Three of Las Vegas’s largest hospitals have not been in total compliance with a federal hospital price transparency rule since it went into effect more than two years ago, a new analysis found. 

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 Las Vegas, the report found University Medical Center of Southern Nevada — a non-profit hospital that’s government owned and operated by the Clark County Commission — to be missing two out of 10 pricing components that are required to be posted online and made accessible to patients. 

As of Dec. 17, 2022, the hospital website is missing: 

• A complete standard charge file (the report found that the standard charges file fails to adequately identify specific plans for all commercial payers.) 
• All payers and plans listed 

The hospital website does have: 

• Industry billing codes (of any type) 
• Shows gross charge 
• Shows discounted cash price 
• Shows negotiated min charges 
• Shows negotiated max charges 
• Shows negotiated rates 
• Has a 300 shoppable list 
• Has a price estimate tool that provides a cash price 

 “UMC strives to ensure the accuracy and comprehensiveness of this file,” UMC spokesman Scott Kerbs said. “The charge file is generated using data from commercial plans with negotiated rates that had patient charges over the previous year. The version posted on our website is from August 2022, and our IT team is currently developing a new version with additional data included. It’s also important to note that rates often apply to multiple plans from the same payer. We also offer personalized assistance for community members via phone.” 

Thw report found that MountainView Hospital, owned by the for-profit HCA Healthcare, is missing five out of 10 pricing components that are required. 

As of Jan. 19, 2022, the hospital website is missing: 

• A complete standard charge file (Standard charges file fails to provide adequate pricing information for major payer negotiated rates as well as de-identified min/max charges; has non-searchable incomplete, overbroad or inapplicable descriptions; contains calculation instructions in place of numerical prices in negotiated rates, minimum and maximum fields, and non-searchable code ranges.) 
• Negotiated min charges 
• Negotiated max charges 
• Negotiated rates 
• All payers and plans listed 

The hospital website does have: 

• Industry billing codes (of any type) 
• Shows gross charge 
• Shows discounted cash price 
• Shows price estimate tool 
• Tool provides a cash price 

Finally, the report found that Sunrise Hospital & Medical Center, also owned by the for-profit HCA Healthcare, is missing two out of 10 pricing components required. 

As of Jan. 19, 2022, the hospital website is missing: 

• A complete standard charge file (The report found that the standard charges file fails to provide adequate pricing information for major payer negotiated rates as well as de-identified min/max charges; has non-searchable incomplete, overbroad or inapplicable descriptions; contains calculation instructions in place of numerical prices in negotiated rates, minimum and maximum fields, and non-searchable code ranges.) 
• All payers and plans listed 

The hospital website does have: 

• Industry billing codes (of any type) 
• Shows gross charge 
• Shows discounted cash price 
• Shows negotiated min charges 
• Shows negotiated max charges 
• Shows negotiated rates 
• Has a 300 shoppable list and a price estimate tool  
• Tool provides a cash price 

Reached for comment, both MountainView hospital spokesperson Jennifer McDonnell and Sunrise Hospital spokesperson Marissa Mussi provided links to lists of insurance plans that are accepted by the hospitals. 

They both pointed out that CMS is the agency that determines compliance and it has only fined two hospitals. 

“Our hospitals implemented the federal requirements in January 2021,” the statements from both HCA-owned hospitals said. “Since then our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured. In addition, we have posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of ‘standard charges.’” 

 

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