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Hospitals failing to put price transparency into practice

por John R. Fischer, Senior Reporter | July 27, 2021
Almost 95% of hospitals are still largely not adhering to the new price transparency rule since it was enacted in January
Just over 5% of U.S. hospitals are complying with the new price transparency rule that went into effect in January, according to nonprofit PatientRightsAdvocate.org.

The activist group claims in a new survey that 94.4% of hospitals are still largely noncompliant with the rule. “Every single day, hospitals and insurance companies can choose to overcharge patients because we have had no ability to see, before we get care, the prices we will be charged. Consumers in healthcare are not just the patients. They are employer- and union-sponsored plans that come out of the employee’s wages. It’s our money to save," Cynthia Fisher, founder and chairman of PatientsRightsAdvocate.org, told HCB News.

Out of a sample of 500 randomly selected hospitals across the U.S., 471 failed to comply, with 403 (80.6%) not publishing payer-specific negotiated charges associated with the names of each third-party payer and plan, as required by the rule. In addition, 258 (51.6%) failed to publish any negotiated rates at all, and 198 (39.6%) did not publish any discounted cash prices.

This conflicts with American consumer attitudes, with 85% in a new poll — also conducted by PatientRightsAdvocate.org — saying that making healthcare prices, quality metrics and their pricing, and outcomes more transparent should be a priority for lawmakers. Eighty-two percent support requiring hospitals to make prices readily available, and 77% support increasing the penalty for noncompliance from $300 per hospital per day to $300 per hospital bed per day. In addition, 56% of adults feel that they or a close family friend have been overcharged when seeking medical care.

These results follow the recent executive order passed by President Biden for the Department of Health and Human Resources to crack down on unfair anti-competitive practices in healthcare and other industries. This includes being in noncompliance with price transparency, particularly by large hospitals that have created monopolization of practices through large-scale consolidation.

PatientRightsAdvocate.org recommends stricter and higher penalties for noncompliance as well as robust enforcement of the rule. It also encourages simple, actional pricing data standards to show actual price information for the development of online shopping tools and for actual and complete, discounted and negotiated prices for shoppable services to be posted. Advanced notification and posting of prices should also be available at both point of care and online to ensure consumers can access pricing data, says the group.

“It’s 'game over' for hospitals to use obfuscation to maximize their revenues at the patient’s expense,” said Fisher. “It’s 'game on' to instead run their hospitals and run insurance companies like every other business in this country, competing for the consumer’s trust and loyalty because of quality and service and best price, because people shop for quality of care at the best price.”

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