By Susan Campbell w/ assistance from John Skelton of Senior Helpers of Tempe & Ahwatukee
PHOENIX (3TV/CBS 5) - The federal government is beginning to take action against hospitals not complying with pricing transparency laws. This month, the Centers for Medicare and Medicaid Services (CMS) issued two civil penalties to hospitals in Georgia, totaling more than a million dollars, for non-compliance, and the agency says it will continue to investigate hospitals around the country to make sure consumers have all the information they are entitled to.
The hospital price transparency law went into effect in January 2021. It requires hospitals to post a comprehensive list of the cost of items and services, and it must be in a consumer-friendly format. “Price transparency is truly informative,” said Cynthia Fisher, the founder and chair of Patient Rights Advocate, a nonpartisan, nonprofit group. “It shifts the power to the consumer to be well-informed of all prices in health care in advance of getting their care, and then consumers can benefit from competition and through their choice drive down the cost of healthcare.”
According to Patient Rights Advocate’s most recent hospital price transparency compliance report, 20 out of 25 hospitals evaluated in Arizona are not in full compliance with the law requiring posted prices. Nationwide, just 14.3% of hospitals are in compliance, according to the group, which evaluated facilities’ websites in December and January.
“They’re supposed to post the actual prices by discounted cash price as well as every single negotiated rate they have for care by every insurance carrier and every health plan,” Fisher said. “The only way we can get to a competitive, fair marketplace is to have actual prices. Everyone knows estimates don’t work.”
Dignity Health said it expects to post additional pricing information soon and released a statement to On Your Side.
“We support price transparency and empowering patients to understand their health care costs. We have offered price estimates to patients in advance of scheduled care for many years, and we will continue to do so going forward. Our first priority related to price transparency requirements was to expand our online tools to help patients estimate their out-of-pocket costs for hospital services based on their specific insurance situation. These enhanced online resources for patients have been published on our hospital websites. We are now working as quickly as possible to fully comply with the complex regulatory requirements to publish our negotiated rates with health plans. In addition to compiling information from our many health plan contracts across our health system, we are analyzing significant amounts of data to ensure the information we publish appropriately represents our negotiated rates in a way that is understandable and complies with the federal rule. We expect to begin posting this information over the next several months.”
It’s unclear if any Arizona hospitals have received warning letters from CMS or are currently being evaluated by the agency for compliance with the federal pricing transparency requirements. A spokesperson for CMS said specifics surrounding compliance would not be publicly available unless a civil penalty is issued.
Soon, consumers will have even more pricing information available to them. Beginning July 1, most group health plans and issuers of a group or individual health insurance will be required to disclose pricing. “This is amazing because this is system-wide health care transparency getting unleashed,” Fisher said. “For the first time, the hospital price transparency rule and the insurance price transparency rule together make both hospitals and insurance companies compete and they’re going to have to compete on quality and price for our hard-earned health care dollars.”