Regular readers of this blog may recall prior blog posts regarding pricing transparency rules. The Centers for Medicare & Medicaid Services developed a rule to help promote transparency, promote competition, and keep costs down by helping inform medical care consumers of potential medical expenses. In order for the rule to achieve its intended purposes, patients need to have easy access to the entire costs of medical procedures. A year and a half after the rule’s implementation, two Georgia hospitals are the first hospitals fined for lack of pricing transparency.
By way of recap, the CMS Hospital Price Transparency Final Rule went into effect on January 1, 2021. The rule requires hospital to make publicly available costs for a delineated list of medical procedures, including room and board supplies. The listings must be machine-readable (ie. searchable). The rule also requires that the hospital not hide related costs (CMS rightly assumes that patients cannot on their own identify all costs that are related) by spreading them out across its listings.
According to CMS, both hospitals received notices of violations, and worked with each hospital on how it could overcome its deficiencies. Despite nearly a year of strategic and technical assistance, neither hospital was able to correct the violations and, in fact, removed the pricing files altogether.
These hospitals are merely examples of a long list of hospitals failing to satisfy the rule’s requirements. An analysis published by the Journal for the American Medical Association demonstrated that among 5,239 hospitals, more than half had neither a machine-readable file or a consumer-friendly display of services and pricing. Only 5.7% of hospitals had both.
Of course with so many hospitals violating the rule, and exposing themselves to monetary penalties, it is possible that these two Georgia hospitals were the first of many to face penalties, or to pursue the appeals process and further delay compliance. Hopefully continued enforcement of this rule will further promote and refine compliance as thousands of hospitals have yet to abide by the rule.
