House Reps Urge HHS To Enforce Hospital Price Transparency Rule

April 15, 2021 - After reports have indicated inconsistent adherence to the CMS price transparency final rule put into effect on January 1, 2021, ranking members on the US House Energy and Commerce Committee wrote a letter urging for HHS to enforce the rule.

The federal rule requires hospitals to post prices (including the hospital gross charge, discounted rate, and payer-specific negotiated rates) in two formats on their website: a machine-readable file for healthcare stakeholders and a consumer-facing tool that allows patients to search for lower priced care.

While the final rule was passed to improve competition by revealing how much health plans pay hospitals for services, hospitals have largely not followed the rule.

The representatives cited data from a new Health Affairs study that reveals 65 of the 100 largest hospitals in the country were “unambiguously non-compliant” with the price transparency rule between late January 2021 and early February 2021.

Of the hospitals that were non-compliant, 82 percent did not include payer-specific rates or were non-compliant in some other way, and 18 percent did not post any files or provided links to non-downloadable databases.

“We were pleased you committed that HHS will ‘do robust enforcement to make sure price transparency is there for all Americans’ at the Senate Committee on Health, Education, Labor, and Pensions hearing on February 23, 2020,” wrote Chairman Frank Pallone, Jr, Ranking Member Cathy McMorris Rodgers, Chairwoman of the Subcommittee on Health Anna G. Eshoo, and Ranking Member of the Subcommittee on Health Brett Guthrie.

“We share your commitment to increasing price transparency for consumers and employers,” they continued. “To that end, we urge HHS to enforce the final rule to ensure hospitals are fully compliant with the disclosure requirements so that patients can readily access the price information for all items and services in an easy-to-use format.”

The letter authors also noted that several other studies have found non-compliance or attempts at compliance that do not meet the requirements of the final rule.

For example, instead of providing the full list of charges and payer-negotiated rates in a single downloadable file, some hospitals are providing consumers with a price estimator tool, they wrote. Additionally, other hospitals require consumers to fill out lengthy forms for cost estimates or fail to provide the codes for services.

What’s more, some hospitals are actively barring patients from accessing price transparency information posted on their websites. The letter to HHS details a report from The Wall Street Journal that reveals hundreds of hospitals, including some of the most prominent hospital systems, have embedded special coding on their website to block the information from appearing on search engines like Google.

Other hospitals have made the valuable pricing information inaccessible to patients by burying the information on their websites or requiring consumers to click through multiple layers of webpages to gain access to the list, the members of Congress wrote.

A Kaiser Family Foundation analysis from this month also revealed that even when the information is readily available on hospitals websites, lack of data standardization in the price transparency tools makes comparing prices accurately across hospitals nearly impossible.

For example, some hospitals include professional fees in the listed prices and other hospitals do not, but this is often not specified in the pricing tool.

Many of the machine-readable files are also inconsistently formatted and do not provide crucial information, such as the full range of plan options and payers within a particular region.

The KFF researchers also found that 56 percent of hospitals lack discounted rates for the uninsured on their online price transparency resource, and only 42 percent had that information listed on their machine-readable files. By not including this data, hospitals could be creating additional care access barriers for this at-risk population.

With significant data to back up the lack of compliance with the rule, representatives called for action from HHS.

“Given the widespread non-compliance by hospitals, we urge HHS to revisit its enforcement tools, including the amount of the civil penalty, and to conduct regular audits of hospitals for compliance,” the letter authors wrote. “We also request a staff briefing on the implementation of the final rule and on the agency’s audit of hospitals’ compliance with the final rule.”