There are no Connecticut hospitals fully complying with a federal rule requiring price transparency according to a recent report from a patients’ rights advocacy organization.
Patient Rights Advocate (PRA), a nonpartisan organization focused on healthcare price transparency, recently released a report surveying the websites of 2,000 hospitals across the United States and found only 421, or 21.1 percent, were in compliance with a federal price transparency rule. None of the 10 Connecticut hospitals included in the survey were compliant.
The Hospital Price Transparency Rule was issued by the Centers for Medicare and Medicaid Services (CMS) on January 1, 2021, and requires all hospitals, regardless of how they are paid, to provide online information about the pricing of items and services. The rule requires hospitals to post this information both as a comprehensive, machine-readable file listing all items and services and as a consumer-friendly display of shoppable services.
Ten Connecticut hospitals were included in the survey, which reviewed a number of metrics. The survey reviewed whether the machine-readable file hospitals are required to post passed a validator tool made available by CMS to verify whether they meet formatting requirements. On July 1, CMS passed an updated rule requiring all machine-readable files to meet specific template layout and technical specifications.
The report reviewed the machine-readable files of all 2,000 hospitals and found 532 hospitals to be noncompliant with this portion of the transparency rule, including six in Connecticut: Bridgeport Hospital, Connecticut Children’s Medical Center, Danbury Hospital, Hartford Hospital, Yale-New Haven Hospital, and Hale-New Haven Hospital’s Saint Raphael Campus.
The report called the rollout of the tool a “roll back of key price transparency requirements” because it allows hospitals to “post percentages and algorithms instead of actual prices” and “will permit estimates and averages instead of dollars-and-cents prices.”
As a result of the new CMS rule, the report also evaluated the sufficiency of pricing data for each hospital based on “the availability of actual, dollars-and-cents prices found in the files.” Of the 2,000 hospitals surveyed, 335, or 16.8 percent, were found to sufficiently disclose dollars-and-cents prices, and 133, or 6.7 percent, were found to be both complying with the price transparency rule and posting sufficient pricing data.
Of the ten Connecticut hospitals surveyed, three had sufficient pricing data available.
According to the report, failure to pass the CMS validator tool was the most significant contributor to hospitals failing to comply with the rule, with 26.6 percent posting files that failed the tool. Additionally, 20.8 percent of hospitals posted price files that did not include information for all payer and plan names. 11.6 percent of surveyed hospitals posted files that included inaccurate minimum and maximum negotiated charges.
The Office of the Inspector General in the U.S. Department of Health and Human Services also recently completed an audit of 100 randomly sampled hospitals and found while 63 complied with the price transparency rule, 37 did not comply with either the requirement to publish a machine-readable file or a consumer-friendly display of shoppable services. The audit estimated that 46 percent of the 5,879 hospitals required to comply with the price transparency rule were not in compliance.
When the rule went into effect, CMS began monitoring hospitals and, for those found to be in noncompliance, can issue a warning, request a corrective action plan, or impose a civil monetary penalty. CMS says it is completing roughly 200 comprehensive reviews a month, up from 30 to 40. As of April 2023, CMS had issued 730 warning notices and 269 corrective action plan requests.
Dating to 2022, CMS has issued 15 civil monetary penalty notices, with four under review. Only one of the hospitals issued a civil monetary penalty notice is in New England. Frisbie Memorial Hospital in Rochester New Hampshire was issued a fine of $102,660 in April 2023 for violations dating back to October 2022. The penalty is based on both the number of hospital beds and the period of time the violations were ongoing.
The Connecticut Hospital Association (CHA) disputed the findings of PRA’s report, saying it does not “line up with the assessment of regulators.”
“CMS is the only arbiter of hospital price transparency compliance. Connecticut hospitals support providing patients with the information they need to make decisions about their care and work directly with patients to avoid unanticipated patient costs.” CHA told Inside Investigator. “Connecticut leads the nation in financial assistance programs and protections against medical debt – including transparency initiatives focused on making sure patients know about costs and financial assistance policies, ensuring assistance is applied to all those who are eligible, and connecting eligible, uninsured patients with a regular source of health insurance coverage.”
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