Taking the Pulse of Hospitals’ Response to the New Price Transparency Rule

Abstract

As of January 1, 2021, most U.S. hospitals are required to publish pricing information on their website to promote more informed decision making by consumers regarding their care. In a nationally representative sample of 470 hospitals, we analyzed whether hospitals met price transparency information reporting requirements and the extent to which complete reporting was associated with ownership status, bed size category, system affiliation, and location in a metropolitan area. Fewer than one quarter of sampled hospitals met the price transparency information requirements of the new rule, which include five types of standard charges in machine-readable form and the consumer-shoppable display of 300 shoppable services. Our analyses of hospital reporting by organizational and market attributes revealed limited differences, with some exceptions for nonprofit and system-member hospitals demonstrating greater responsiveness with respect to the consumer-shoppable aspects of the rule.

US Hospital Characteristics Associated With Price Transparency Regulation Compliance

“…As of December 2021, 68% of hospitals had released payer-specific negotiated prices, more than 50% higher than rates reported earlier in the year. [3][4][5] The higher compliance rate may be attributable to reporting delays from technical difficulties or pressure from the media and CMS.…”

Use of Neuroimaging for Patients With Dizziness Who Present to Outpatient Clinics vs Emergency Departments in the US

“…It is unclear how patients, clinicians, and health plans will respond to price transparency. 63 Legislated price transparency assumes that patients will be encouraged to pursue the lowest price and that the resultant market-based price competition will force lower prices. 64 With seemingly low fees, whether from market competition or plans, those who desire neuroimaging may be even more likely to pursue it.…”

“…Thirteen of the 70 CMS-specified shoppable services are imaging procedures, including CT and MRI. It is unclear how patients, clinicians, and health plans will respond to price transparency . Legislated price transparency assumes that patients will be encouraged to pursue the lowest price and that the resultant market-based price competition will force lower prices .…”

“…With seemingly low fees, whether from market competition or plans, those who desire neuroimaging may be even more likely to pursue it. Thus, while health plans aim to lower costs, informed and potentially anxious patients may stimulate the overuse of neuroimaging for dizziness, especially in outpatient settings that provide more time to shop . To limit the unwarranted adoption of patient-driven imaging tests, there may be a need for dizziness care to be a focus of campaigns, such as Choosing Wisely, that engage patients in clinical discussions regarding testing and treatments with the goal of encouraging care that is supported by evidence and is truly necessary …”

Estimating the Impact of New Health Price Transparency Policies

“…The hospital rule became effective in 2021 but has had limited—yet increasing compliance by US hospitals. 6 , 7 The hospital rule also required “clear and accessible pricing information online” in 2 formats: a “machine readable file” with common items and services and a display of shoppable services in a consumer -friendly format. The insurer rule was delayed from January 1, 2022, to July 1, 2022, for implementation by the Administration of President Joseph Biden for further clarification and implementation instructions.…”