Only 21 of 51 (41%) Georgia hospitals reviewed by Patient Advocate (PRA) were fully complying with the federal Hospital Price Transparency Rule as of the latest report from the Patients Rights Advocate organization.
PRA’s report published this month found compliance among hospitals in Georgia is up 1% since the last report, released in February. Part of that increase is from enforcement through fines.
The rule, which has been in effect for four years, requires all hospitals in the United States to publish on their website a machine-readable pricing file for every item and service the hospital offers down to the Band-Aid, PRA Director of Research Ilaria Santangelo said.
The American Hospital Association sued to keep their prices hidden, she said, but the courts ruled in consumers’ favor and required hospitals to post their prices. Now, all negotiated rates, insurer negotiated rates by payer and plan, including the discounted cash price, are required to be made public so customers can see what a colonoscopy is going to charge you for your Aetna PPO plan or what that same colonoscopy would cost if you paid cash, Santangelo said.
The Centers for Medicare and Medicaid Services (CMS) recently lowered the transparency standards, which includes the option to omit actual dollars and cents pricing, meaning that, effective July 1 this year, hospitals are allowed to post percentages in algorithms instead of actual dollars and cents pricing, and beginning Jan. 1, they’re going to be allowed to post estimates instead of actual dollars and cents pricing, Santangelo said.
“This is really unfortunate because it’s just a way to further obfuscate the actual prices of these items and services upfront,” she said.
CMS is the sole arbitrator of compliance, but, in almost four years, the agency has only issued 15 civil monetary penalties for noncompliance, and PRA is finding a much higher percentage of noncompliance amongst hospitals.
“Enforcement works,” Santangelo said. “CMS fined two hospitals in Georgia, and within two weeks, these hospitals came into full compliance and posted exemplary files. So? So enforcement works. It can be done. We’ve seen it work.”
The argument made by some hospitals that transparency is too difficult or complicated is invalid, she said, because the ability to send a bill directly after a procedure shows that negotiations are done upfront for items and services.
Non-emergent care, which is about 90% of health care services, is shoppable, Santangelo said.
“We see compliant hospitals posting dollars and cents pricing by payer and plan for their items and services,” Santangelo said. “So, hospitals can do this. It is being done.”
The Patients Rights Advocate website has a hospital price files finder by state with every single hospital that’s required to post their machine-readable pricing file.
“Having some information is better than having no information at all, right?” Santangelo said. “We use these machine-readable files to provide remedy and recourse for patients that, you know, have had a surprise or potentially fraudulent bill come in the mail. It’s it just gives them, you know, an opportunity to to try and shop or even file a medical bill.”
This story comes to The Georgia Sun through a reporting partnership with GPB a non-profit newsroom focused on reporting in Georgia.
