In mid-June, JAMA published a study that found that a majority of hospitals are not complying with the transparency rule finalized in 2019. The final rule requires hospitals to publish discounted cash prices for uninsured patients and payer-specific negotiated rates for all services. Hospitals must also publish price data, including expected out-of-pocket costs, for “shoppable services,” such as x-rays that can be scheduled in advance. The price data must be published in an easily understandable format to make it easier for patients to engage in price shopping.
The study randomly sampled 100 hospitals in addition to the 100 highest-earning hospitals of 2017. Of the randomly selected 100, 83 were noncompliant with at least one of the rule’s requirements. Of the highest-earning hospitals, the rates were slightly more compliant with only 75 of the hospitals noncompliant with at least one requirement.
More specifically, of the randomly-selected hospitals, only 33 reported payer-specific negotiated rates, only 30 reported discounted cash prices, 52 provided a price estimator tool for shoppable services (of which only 23 posted payer-specific negotiated rates in a machine-readable file). Of the 100 highest-earning hospitals, only 35 reported payer-specific negotiated rates and 40 reported cash prices, in a machine-readable format. For these hospitals, 86 provided a price estimator tool for shoppable services (of which only 34 posted payer-specific negotiated rates in a machine-readable file).
The study further notes that all of the cost estimator tools reviewed required patients to input their personal insurance information to see the payor-specific prices, but the discounted cash prices could be seen without inputting such information.
While this study uses a very small sample size, it falls in line with previous studies that showed significant non-compliance by hospitals. The study’s authors believe that compliance might be limited “because the penalties for noncompliance are minimal (maximum $300 per day) and the costs of disclosure potentially great.”
The authors also noted that the timing of the study may have an impact on the results, as they analyzed websites two months after the rule was implemented and the rule was implemented during the COVID-19 pandemic, when many providers were focused on combatting the pandemic.
“Compliance may increase over time, but the early selective compliance suggests reluctance that may persist,” researchers said, suggesting policymakers consider stiffer penalties, additional technical assistance or public reporting of noncompliance.