Hospital Transparency? Good Luck

“There is “sobering evidence” that the level of price transparency is actually getting worse…….

No way to enforce hospital price transparency rule, CMS says

By Tony Abraham

Jan. 11, 2019

Dive Brief:

  • CMS administrator Seema Verma said Thursday the agency has no means of enforcing its new price transparency rule, which mandates hospitals post standard charges online in a machine-readable format.
  • Seema told reporters said that while “there are no penalties at this time,” CMS is asking in a request for informationwhat the enforcement mechanism for the rule should be. There is no timeline for penalty implementation, she said.
  • CMS also does not know — or would not make it known — how many hospitals are currently complying with the rule. Rather, Verma said, “it is the expectation that all of them will comply.”

Dive Insight:

The new rule, which went into effect on the first day of the year, was considered by many to be in an inadequate first step toward price transparency. It doesn’t require posting any more information than hospitals already provide the public by law. Essentially, it mandates hospitals post that information online in spreadsheets.

Some have criticized hospitals for burying the pricing information on their websites. Ascension, one of the nation’s largest hospital operators, has a one-stop shop pricing website, which lists cost information for each of their hospitals across the country — but it’s hard to find.

The company said it supports price transparency and is in compliance with the regulation. However, it noted the pricing can be confusing for patients. “Pricing does not reflect our financial assistance and charity care policy, and could vary by individual patient and by facility,” Ascension said in a statement to Healthcare Dive. “We encourage those who are seeking or scheduling care to contact us for the pricing that is right for you.”

Other critics have said the price listing can be misleading for patients, and chargemaster information isn’t particularly helpful because hospitals rarely get paid on the sticker price.

Still, Verma was adamant that the rule is an “important first step” toward lowering costs by getting patients the information they need to compare prices. If patients can’t compare costs, she said, competition is stifled. Consumers have been “shut out” of healthcare when they should be the “driving change.”

Studies have shown, however, that Americans aren’t wild about shopping for healthcare. A Health Affairs report found just 13% of respondents responsible for cost-sharing in their last healthcare encounter sought cost information before receiving care. Only 3% compared prices of different providers.

That’s not likely to change any time soon. According to a recent JAMA Internal Medicine report, hospitals are not improving when it comes to providing price estimates for procedures. The study’s authors also said there is “sobering evidence” that the level of price transparency is actually getting worse. The percentage of hospitals that were unable to provide price information jumped from 14% to 44% between 2012 and 2016.

“We are just getting started as we work to increase pricing transparency,” Verma said Thursday. The solution, she added, isn’t as simple as revealing prices.