Although CMS' price transparency rule took effect Jan. 1, several recent studies reveal a low compliance rate from hospitals across the U.S.
The price transparency rule aims to make hospital pricing information readily available to patients to compare costs and make more informed healthcare decisions. To aid with this, hospitals in the U.S. are required to post both a machine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a consumer-friendly format.
Here is a breakdown of five studies that showcase compliance from hospitals across the U.S.:
1. A look at compliance rates from U.S. News' top 20 honor roll hospitals. A study published in the The American Journal of Managed Care found that just one of the top 20 hospitals ranked by the U.S. News & World Report displayed minimum negotiated charges on its website. Researchers evaluated hospital websites for five common shoppable services: brain MRI, abdominal ultrasound, cardiac valve surgery, total joint replacement and vaginal childbirth. The survey found that of the top 20 hospitals, 13 displayed the cash prices for both brain MRIs and abdominal ultrasounds, 10 posted prices for joint replacements, 10 reported cash prices for childbirth and eight reported cash prices for cardiac valve surgery. In comparison, negotiated rates were less likely to be published. Only one of the 20 hospitals displayed the negotiated price for brain MRIs and abdominal ultrasounds. None of the hospitals displaced negotiated prices for hospital services.
2. A look at compliance from the top 100 revenue-grossing hospitals and 100 randomly sampled hospitals. Research published June 14 in JAMA Internal Medicine found that of the 100 top-grossing hospitals, 75 percent failed to comply with at least one of the rule's requirements, and 86 percent offered a price estimator tool. Of the 100 randomly sampled hospitals, 83 percent failed to comply with at least one of the rule's requirements. A little more than 50 percent of the hospitals had a cost estimator tool, but they all required patients to input their personal health information to access it.
3. A look at compliance from a sample of 5,288 hospitals' websites. In a study published May 14 in JAMA Network Open, researchers looked at 5,288 hospitals associated with a website and found that just 48.5 percent of them had chargemaster data on their websites. They also found that 305 institutions had broken links or incorrectly linked files, and 138 hospitals only had online cost estimators.
4. A look at compliance at the largest hospitals based on bed count. A study published March 16 in Health Affairs found that 65 of the 100 largest U.S. hospitals, based on bed count, were not in compliance with the rule. Twelve of the 65 noncompliant hospitals didn't post any files or provide links to searchable databases that were not downloadable. The rest of the noncompliant hospitals either did not include payer-specific negotiated rates with the name of the payer and plan clearly associated with the charges or were noncompliant in another way.
5. A look at compliance for more than 1,000 providers across 27 states. Research released Feb. 9 by consulting firm Guidehouse found that healthcare providers are favoring consumer-friendly files when complying with the price disclosure rule. In particular, 60 percent of healthcare providers that have complied with CMS' price transparency rule are displaying prices in consumer-friendly formats. Noncompliant providers told Guidehouse they have not met CMS' requirements yet because of significant resource constraints, confusion about the rule or waiting to see how other providers comply.