Price Transparency – Few Hospitals Comply

Price Transparency – Few Hospitals Comply

Only 5% hospitals are compliant with price transparency rule. Here’s how they did it.

Baptist Memorial Health Care used a capability provided by Epic to pull together data from various sources including the health system’s chargemaster, said Ron Wachsman, vice president of revenue cycle, in a phone interview. The health system gathered a wide range of data, from patient accounting information to payer contract data.

The hospitals that were found to be fully compliant with the federal price transparency rule had a few strategies in common, including picking the right technology partner and beginning their efforts early — in some cases before the rule was even proposed. 

By ANUJA VAIDYA

The overwhelming majority were noncompliant and included some of the most prominent health systems in the country — NewYork Presbyterian, Cedars-Sinai Medical Center, Rush University Medical Center, Geisinger Medical Center and Intermountain Medical Center. 

But, the 28 compliant facilities include large, well-resourced organizations, regional health systems and independent hospitals from all over the country. This indicates that size and location have little to do with the likelihood of complying with the rule. For a full list of compliant and non-compliant hospitals, click here

The rule states that hospitals must publicly share the prices they negotiate with payers for at least 300 common services and items, such as MRI scans and kidney function panel tests. Hospitals are required to present the prices in two ways: as a machine-readable file with all items and services and a display of shoppable services in a consumer-friendly format. 

For most of the organizations that spoke with MedCity News, finding the right technology partner and starting on efforts early were essential for ensuring compliance.

Baptist Memorial Health Care used a capability provided by Epic to pull together data from various sources including the health system’s chargemaster, said Ron Wachsman, vice president of revenue cycle, in a phone interview. The health system gathered a wide range of data, from patient accounting information to payer contract data.

So, the health system had to draw on the expertise of people working in its IT, managed care, decision support and analytics, business office and registration divisions to achieve compliance, he said.

Mass General Brigham’s Remorenko echoed similar hurdles: the technology required to build and post the big file, which was advanced and beyond the scope of its in-house team, the additional internal and external resources needed and the level of subject matter expertise required to interpret some of the more generic aspects of the rules.

There was also the issue of the timing, she said. Healthcare facilities needed to work on price transparency efforts as the Covid-19 pandemic ravaged their resources.

“I think our internal commitment to this work and ability to partner with Epic and others contributed to our compliance,” Remorenko said.

But this type of commitment to price transparency appears to be rare among U.S. health systems. As a result, the government is taking a harder stance on enforcement. In a new rule announced three days after the Washington Post published the report, the Centers for Medicare & Medicaid Services proposed stringent penalties for non-compliance: fines ranging from $109,500 to $2 million per hospital per year.

Whether this will be enough to drive up compliance remains to be seen.