Recently, PatientsRightsAdvocate.org published its Transparency in Coverage Report, finding that some large hospitals are not posting their complete price lists as is required by federal rules. The analysis, focused on seven hospitals in Florida and Texas (owned by two major health systems – Ascension Health and HCA Healthcare), looked at price disclosures from the hospitals and cross-referenced the disclosures with information on prices negotiated with insurance companies.
Summary of Findings
The report found that data obtained from machine-readable files showed numerous instances where prices for services were omitted from the hospitals’ lists. Some prices in insurance company files appear with an “N/A” or are blank in the corresponding hospital price lists. “This concrete evidence from the insurance files demonstrates that real prices exist and hospitals are flouting the hospital price transparency rule,” the report said.
Ascension Hospitals
Specifically, at Ascension Seton Medical Center in Austin, TX, Patients Rights Advocate found actual prices in the Transparency in Coverage files for 16 rates negotiated with United Healthcare by plan and 12 rates negotiated with BCBS by plan that were shown as “N/A” in the Hospital Standard Charges File. For Ascension St. Vincent’s Clay County in Middleburg, FL, the Standard Charges File did not contain negotiated rates for any services identified with Current Procedural Terminology (CPT) codes. However, a United Healthcare Transparency in Coverage file for Florida did show negotiated rates for all CPT codes contained in the list of CMS-required shoppable codes.
HCA Healthcare
At HCA Florida Northside in St. Petersburg, Florida, a portion of the Standard Charges File displayed more than 300 codes (CPT 36555 through CPT 36861), but it showed one single negotiated rate for all codes within the range, $16,069 for a PPO plan. The Transparency in Coverage File data showed many different rates corresponding to 300+ codes in the range indicated in the Standard Charges File, a likely indicator that it failed to disclose complete pricing data as required.
At HCA Houston Healthcare Clear Lake in Webster, Texas, there were only seven distinct prices for a set of 68 Medicare Severity Diagnosis Related Groups (MS-DRG) codes from BCBS HMO plan with codes appearing as ranges and in groups. The Transparency in Coverage insurance file showed 719 distinct prices for MS-DRG codes.
At HCA Medical City Dallas, a portion of its Standard Charges File showed rates for a BCBS of Texas Blue Premier plan where several codes would appear in groups where a single rate corresponded to all codes within the group. For example, code MS-DRG 807 appearing in line 42898 of the Standard Charges File showed one rate, but the Transparency in Coverage File showed a different rate for the same code.
At HCA Medical City Fort Worth, there was only one distinct dollar price for all 62 MS-DRG codes that appeared as a group in the part of the file showing rates for a BCBS of Texas Blue Premier plan. In contrast, the Transparency in Coverage File for a BCBS of Texas Blue Premier plan showed 58 distinct negotiated rates for the 62 MS-DRG codes in that group.
Finally, at HCA Florida Raulerson Hospital in Okeechobee, Florida, there was only one distinct price for all six MS-DRG codes that appeared as a range in the portion of the Standard Charges File showing rates for Cigna, compared to six distinct negotiated rates in the Transparency in Coverage file (one for each MS-DRG code in the range).
Responses
Cynthia Fisher, chairman of PatientRightsAdvocate.org, called the findings the “tip of the iceberg” of what publicly disclosed data files mandated by the new regulations will reveal.
Despite the findings, Ascension sent an emailed statement saying it is complying with the transparency requirements and has actually gone above the requirements by offering consumers tools to estimate costs and provide feedback. HCA Healthcare also disagreed with the findings, saying it had implemented federal transparency requirements in January 2021 and provides a patient payment estimator on its website in addition to posting third-party contracted rates in machine-readable file formats.