SUMMARY:

Three of Nashville’s largest non-profit 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. 

DETAILS:

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 Nashville, PRA found non-profit Vanderbilt University Medical Center to be missing two out of 10 pricing components that are required to be posted online and made accessible to patients. 

As of Jan. 14, 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 
• Shows price estimate tool 
• Tool provides a cash price 

PRA also found non-profit Ascension Saint Thomas West and Ascension Saint Thomas Midtown Hospital to be missing two out of 10 pricing components that are required. 

As of Dec. 10, the hospital website is missing: 

• A complete standard charge file (the report found that the standard charges file fails to provide an adequate amount of negotiated rates.) 
• Shows negotiated rates 

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 
• All payers and plans listed  
• Shows price estimate tool 
• Tool provides a cash price 

Ascension spokesperson Nick Ragone said, “We’re proud to be a leader in price transparency — not only complying with the rule but going beyond it, to offer consumers tools to estimate costs and provide feedback. CMS itself has indicated that only a small number of hospitals across the country are not in compliance. We will continue to find ways to make sure consumers and patients have the most current information available to make an informed healthcare decision.” 

Vanderbilt didn’t respond to our requests for comment. 

 

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