The consulting firm Guidehouse recently performed an analysis on compliance data for more than 1,000 health care providers across 27 states to see how they were faring with compliance with the price transparency rules now required by the Centers for Medicare and Medicaid Services (CMS).
Under the rule, there are two ways hospitals are required to disclose their pricing:
- A comprehensive machine-readable file that contains five types of standard charges for all items and services provided by the hospital
- A consumer-friendly shoppable services file with at least 300 shoppable services (including 70 CMS-specified services and 230 hospital-selected services). This requirement may be met by use of a patient price estimator tool.
On the provider websites, Guidehouse looked for each of the five standard charges to be present in at least one of the data files. In reviewing the websites, Guidehouse determined that if the file was present and the provider had all (or even some form) of the standard charges, they were considered to be compliant. If none of the requirements were met, the provider was considered noncompliant.
Providers were about 60% compliant with the consumer-friendly file and about 48% compliant with the machine-readable file. While most providers were compliant with at least one of the provider types, Guidehouse found that about 30% of providers were not compliant under either manner of disclosure. Noncompliant hospitals indicated several possible reasons for noncompliance, including significant resource constraints, a lack of understanding of the requirements under the rule, and/or they are waiting to see what their competitors do.
Guidehouse also found that the larger hospitals and health systems seemed to be the most likely to be compliant and used some of their existing tools to meet the requirements under the consumer-friendly shoppable services file.
There was a lack of consistency in format and content for hospitals that were found to be compliant with the machine-readable file. This is likely to make it difficult for patients and others to understand and derive insights from the data without significant changes.
Guidehouse acknowledged the “herculean task” CMS faces in evaluating compliance with the rule and enforcing corrective actions. CMS can fine hospitals $300 a day for each day they are not in compliance.
Guidehouse expects that compliance with the rule will continue to improve as resource constraints lesson and as additional clarity and standardization points are given to providers. However, the consulting firm notes that “having a strategic plan to mitigate risks and capitalize on the benefits of appropriate compliance is key.” Guidehouse also noted that while there are risks in making this information public (price scrutiny and pressure from payers, consumers, and competitors), it’s possible that through positive press and transparency, consumer trust will increase.