Fewer hospitals posting prices despite price transparency push

Hospitals undermine price transparency

Using algorithms or percentages in lieu of actual prices undermines the hospital price transparency regulation. The vast majority of the posted formulas and algorithms reviewed in the latest report "do not provide sufficient details that would allow the public to derive the dollar amount based on the information provided," PRA said.

For example, 159 of the 236 hospitals that did not post any dollar-and-cents prices used an algorithm that cannot be quantified as an actual price by consumers or researchers. The algorithm is "Conditional payment logic at the claim level including numerous contracting methods, hierarchical applications, and service utilization requirements."

Whether it was this algorithm or a similar one, half of the hospitals in the report posted algorithms somewhere in their files that cannot be quantified as actual prices because of ambiguity or missing information, PRA reported.

Additionally, three-quarters of hospitals posted at least one algorithm in their files that requires interpretation by a contract expert. Another 14% posted algorithms that require access to proprietary information or purchased datasets, the report stated.

Hospitals continued to undermine the spirit of price transparency requirements by posting more percentages. PRA reported that nearly 73% of the hospitals reviewed now post negotiated rates as percentages without actual prices versus about 40% in the November 2024 report.

The percentage of hospitals not posting any dollar-and-cents prices also increased from about 9% of hospitals to almost 13%.

"When prices remain hidden, patients continue to be financially harmed, overcharged, and fearful to seek care for fear of the unknown cost," PRA said in the report.

Improving hospital price transparency

Dollar-and-cents pricing in hospital price transparency files will "allow Americans to make informed decisions, be protected from overcharges, and benefit from freedom of choice that will ultimately lower costs," PRA stated.

In a comment letter to CMS -- sent in response to its proposed 2026 Outpatient Prospective Payment System (OPPS) rule -- PRA offered several recommendations to improve hospital price transparency requirements to truly empower consumers with upfront healthcare costs. The recommendations were to:

• Require real dollar prices, except when a price cannot be expressed as a dollar amount, in which case hospitals must provide all necessary information for the average patient to determine the amount without third-party assistance.
• Mandate the disclosure of full contract terms in public files, including all carve-outs, stop-loss provisions and other exceptions, in addition to base rates.
• Require the reporting of accurate discounted cash prices.
• Have hospitals list their Type 2 National Provider Identifiers to provide patients and employers with additional information.
• Require hospital executives to attest to the accuracy of the price transparency files.
• Increase enforcement of the requirements, specifically by withdrawing a proposal to reduce penalties for noncompliance when a hospital waives its right to a hearing.

The proposed 2026 OPPS rule would require hospitals to report actual 10th, median and 90th percentile allowed amounts to improve the accuracy of hospital files. It would also require attestation of accuracy and encode national provider identifiers.

However, industry stakeholders like the American Hospital Association (AHA) emphasize in their comment letters that the administration's focus on enhancing the files diverts attention from more consumer-friendly information that helps patients understand costs.

"The outsized focus on machine-readable file data can distract patients from the more intuitive tools that provide individualized, and therefore more accurate, estimates based on patients’ cost-sharing requirements, their progress toward meeting their deductible, and other pertinent information such as patient demographics," AHA wrote in its letter.

CMS typically releases its final OPPS rules in November, with policies taking effect by Jan. 1.

Jacqueline LaPointe is a graduate of Brandeis University and King's College London. She has been writing about healthcare finance and revenue cycle management since 2016.