Hospitals still do not comply with the rules of transparency

Almost two years after the Trump era Cost transparency rule Valid, many hospitals ignore the requirement to publish prices For popular online goods and services – with little risk of facing penalties.

News Leadership: a new report Patient advocacy groups first shared with Axios show the industry’s continued resistance to a rule some believe Can lead to more price competition or more regulation.

  • The report, published today by consumer advocacy group, is one of the first to compare hospital disclosures and a separate set of public pricing reports that insurers and group health plans had to start publishing on July 1.
  • The group reviewed 20 price statements for a sample of hospitals and found that the prices omitted by the hospitals can be found in the insurance company’s files.
  • “Some rates found in insurance companies’ rate files appear with ‘N/A’ or blank in corresponding hospital price lists,” the group wrote. “This concrete evidence from insurance filings shows that real prices exist and that hospitals are violating the hospital price transparency rule.”

details: The Hospital Transparency Regulation went into effect in January 2021. Since then, there has been widespread evidence of industry resistance, such as a June study which found that only 6% of facilities covered by the rule were fully compliant in the first six months of its entry into force.

  • Just Two hospitals in Georgia It has been fined by the Centers for Medicare and Medicaid Services since the regulation went into effect. CQ Roll Call . has been reported In June, since January 2021, CMS has issued about 352 warning letters to hospitals for non-compliance.
  • Both Republican and Democratic members of the House Energy and Commerce Committee The Biden administration urged “To conduct strict supervision and enforce full compliance.”
  • More insurance company transparency requirements are set to come into effect In the next two years. In 2023, insurers must share the costs of the 500 most “shoppable” health care services in the cost estimating tool, and by 2024, publicize the cost of each item and service they provide.

Between the lines: The benefits to hospitals from not sharing rates may actually outweigh the costs of fines, Sabrina Corlett, a research professor at Georgetown University’s Center for Health Insurance Reforms, told Axios.

  • “What happens if insurers, employers, regulators, legislators, and the media get the rates they negotiate with taxpayers?” Corlett said. “For a lot of hospitals, they’d rather not disclose this information because it could put them at some disadvantage to those different interested parties.”
  • She added that the CMS may also struggle to enforce compliance because there is a limit to the amount of penalties that can be imposed and the agency’s resource constraints.

the other side: The hospital industry says reports of non-compliance amplify the problem.

  • “While hospitals are moving forward to help patients understand expected costs of care, some outside groups are taking this opportunity to mischaracterize what is happening in the field in relation to the hospital price transparency rule,” American Hospital Association spokesman Sean Barry said in a statement. to Axios.
  • “These groups ignore CMS guidance on aspects of the rule and, as a result, come to very different conclusions about the state of implementation across the hospital domain. CMS, the only real verdict, has indicated that far fewer hospitals may be,” Barry said.
  • CMS did not provide a comment by the deadline.

Zoom out: With federal law enforcement delayed, states and cities began to step in.

  • In Colorado, Governor Jared Polis signed bipartisan legislation to a law in June that prohibits hospitals or collection agencies from collecting unpaid patient bills if the facility does not comply with federal transparency rules. I entered Valid in August.
  • In New York City, Council Member Julie Menen said in September It will introduce bills that would add a municipal enforcement mechanism to federal regulations.
  • In Pennsylvania, Democratic lawmakers in the state legislature Introduced a bill in September This may also require hospitals to publish a list of standard charges for each item and service they provide online.
  • “States can play a really critical role,” Corlett said. “You can impose fines, you can make it a condition of licensing, you can make it a condition of contracting. It’s pretty simple, right? States can just say, ‘We’re not going to pay you unless you’re in compliance with federal law.'” ”

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