Hospital price transparency compliance improves, but lags at 49%

Compliance with hospital price transparency rules is improving, but according to PatientRightsAdvocate.org, there's still room for growth.

The nonprofit, which focuses primarily on promoting price transparency, released its latest Hospital Price Transparency Report, finding that compliance has climbed to 49% of 2,000 reviewed hospitals. That's up from 21% just about two years ago.

Implemented in January 2021, the CMS Hospital Price Transparency Rule requires all U.S. hospitals to publish their standard prices online so patients can compare costs before receiving care.

Prices must be published in a machine-readable format so computer programs or researchers can parse the information. For consumer-facing prices, the CMS requires hospitals to publish a patient-friendly list of at least 300 common "shoppable" services that patients can schedule in advance.

Compliance with the rule has been notoriously bad. Six months after the rollout, compliance was only about 5%. By 2023, PRA said about a third of facilities fulfilled rule requirements, but that number dipped again in November 2024.

Now, just shy of half of healthcare facilities adhere to Hospital Price Transparency rules, which PRA credits to clearer communication and stronger enforcement from the CMS. The agency has made updates to its GitHub specifications, FAQs and other communications, which PRA said help hospitals better comply with file format standardization and file access requirements.

Moreover, the CMS seems to be cracking down harder on noncompliance. In June, the agency sent warning letters to more than 500 hospitals, which PRA said allowed contacted hospitals to understand their specific noncompliance issues. Additionally, the CMS fined 28 hospitals for noncompliance, which is up from only 15 hospitals as of PRA's last compliance report.

"CMS has made progress enforcing its hospital transparency rules, but this report shows that most hospitals still owe patients clear, usable dollars-and-cents prices they can look up before receiving care," Cynthia Fisher, founder and chair of PRA, said in a press release. "Too many patients are still being denied the real, upfront prices they need to shop for affordable care and protect themselves from overcharges."

Only 18% of hospitals surveyed publish dollar-and-cents prices for at least half the items or services in their price data file, PRA data showed. Additionally, many hospitals' algorithms or formulas require access to additional data before a price can be calculated and used by patients.

There are some legislative fixes currently under discussion, PRA said. The Patients Deserve Price Tags Act was approved by the Senate Committee on Health, Education, Labor and Pensions in July.

If passed, the bill would require hospitals, clinical laboratories, imaging providers and ambulatory surgical centers to post dollar-and-cents prices for both cash and health plan-negotiated rates. It would also require those entities to disclose any formulas, algorithms, schedules, contractual methodologies or other necessary information to calculate prices.

"When patients have access to real dollar-and-cents prices, they can shop as informed consumers, spot wide price variation, and be protected from overcharges," Fisher stressed.

Sara Heath is an executive editor at Xtelligent Healthcare Media, where she covers patient engagement, healthcare policy and health IT.