While the majority of hospitals around the country aren’t following a federal price transparency rule that has been in effect more than two years, two of Baltimore’s largest non-profit or not-for-profit hospitals are among a small group of hospitals around the country that are in complete compliance.
The Hospital Price Transparency Rule went into effect on Jan. 1, 2021, and requires that hospitals “post their standard charges prominently on a publicly available website,” according to Centers for Medicare & Medicaid Services, part of the Department of Health and Human Services.
“Standard charges must be posted two ways: Single machine-readable digital file containing the following standard charges for all items and services provided by the hospital: gross charges, discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges,” CMS explained. And a “display of at least 300 ‘shoppable services’ (or as many as the hospital provides if less than 300) that a health care consumer can schedule in advance. Must contain plain language descriptions of the services and group them with ancillary services, and provide the discounted cash prices, payer-specific negotiated charges, and de-identified minimum and maximum negotiated charges.”
The agency is in charge of monitoring and enforcing these price transparency requirements. For noncompliance, hospitals may be issued a warning notice, file a corrective action plan, and have a civil monetary penalty imposed and publicized on a CMS website.
Hospital representatives often point to the CMS website where it lists the
hospitals that have received fines, to show they’re not on it, and thus complying with the transparency rule. However, being absent from the list of fines hospitals doesn’t mean an institution is in compliance.
The only civil fines CMS have issued are $883,180 to Northside Hospital Atlanta and $214,320 to Northside Hospital Cherokee. Those two hospitals immediately came into exemplary compliance, according to Patient Rights Advocate, a nonprofit fighting for systemwide healthcare price transparency, that pointed out these two hospitals are “out of the thousands that are likely noncompliant.” The HHS Inspector General is investigating whether CMS is doing its job in monitoring and enforcing the rule, and is expected to issue its findings sometime this year.
“Meaningful price comparisons are possible only with full compliance with price disclosure rules,” a recent Patient Rights Advocate report noted. “An overwhelming three-quarters of the nation's largest hospital systems are noncompliant. Within these systems, 6% of the hospitals reviewed posted no usable pricing file.”
“This blatant obfuscation of prices and flouting of the rule demonstrates that implementation and enforcement efforts must be rigorously examined and markedly strengthened to improve compliance, enable technology innovators to parse the pricing data, and empower American consumers with upfront prices,” the PRA report, Fourth Semi-Annual Hospital Price Transparency Report, published in February, continued.
Patient Rights Advocate reviewed the websites of 2,000 U.S. hospitals, focusing on the nations’ largest health systems, and found that under 25% were in full compliance with the rule’s price transparency requirements.
That’s an improvement over the 16% compliance the organization found in its August 2022 report.
“Though the majority of hospitals have posted files, the widescale noncompliance of 75.5% of hospitals is due to most hospitals’ files being incomplete, illegible, or not having prices clearly associated with both payer and plan,” the PRA report found. “This noncompliance obstructs the ability of patients, employer and union purchasers, and technology developers to comparatively analyze prices, make informed decisions, and have evidence to remedy errors, overcharges, and fraud.”
In Baltimore, Johns Hopkins Medicine and the University of Maryland Medical System each have 10 out of 10 pricing components that are required to be posted online and made accessible to patients.
While many hospitals have a price estimate tool and a standard charge file on their website, the charge file is often missing details — incomplete, broad or inapplicable descriptions, calculations instead of prices, missing minimum and maximum rates for services, missing some insurance plans information, all things that leave patients guessing.
Johns Hopkins Medicine and the University of Maryland Medical System have complete standard charge files, so patients can get a full picture of what they will pay.
“The University of Maryland Medical System, including the University of Maryland Medical Center, the System’s flagship academic hospital, works continually to help ensure Marylanders have access to information they need to make informed choices about their health care,” University of Maryland Medical System spokeswoman Tiffani Washington said. “We go above and beyond federal price transparency requirements to offer pricing for an intensive list of the most common hospital-based shoppable procedures via an easy-to-use online estimator tool for patients and families seeking care. We also have a dedicated hotline to offer personalized support for patients with questions on costs and services.”
Johns Hopkins didn’t respond to our request for a comment.