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Where's The Compliance With Price Transparency?

Analysis  |  By Amanda Norris  
   February 23, 2022

A recent study shows only 14% of hospitals are fully complying with CMS' price transparency rule.

A study published by PatientRightsAdvocate.org shows that most organizations are still not fully complying with the hospital price transparency rule even though we are now in year two of the legal requirement. 

The report assessed the compliance with the law by reviewing 1,000 U.S. hospitals out of the over 6,000 accredited hospitals in the country.

Of the 1,000 total hospitals reviewed in the study, only 14.3% were fully complying with the rule. The study also found that only 37.9% of the hospitals posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria of the rule, such as rates by each insurer and named plan.

Some of the largest hospital systems in the country fell short in this study.

"Only 0.5% of hospitals owned by the three largest hospital systems in the country–HCA Healthcare, CommonSpirit Health, and Ascension–were in compliance. Notably, only two of the 361 hospitals owned by these three hospital systems were compliant with the rule," the PatientRightsAdvocate.org study said.

These three large hospital systems had a combined total revenue of almost $120 billion in 2021, according to the study.

This is not much of an improvement from the findings published in June 2021 by JAMA Internal Medicine, which found that hospital compliance with the price transparency rule was spotty and selective.

Researchers in the 2021 study 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. At the time, the JAMA study found that 83 were noncompliant with at least one major requirement of the rule.

Under the authority of the Affordable Care Act, a federal hospital price transparency rule took effect January 1, 2021, requiring hospitals to post all prices online, and easily accessible without barriers such as having to submit personal identifying information.

The hospital industry previously fought the rule in the courts, but court judges eventually upheld the price transparency rule in its entirety.

 

Amanda Norris is the Associate Content Manager of Finance, Payer, Revenue Cycle, and Strategy for HealthLeaders.


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