Many Hospitals Still Not Obeying Federal Price Disclosure Rules, Survey Says

This article has been updated with additional comment from hospitals.

Many hospitals nationwide – and in Oregon – continue to fall short on a federal mandate to fully disclose prices to patients on their websites, a nonprofit said.

The organization, PatientRightsAdvocate.org, during the course of last year and early this year, spot-checked 1,000 randomly selected hospitals among the more than 6,000 accredited hospitals nationwide. It found that 14% of hospitals had websites that complied with the federal rules, according to its report.

But local hospitals say the findings are off base.

The group said it examined the websites of 11 Oregon hospitals, of which three — Oregon Health & Science University, PeaceHealth Sacred Heart at RiverBend in Springfield, and St. Anthony Hospital in Pendleton — were compliant.

The websites of the others — Asante Rogue Regional Medical Center in Medford; Kaiser Permanente Sunnyside Medical Center in Portland, Legacy Emanuel Medical Center in Portland, Mercy Medical Center in Roseburg, Providence Portland Medical Center, Providence St. Vincent Medical Center in Portland, Salem Hospital, and St. Charles Medical Center in Bend — were not, the group said.

Some hospitals have conceded their websites don’t fully comply with the federal requirements. But other hospitals have said their websites follow the law and that criticisms by PatientRightsAdvocate.org are off the mark.

“We are following federal regulations. We are not sure this patient advocacy group is using the same requirements to make their determination,” said Lisa Goodman, a spokesperson for St. Charles.

Michael Foley, a spokesperson for Kaiser Permanente, said the group “erroneously categorized Kaiser Permanente as non-compliant for elements that should be deemed as non-applicable.”

Lisa Wood, a spokesperson for Salem Health, similarly said the group got it wrong. “Salem Health has fully participated in the price transparency process, working with a third-party vendor to ensure that we are conforming to the new CMS rules. We value transparency and recognize that health care costs are too complicated.” 

But she said that in the wake of the report, the health system has tweaked its reporting to make its compliance more clear. “We appreciate the feedback from Patient Rights Advocate and have made some changes to make the data easier to understand,” Wood added.

The most typical shortcoming was hospitals failing to post all the prices they had negotiated for services and procedures with all the health insurance plans they accepted, said the nonprofit.

A spokesperson for the Oregon Association of Hospitals and Health Systems, Dave Northfield, told The Lund Report that the federal “reporting requirements are very specific and complicated by the fact that many hospitals are tracking up to 15 different insurers. Hospitals have been under real stress caring for patients during the pandemic and adding another administrative burden is not what they should be focused on. Oregon’s hospitals have a long history of working with consumers to help them understand how best to access the right care at the right time. We also created the Oregon Hospital Guide, an interactive database that makes cost information accessible for dozens of the most common procedures.”

Providence “is in the process of posting negotiated rates,” said Providence Oregon spokesperson Gary Walker. “Price transparency is an essential component to improving health care in the U.S., and we’re working toward compliance with the federal transparency rule,” he said.

Providence already posts copious amounts of price data, he said. It has long provided customized out-of-pocket estimates for patients and recently launched an online price estimator for 300 common procedures to make the process self-serve, he said.

The federal price disclosure law took effect Jan. 1, 2021.

“Unfortunately, the vast majority of hospitals remain noncompliant after more than a year has passed since the Hospital Price Transparency rule took effect. Hospitals’ omission of price information in advance of care blocks consumers from benefiting from knowing the competition, seeking fair and equitable prices, and having the choice to lower their costs,” said Cynthia Fisher, founder and chairman of PatientsRightsAdvocate.org.

Compliance has improved since last year, when a PatientsRightsAdvocate.org survey found just 5% of hospitals were compliant. 

For individual consumers, the new, federally mandated pricing disclosures — heavy with obscure medical terminology, procedural codes, abbreviations and caveats that some major costs are not included — highlight the difficulty of figuring out how much it will cost out of pocket for a procedure at a specific hospital, let alone comparing prices among different hospitals.

The disclosures, mandated in a rule issued by the Trump administration in 2019, were a bid to let market forces dampen the dizzying rise in health care costs, according to the federal Centers for Medicare & Medicaid Services.

Under the rule, hospital websites typically list many hundreds of procedures and their costs in excruciating detail, including many variations on a single type of procedure, with each variation carrying a different price.

For a patient, zeroing in on the exact services they will get, the prices their insurer has negotiated and their out-of-pocket expenses can be very difficult. Even then, the websites carry warnings that the quoted prices are simply unguaranteed estimates and may not include a number of big additional costs, such as paying for the surgeon, anesthesiologist or radiologist, who typically are not hospital employees and bill separately.

You can reach Christian Wihtol at [email protected].

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Comments

More proof that those who advocate that health care prices are best controlled by the market are not being serious - since they cannot themselves figure what the prices are.

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