Adherence to a Federal Hospital Price Transparency Rule and Associated Financial and Marketplace Factors

Haque, Waqas; Ahmadzada, Muzzammil; Janumpally, Sanjana; Haque, Eman; Allahrakha, Hassan; Desai, Sunita; Hsiehchen, David

doi:10.1001/jama.2022.5363

Cited by 22 publications

(29 citation statements)

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“…noncompliance. 19,20 To improve compliance with price transparency, fines actually need to be enforced and possibly increased.…”

Section: Discussionmentioning

confidence: 99%

“…This implies that either fines are not being imposed or are not sufficiently costly to hospitals. We suspect that the primary issue is the former, because as of June 9, 2022, of the 5239 total hospitals registered with CMS, only 2 hospitals have been fined for noncompliance . To improve compliance with price transparency, fines actually need to be enforced and possibly increased.…”

Section: Discussionmentioning

confidence: 99%

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Large Variations in the Prices of Urologic Procedures at Academic Medical Centers 1 Year After Implementation of the Price Transparency Final Rule

et al. 2023

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ImportancePatients with urologic diseases often experience financial toxicity, defined as high levels of financial burden and concern, after receiving care. The Price Transparency Final Rule, which requires hospitals to disclose both the commercial and cash prices for at least 300 services, was implemented to facilitate price shopping, decrease price dispersion, and lower health care costs.ObjectiveTo evaluate compliance with the Price Transparency Final Rule and to quantify variations in the price of urologic procedures among academic hospitals and by insurance class.Design, Setting, and ParticipantsThis was a cross-sectional study that determined the prices of 5 common urologic procedures among academic medical centers and by insurance class. Prices were obtained from the Turquoise Health Database on March 24, 2022. Academic hospitals were identified from the Association of American Medical Colleges website. The 5 most common urologic procedures were cystourethroscopy, prostate biopsy, laparoscopic radical prostatectomy, transurethral resection of the prostate, and ureteroscopy with laser lithotripsy. Using the corresponding Current Procedural Terminology codes, the Turquoise Health Database was queried to identify the cash price, Medicare price, Medicaid price, and commercial insurance price for these procedures.ExposuresThe Price Transparency Final Rule, which went into effect January 1, 2021.Main Outcomes and MeasuresVariability in procedure price among academic medical centers and by insurance class (Medicare, Medicaid, commercial, and cash price).ResultsOf 153 hospitals, only 20 (13%) listed a commercial price for all 5 procedures. The commercial price was reported most often for cystourethroscopy (86 hospitals [56%]) and least often for laparoscopic radical prostatectomy (45 hospitals [29%]). The cash price was lower than the Medicare, Medicaid, and commercial price at 24 hospitals (16%). Prices varied substantially across hospitals for all 5 procedures. There were significant variations in the prices of cystoscopy (χ23 = 85.9; P = .001), prostate biopsy (χ23 = 64.6; P = .001), prostatectomy (χ23 = 24.4; P = .001), transurethral resection of the prostate (χ23 = 51.3; P = .001), and ureteroscopy with laser lithotripsy (χ23 = 63.0; P = .001) by insurance type.Conclusions and RelevanceThese findings suggest that, more than 1 year after the implementation of the Price Transparency Final Rule, there are still large variations in the prices of urologic procedures among academic hospitals and by insurance class. Currently, in certain situations, health care costs could be reduced if patients paid out of pocket. The Centers for Medicare &amp; Medicaid Services may improve price transparency by better enforcing penalties for noncompliance, increasing penalties, and ensuring that hospitals report prices in a way that is easy for patients to access and understand.

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“…noncompliance. 19,20 To improve compliance with price transparency, fines actually need to be enforced and possibly increased.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Large Variations in the Prices of Urologic Procedures at Academic Medical Centers 1 Year After Implementation of the Price Transparency Final Rule

et al. 2023

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“…2 Even by September 2021, more than one-half of the 5239 hospitals that registered with the Center for Medicare & Medicaid Services (CMS) did not post a machine-readable file or display any shoppable services. 3 In response to the low compliance, the CMS raised the penalty for noncompliant hospitals to $300 per day for small hospitals and up to $5500 per day for large hospitals beginning from January 1, 2022. 3 Despite the steeper penalties, the compliance rate remains low.…”

mentioning

confidence: 99%

“…3 In response to the low compliance, the CMS raised the penalty for noncompliant hospitals to $300 per day for small hospitals and up to $5500 per day for large hospitals beginning from January 1, 2022. 3 Despite the steeper penalties, the compliance rate remains low. For example, Gul et al 1 note that as of March 2022, only 29% to 56% of academic hospitals disclosed commercial prices for 5 common urologic procedures.…”

