Appointed North Carolina officials battle over hospital price transparency

North Carolina's treasurer is calling out major health systems in the state for failing to comply with CMS' price disclosure requirements, in conflict with the state's attorney general who says 122 hospitals are in compliance, several news organizations reported this month.

The state treasurer, Dale Folwell, is backing the findings of a February Patient Rights Advocate report that found that 85.7 percent of a random sample of 1,000 hospitals are not compliant with the law, including 17 hospitals in North Carolina, according to the Carolina Journal

The report specifically calls out Nashville, Tenn.-based HCA Healthcare — an 188-hospital system — which reportedly has no compliant hospitals. In North Carolina alone, HCA owns seven hospitals, which were all found to be noncompliant in the Patient Rights Advocate report. 

"The study raises clear doubts concerning the compliance by certain North Carolina hospitals with federal price transparency rules," Mr. Folwell said, according to the Journal. "Only four out of 21 analyzed North Carolina hospitals complied with price transparency rules in 2021."

The report counters North Carolina Attorney General Josh Stein, whose January report found that 122 of the 147 hospitals in the state are following price transparency rules and that he is "encouraged" by their compliance. All North Carolina hospitals owned by HCA's Mission Health were found to be compliant in the attorney general's probe. 

"The attorney general graded Mission HCA as 'fully compliant,' despite the systems' failure to post any negotiated rates, according to the Patient Rights Advocate's study," Mr. Folwell said, according to the Journal

Cynthia Fisher, founder of Patient Rights Advocate, told the Journal that most North Carolina hospitals are "flouting compliance" with the regulation when they are not, which harms employers and consumers. 

"Hospitals' omission of comparative price information blocks consumers from benefiting from knowing the competition, seeking fair and equitable prices," Ms. Fisher said. 

Mr. Folwell also released a report Jan. 26 finding that North Carolina nonprofit hospitals are attempting to collect millions of dollars from patients who are eligible for free or discounted charity care. Under the ACA, nonprofit hospitals must provide free or discounted charity care to poor patients or jeopardize their tax-exempt status. The report also found that the majority of nonprofit hospitals in North Carolina failed to provide enough charity care to equal tax breaks valued at more than $1.8 billion in 2020.

"We have these corporations disguising themselves as nonprofits," Mr. Folwell told The News & Observer in a Feb. 13 article. 

Cody Hand, senior vice president of the North Carolina Healthcare Association, told The News & Observer that charity care expenses are only a portion of the community benefits a nonprofit hospital provides and that the group is willing to sit down to talk to Mr. Folwell about ways to keep healthcare costs down in the state. 

Mr. Stein also told The News & Observer that he has worked hard to reduce healthcare costs in North Carolina by suing drug companies inflating their prices. He also said he needs the legislature to give him more control over hospital mergers and acquisitions.

Mr. Stein added that Mr. Folwell has not given his opinion on Medicaid expansion, which he said would make healthcare more affordable. Medicaid expansion is "none of my business," Mr. Folwell responded.

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