLeaders.

"Revenue cycle leaders need to first make sure they are following CMS' guidelines to complete a comprehensive, machine-readable file of all services and items," she says. "Ensure all requirements are met—like how a separate file must be posted for each hospital. And be cognizant of multiple hospitals operating under a single hospital license with different sets of standard charges."

Also, ensure that list is posted on a publicly available website.

Once completed, make sure to post a display in a publicly available website of 300 shoppable services in a consumer-friendly format. This should include the 70 CMS-specified, shoppable services, Lockhart says. Revenue cycle leaders should also establish a cadence to ensure both displays are updated annually, Lockhart says.