On January 1, 2021, hospitals in the United States have been required to make their prices transparent for consumer review. Under the Hospital Price Transparency Rule, hospitals are now required to list the price they charge for 300 “shoppable services” and explain the services in easy-to-understand language. Included in those 300 “shoppable services” are 70 core services that are mandated for disclosure and a more flexible 230 choices. Hospitals are required to include the discounted cash price for uninsured patients and the negotiated price a hospital has agreed upon with payors (including their highest and lowest negotiated rate for each of the 300 services).
However, a new report issued by ADVI found that there is a wide variation in the way the pricing has been made available. ADVI examined the top twenty largest hospitals in the United States for compliance with the rule and analysis of the data provided by each.
The report found that a multitude of issues with the implementation, including: not all hospitals following the mandate, some hospitals burying the information on their website, and other hospitals not providing the required 300 shoppable services. Other issues with the data included: the data was not always downloadable in a usable format and some hospitals did not provide HCPCS codes for services.
One of the biggest problems is the variability in pricing information. Among the data analyzed by ADVI, the price of code 99203 (Level 3 Evaluation and Management code), one of the most commonly billed services in Medicare, ranged from $200 to $1534. Another high-volume radiology code, 70450 (CT, head or brain, without contrast) ranged from $90 to $2,033.
These findings are consistent with ADVI’s analysis of another requirement around hospital transparency. In September 2019, ADVI published “A Review of Hospital Standard Charges and Recommendations for Best Practices to Improve Health Care Transparency,” which found similar issues around hospital compliance with federal transparency mandates around the publication of hospital chargemaster documents.
According to Caitlin Sheetz, Head of Analytics at ADVI, “ADVI analytics found inconsistent and incomplete pricing information from the top 20 US hospitals following CMS’ price transparency mandate. Data analyzed showed wide variation in the range of prices for services as well as hospitals’ terms for pricing information.”
While transparency in hospitals’ pricing may be promoted as being beneficial to patients, the implementation of this policy by hospitals has many hurdles to overcome before it can (if ever) be useful.
CMS Compliance Audits
The Centers for Medicare and Medicaid Services (CMS) has also started to audit the compliance of this policy on a select sample of hospitals, at least in part based on multiple complaints of noncompliance. To field the complaints, CMS has made an online form available to the public and has encouraged patients to submit complaints if they cannot find a hospital’s standard charges online.
If after an investigation, CMS finds that a hospital is noncompliant with the rule, they may either request a corrective action plan, assess a penalty of up to $300/day, or publicize the penalty on the CMS website.