Study: More than half of U.S. hospitals don't follow pricing disclosure rules

Dec. 9 (UPI) -- More than half of all hospitals in the United States did not comply with new pricing disclosure rules in the first five months since they were implemented, a study published Thursday by the Journal of General Internal Medicine found.

The rules require hospitals to publicly disclose prices for care found wide fluctuations across states, with some states achieving 75% or higher compliance and others coming in at 25% or below, the data showed.


Across all 50 states, 55% of hospitals did not comply with the new federal rule that went into effect on Jan. 1, the researchers said.

"The findings suggest that hospitals do not make decisions in isolation. Rather, their decisions reflect market pressure from their peers," study co-author Ge Bai said in a press release.

"If the average compliance status in the same region is high, a hospital is more likely to comply," said Bai, a professor of health policy and management at the Johns Hopkins Bloomberg School of Public Health in Baltimore.


The Hospital Price Transparency Rule, which is enforced by the Centers for Medicare and Medicaid Services, requires hospitals to provide clear pricing information online about services provided.

The information must be posted in a machine-readable file format that can be imported or read into a computer system, the agency says.

Hospitals also must include standard pricing for at least 300 services, ranging from colonoscopies to CAT scans, though they not required to disclose prices for emergency services.

The rule is intended to allow consumers to compare prices and estimated cost of services. Bai and her colleagues said it also could help patients make more informed decisions about care and potentially drive down costs through competition.

Non-compliant hospitals can face steep penalties of up to $2 million a year, according to the Centers for Medicare and Medicaid Services.

For this study, the researchers ranked publicly available Hospital Price Transparency Rule compliance information for all 50 states, Washington, D.C., and 305 geographic regions in the United States.

The researchers based their analysis on files from more than 3,500 U.S. hospitals in the first five months of 2021, from Jan. 1 through June 1.

Using data from Turquoise Health, a data service company that collects hospital pricing information, the team analyzed a nationally representative sample of machine-readable files from 3,558 general acute hospitals, or 88% of such hospitals nationally.


Hospitals were categorized based on "compliance," or a hospital that posted a machine-readable file with negotiated prices for at least one health insurance plan, and "non-compliance," or a hospital that had not posted a machine-readable file and no negotiated prices.

At least 75% of hospitals were compliant with the Hospital Price Transparency Rule in Hawaii, Rhode Island, Indiana, Michigan and Washington, D.C., the data showed.

But, at most, 25% of hospitals were compliant with the rule in Delaware, Maryland, Washington and Louisiana.

Additionally, a hospital was 42% more likely to be compliant with the Hospital Price Transparency Rule if all other hospitals in the same geographic region were compliant as well.

Within the country's 305 referral regions, in 194, or 64%, more than half of hospitals were not compliant with the new disclosure requirement, the data showed.

All hospitals in 20 referral regions, including those in Arizona, Connecticut, Georgia, Illinois, Indiana, Kentucky, Michigan, North Carolina, New Jersey, Pennsylvania, Tennessee and Virginia, were compliant with the rule.

However, all hospitals in 26 regions, including regions in Arkansas, California, Delaware, Florida, Iowa, Illinois, Louisiana, Maryland, Mississippi, Ohio, South Carolina, Texas, Virginia and West Virginia, were non-compliant with the Hospital Price Transparency Rule.


A hospital's health information technology preparedness, defined as the proportion of its fixed assets devoted to health IT, is also associated with greater compliance, as were for-profit hospitals, system-affiliated hospitals and non-urban hospitals, according to the researchers.

"Interestingly, hospitals that have invested more in health IT are more likely to post their pricing information online," Bai said.

"This could be because they have more financial resources and personnel to mitigate the cost for implementing the Price Transparency Rule," she said.

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