While hospitals post a mixed record on complying with a major price transparency rule, the Biden administration has not announced how they are going to keep facilities in line.
Several studies and analyses have shown that larger health systems have not done a good job fully complying with the rule to post payer-negotiated rates online. The results come as the Centers for Medicare & Medicaid Services (CMS) has not announced major enforcement actions against hospitals not meeting the controversial rule’s requirements.
“So far with the current administration, we haven’t seen the agency put out any information on the auditing process or changes to the reporting requirements or changes to the penalties for noncompliance,” said Caitlin Sheetz, director and head of analytics for consulting firm ADVI, in an interview with Fierce Healthcare. “Unless that changes, I don’t think we are going to see large shifts in hospital behavior.”
The payment rule went into effect Jan. 1 and requires hospitals to publish a machine-readable file outlining their payer-negotiated payment rates and another website that should enable consumers to search for 300 shoppable medical services. The goal of the rule is to enable consumers to find the best price for shoppable procedures.
But compliance among hospitals has been mixed.
A March blog post in Health Affairs found that of 100 large hospitals analyzed, 65 were “unambiguously noncompliant.”
Of the remaining 35 hospitals, 22 appeared to be compliant, and several facilities exceeded the regulations.