House lawmakers are exploring taking a larger role in getting hospitals to comply with a landmark price transparency rule.
Several members of the House Energy and Commerce Committee’s health subcommittee asked experts Tuesday how to get more hospitals in line with the rule that requires them to share pricing data on certain shoppable services. Lawmakers found a hodgepodge of responses to the law, which requires hospitals to put data online in an easy-to-understand format so consumers can price shop.
“I looked at a couple of these websites, and they are not equal,” said Lisa Blunt Rochester, D-Delaware. “Some are difficult to understand.”
The Centers for Medicare & Medicaid Services has warned nearly 500 hospitals about their compliance with price transparency regulations and recently raised the fee for noncompliance from more than $100,000 a year to more than $2 million per hospital. An analysis the agency conducted in late 2022 found that 70% out of 600 randomly selected hospitals were in compliance with the rule’s mandate to post online a machine-readable file of applicable services and a patient-friendly tool to help consumers price compare.
Lawmakers asked several witnesses at the hearing on ways to boost hospital compliance, a signal that Congress could step in if facilities continue to drag their feet.
"Since the hospital rule went into effect, studies have found most hospitals are not meeting the requirements of this final rule," said Rep. Debbie Dingell, D-Michigan. "One concern we hear are difficulties with erratic compliance."
One suggestion from Sophia Tripoli of the advocacy group Families USA called for lawmakers to codify the price transparency rule that has been in effect since 2021. She added that even though there is a monetary penalty for not complying with the rule, hospitals aren’t incentivized enough to turn over their prices.
“It’s just about the business model of the sector, which is to keep prices hidden,” said Tripoli, director of healthcare innovation at Families USA. “There is not a strong enough financial incentive or requirement to disclose prices.”
She added that hospitals should be prohibited from posting prices as a percentage of Medicare and gross charges.
“We need to understand beyond a confusing code,” Tripoli said.
There should also be more standardization in how to submit the files, added Chris Severn, CEO and co-founder of Turquoise Health, a startup that has created databases on the pricing data.
Turquoise has 5,100 hospitals in its database, and “we had to write over 1,000 unique programs to bring that data in,” Severn said.
“The first step to making compliance enforcement easier is having a standard to look through these 6,000 files,” Severn said.