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confidence: 99%

Price Transparency in Hospitals—Current Research and Future Directions

2023

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The Hospital Price Transparency Final Rule (the rule, hereafter), which requires hospitals to post the payer-specific negotiated prices, discounted cash prices, and standard charges for all items and services in a machine-readable format, became effective on January 1, 2021. The rule also requires a customer-friendly list of such price-related information for 300 shoppable services, of which 70 services were specified in the rule and the remaining 230 could be selected by each hospital. The rule is unprecedented because there has never been nationwide reporting of commercial prices negotiated between hospitals and health plans. Researchers have analyzed the price data reported under the rule. Gul and colleagues 1 examined the prices of 5 common urologic procedures disclosed by 153 academic hospitals. This commentary evaluates their findings in the context of the extant

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“…22 This finding is consistent with a June 2022 study of 5239 US hospitals, which reported that only 729 (5.7%) were compliant with requirements after 6 to 9 months and that greater compliance was associated with lower revenue per patient-day and within unconcentrated health care markets. 23 The general lack of industry compliance was likely in part due to the modest maximum penalty for hospitals who failed to comply, set at $300 per hospital per day, or $109 500 per year. 5 Hence, the policy was updated in 2022 by scaling the penalty for larger hospitals to $10 per bed per day and raising the maximum annual penalty to $2 007 500 per hospital.…”

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confidence: 99%

What Should “Shopping” Look Like in Actual Practice?

Patel

Ehrenfeld

Miller

2022

AMA Journal of Ethics

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In health care, lack of transparency about the cost of health care services to patients during clinical encounters has contributed to increased costs and high out-of-pocket expenses. Federal policy has responded to the need for more transparency and spurred discussion about ethics and the clinician's role in being transparent with patients at the point of service. This article investigates and encourages state, private market, and federal policy efforts to address what health care costs patients. This article also applies the ethical framework of principlism to cases and considers what a "shoppable service" model would demand of clinicians in practice.The American Medical Association designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 Credit™ available through the AMA Ed Hub TM . Physicians should claim only the credit commensurate with the extent of their participation in the activity. Necessity of Price TransparencyHealth care delivery differs from other consumer-facing services, such as dental, legal, or veterinary services, due to limited price transparency at the point of service. 1 This opacity has contributed to increased costs and associated out-of-pocket expenses and affects patients' health care decisions, as nearly 33% of Americans in 2019 reported that they or a family member delayed treatment due to cost. 2 As a significant portion of health care costs result from physician-driven patient care decisions, 3 clinicians must increasingly consider their responsibility to address cost. Providing high-value care and considering patients' financial well-being in shared decision making, especially for "shoppable services," expands the clinician's role as a steward of health care resources and as an advocate for patient-centered care. 4 In 2017, shoppable services, defined as "service[s] that can be scheduled by a healthcare consumer in advance," 5 composed an estimated 36% of medical spending and 43% of out-of-pocket spending. 6 Recent policy efforts by the Centers for Medicare and Medicaid Services (CMS) support price reporting for shoppable clinical and diagnostic services to drive innovation; to facilitate informed, price-conscious decision making; and to promote competition. 5

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Adherence to a Federal Hospital Price Transparency Rule and Associated Financial and Marketplace Factors

Abstract: This study evaluates US hospitals’ disclosure of standard service charges as mandated by a federal price transparency rule and hospital characteristics among acute care hospitals.

Cited by 22 publications

References 1 publication

Large Variations in the Prices of Urologic Procedures at Academic Medical Centers 1 Year After Implementation of the Price Transparency Final Rule

Large Variations in the Prices of Urologic Procedures at Academic Medical Centers 1 Year After Implementation of the Price Transparency Final Rule

Price Transparency in Hospitals—Current Research and Future Directions

What Should “Shopping” Look Like in Actual Practice?

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