Dive Brief:
The percentage of hospitals in full compliance with federal price transparency rules fell from February to November, from 34.5% to 21.1%, according to a new report from watchdog group Patient Rights Advocate.
The backslide in compliance is due to weak federal oversight, which has allowed hospitals to post prices that aren’t clearly associated with payers and not in required formats, the PRA said.
PRA Chairman and Founder Cynthia Fisher wrote to President-elect Donald Trump on Wednesday asking him to get tougher on price transparency in light of the findings and reverse Biden-era CMS guidance that the organization says is too flimsy.
Dive Insight:
The first Trump administration issued a number of price transparency rules meant to help patients shop for care and drive down medical costs, including one targeting hospitals that went into effect in 2021.
Under the requirements, hospitals must post payer-specific rates for all services and prices for their 300 most common procedures in a consumer-friendly format.
While all 2,000 hospital websites reviewed by PRA had a machine-readable file posted on their website as of Nov. 13, the quality of those files varied greatly, according to the report.
Only about 17% of all hospitals reviewed posted dollars-and-cents price data that could be used by consumers to shop for prices, PRA found.
“By keeping their prices hidden, hospitals continue to block American consumers from their right to compare prices and protect themselves from overcharges,” Fisher said in a statement accompanying the report.
Once again, some of the nation’s top health systems were called out for noncompliance, including Ascension, AdventHealth, Kaiser Permanente, Bon Secours Mercy and Mercy — all of which had zero fully compliant hospitals, per the report.
Fisher blamed the Biden administration in part for hospitals’ failure to provide clear pricing data, alleging recent CMS guidance had undercut the purpose of the transparency rules.
As of July, hospitals have been allowed to post percentages and algorithms instead of actual prices. PRA warned hospitals will be able to further “obfuscate” prices further come 2025, when they will be permitted to post price estimates and averages instead of dollars-and-cents pricing.
The organization also criticized the CMS for being too lax on punishing hospitals that failed to comply with price transparency rules. The Biden administration has fined 15 hospitals for noncompliance to date, a small number compared to the 1,579 hospitals PRA found to not be meeting the requirements. And, only one of those fines occurred this year.
The Trump administration could be tougher on price transparency, given it promulgated the rules in the first place.
And while Republicans typically favor less regulation in healthcare, conservative members of Congress have signaled support for enhanced oversight of price transparency initiatives.
Last year, Republican members of the House Ways and Means committee slammed the CMS for its lack of oversight on price transparency compliance. Sen. Mike Braun, R-Ind., has also introduced legislation aimed at strengthening price transparency rules, though it remains stalled in the Senate.
However, nominations to lead federal healthcare agencies of industry outsiders, including Robert F. Kennedy Jr. as the secretary of the HHS and television doctor Mehmet Oz as CMS administrator, are creating uncertainty about Trump’s second-term health agenda.
Fisher sought to make the matter personal in her letter to the President-elect, writing that hospitals are “willfully flouting your rule” through their lack of compliance.
“On behalf of all American healthcare consumers, please prioritize strengthening and enforcing the hospital price transparency rule immediately upon taking office. Please reverse the Biden administration’s rollbacks, and please issue financial penalties to noncompliant hospitals,” Fisher wrote.
