Hospitals Still Not Fully Complying With Federal Price-Disclosure Rules

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Some Health Care Systems Post Incomplete Pricing Data or Nothing, No Penalties Yet From the Biden Administration

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Some hospitals that failed to publish their prices said that doing so would put them at a competitive disadvantage and did not believe the information would be useful to consumers, or that the technical requirements were difficult. “This work requires extensive resources and considerable investment,” CommonSpirit said in a statement. The system operates 140 hospitals, including 27 of 31 in California, for which the Journal was unable to find posted prices negotiated by private insurers until recently.

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No hospital has been penalized as of the end of December, according to the Centers for Medicare and Medicaid Services, which is responsible for enforcing the rules. The maximum fine this year for violators is $109,500 per hospital, and the fine increased to $2 million in January.

A CMS spokesperson said the agency has issued about 335 warnings for violations and is providing information and technical support to hospitals to increase compliance by early December. Regulators also requested that 98 hospitals submit plans on how and when they would comply.

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In its final rule, CMS summarized public comments and responses, saying that patients indicated that public value-disclosure is “essential for individual decision-making.” CMS said the burden of collecting data was greater than the public’s need for pricing information, but pushed back the initial date of release by a year.

The requirement, which took effect on January 1, 2021, launched a nationwide trial to see whether price transparency could be an effective tool to help lower healthcare costs.

Under the rules, hospitals will have to make public two different sets of prices. One set of prices includes 300 common services that can be determined ahead of time, allowing individual patients to make purchases. The second is a comprehensive price list, which includes all prices for all services. Hospitals under different health-insurance contracts typically have multiple prices for the same service.

More than 1,000 hospitals complied. The Journal’s analyzes of this data have revealed wide disparities in prices, with higher prices often charged to uninsured or those with limited insurance, who may be able to pay the least for care.

“We support transparency and we work to provide meaningful cost and quality information to help our patients make informed decisions about care,” said Sutter, a Northern California nonprofit with 23 hospitals. A spokesperson for Health said, which largely complies with the rules.

Turquoise Health Company, a startup focused on collecting pricing-transparency data, uses a five-point scale to determine how well hospitals have complied with regulations. As of this week, Turquoise has given only 51% of hospitals a score of 4 or 5, indicating they have issued a significant amount of interaction rates. Some hospitals may have published additional data since Turquoise last checked its disclosures.

The lack of full compliance has hindered the ability of consumers, employers and insurers to use price data to find the best deals.

“Transparency is the table bet,” said Ashok Subramaniam, chief executive officer of Centivo, which negotiates hospital prices for health plans that employers offer as benefits to workers. “If you are not going to comply, So it’ll look like you’re hiding something.”

In cases when Centivo may get price figures this year, it used the comparison to compete for the business of more employers, where Centivo gets favorable deals from hospitals, Mr. Subramanian said. “It’s in black and white now.”

But this was not possible where hospitals kept the prices a secret, he said.

Some employers have urged local hospitals to improve compliance and called for more aggressive enforcement from regulators. “Why aren’t they doing more?” said Gloria Sachdev, CEO of Employers Forum of Indiana, a coalition of employers.

Employers are among the nation’s largest health care consumers, contracting with insurers to network hospitals and doctors who are covered in worker health benefits. They account for about three-quarters of family premium costs, according to the nonprofit Kaiser Family Foundation.

Hundreds of hospitals posting pricing data on their websites hid information from online search results by using special webpage coding, which blocks pricing data on their websites from search engine results.

After the Journal reported that hundreds of hospitals had their data blocked, hospital pricing webpages cannot use this kind of coding, under new rules that take effect in 2022.

North Oaks Health System, based in Hammond, La., posted some data in early 2021 but pulled it down two weeks later, the system’s chief financial officer, Mark Anderson, said in an interview in June. He added that none of the system’s closest competitors have posted their rates.

“You get nervous about having those negotiated rates out there. You don’t know who will look at those rates and say, ‘I want to negotiate Medicare rates,'” he said. “We didn’t want to put ourselves at a competitive, strategic disadvantage.”

This week a representative for North Oaks pointed to a data file the hospital posted on its site on July 1. There is a single price for each procedure on file, and the website includes a phone number that consumers can call for more information. The file does not include the required price that the hospital negotiates with each insurer.

“Due to the highly competitive environment we are not on the website, but we are working with individuals on an individual basis,” Anderson said this week via a spokesman. “We believe this is a better service for our customers.”

Texas-based Crystus Health said on its website earlier this year that it planned to defy the rules because its comprehensive list of prices “will only be useful to our competitors.”

A Christus spokesperson said five Christus hospitals received warning letters from CMS, followed by a notice that they must complete a remedial plan to come into compliance.

According to the spokesperson, Christus expects his hospitals to be fully compliant before January 1.

Hospitals stopped making prices public because Cristus officials didn’t believe the required disclosures would be useful to patients, she said. Instead, Christus made it available to billing specialists to take patients’ questions about prices, she said.

Providence, a 52-hospital system located in Renton, Wash., has price-estimation tools available to patients and is working to post its comprehensive list of prices negotiated by payers, said Melissa Tizon, a Providence spokeswoman. None of the system’s six hospitals in the Los Angeles area had disclosed their negotiated prices, as a Journal review of the disclosures revealed this week.

Caring for Covid-19 patients has been a top priority in Providence, Ms Tizon said. “The process of meeting the rules and its requirements is complex and time-consuming,” she said.

CommonSpirit first began posting comprehensive price lists at least three months after the deadline.

The hospital system needs to compile and analyze its hospital price data before making it public, the system said in April. As of this month, nearly all CommonSpirit hospitals in California still haven’t complied, a journal review of the disclosures found. A CommonSpirit spokesperson said hospitals post prices as their data is ready.

Write Melanie Evans at [email protected], Anna Wilde Matthews at [email protected] and Tom McGinty at [email protected]

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