Report: Only 14.3% of hospitals compliant with price transparency rules one year in

Six months after finding only 5.6% of hospitals were in line with major price transparency requirements, an updated analysis from found hospitals’ compliance has increased to just 14.3%—with the country’s largest health systems serving as the worst offenders.

According to the report, only 0.5% of hospitals owned by CommonSpirit Health, Ascension and HCA Healthcare met the federal requirements. For-profit HCA, the largest of the three, was found by the group to fall short across every one of its 188 hospitals.

“We are now entering the second year since the hospital price transparency rule became law, and compliance remains at very low levels. The largest hospital systems are effectively ignoring the law, with no consequences,” wrote in its report.

From Dec. 7, 2021, through Jan. 28, 2022, analyzed the websites of 1,000 hospitals for each measure required by the Centers for Medicare & Medicaid Services (CMS)’ regulations, which went into effect on Jan. 1, 2021. Of note, the sample included the same 500 hospitals previously reviewed by the advocacy group in its first iteration of the report, published last July.

According to the report, 85.7% of the 1,000 hospitals did not post a complete machine-readable file of standard charges, while 4.1% did not post any standard charges file whatsoever. Additionally, 58.6% did not clearly publish payer-specific negotiated charges while 26.2% did not publish any discounted cash prices.

RELATED: CMS issued over 300 warnings, but no fines, to hospitals falling short on price transparency last year

As for the requirement to display a list or price estimator tool for 300 common shoppable services, the group found 28.7% of the hospitals presented the list in a consumer-friendly display; however, most of those hospitals remained non-compliant because their files were incomplete. Similarly, while 84.7% of hospitals published a price estimator tool, about a fifth of those still violated the requirements by not allowing uninsured or self-pay patients to see discounted cash prices.

“The lack of compliance by hospitals is about more than simply the failure to follow the legal requirements,” the group wrote. “It is also about the failure of hospitals to provide critically needed information to consumers so they can make better health decisions. Empowered with comparative price and quality information in advance of care, consumers, including employers and unions, can improve health outcomes while lowering costs by taking advantage of the benefits of competitive market efficiencies.”

In a letter to President Joe Biden accompanying the report’s publication, Founder and Chairman Cynthia Fisher applauded the administration’s intent in applying the rule and recently raising penalties for non-compliant hospitals.

However, with so many hospitals still falling short, she called on President Biden to take additional actions to encourage and enforce compliance. These included executive action to make hospital price transparency compliance a Condition of Payment or Condition of Participation in Medicare and Medicaid as well as administering the first fines and public warnings to those that have already been contacted by CMS regarding noncompliance.

“Achieving true price transparency will finish the job you started with the Affordable Care Act and make the cost of care truly affordable for the American people,” Fisher wrote to the president. “We encourage you to boldly enforce the current hospital price transparency rule and refuse any additional delays to the Transparency in Coverage Rule.”

As of early December, CMS said it has issued roughly 335 warning notices and 98 requests for a corrective action plan to non-compliant hospitals. However, the agency said it had not yet seen fit to issue a civil monetary penalty or publicly name any hospitals.

Industry-wide compliance with CMS’ transparency requirements was notoriously pockmarked, with numerous analyses from researchers and consulting firms detailing inconsistencies throughout the year.

Hospitals, for their part, have pointed to what they consider to be confusing or imprecise language in CMS’ rule as a barrier to their good faith efforts to reach compliance.

CommonSpirit Health, one of the primary offenders highlighted in the report, said that price transparency and the end goal empowering patients has been "a top priority" for the system and that all of its hospitals currently offer online patient tools to estimate out-of-pocket costs for shoppable services by specific insurance information. 

Additionally, "a majority of the hospitals we own have posted machine-readable files with our standard charges, cash prices and negotiated rates on their websites. This has been a complex and time-intensive process and we expect to have the remainder of the files published by April," the system said in its statement.