Over- and underreporting of prices: most hospitals are not compliant with the Hospital Price Transparency Rule

Author:

Mead Mitchell123ORCID,Ibrahim Andrew M123ORCID

Affiliation:

1. Department of Surgery, University of Michigan , Ann Arbor, MI 48109 , United States

2. Center for Healthcare Outcomes and Policy, University of Michigan , Ann Arbor, MI 48109 , United States

3. Taubman College of Architecture and Urban Planning, University of Michigan , Ann Arbor, MI 48109 , United States

Abstract

Abstract Concern has been raised about the effectiveness of the Hospital Price Transparency Rule to facilitate a clear understanding of health care prices due to poor reporting by hospitals. However, the relationship between what services the hospital provides and what prices they report is not clear. We assessed reported prices in the Turquoise Health database and compared them at the hospital level with the CMS Provider of Services File to identify if a shoppable service was provided at a hospital. We found significant mismatch between the hospital prices being reported and the services being provided. For example, 56% of hospitals providing at least 1 shoppable service that requires public price reporting did not report any prices. Of hospitals reporting prices, most hospitals (66%) reported prices for only a portion of the services they provide. In addition, 12% of hospitals reported prices for services they do not provide. Only 6% of hospitals had complete concordance with price reporting and services they actually provide. Current compliance enforcement and penalties do not appear to be adequate to achieve the goals of the Hospital Price Transparency Rule.

Funder

Boards for Academy Health

Center for Health Design

Publisher

Oxford University Press (OUP)

Reference27 articles.

1. Medicare and Medicaid Programs: CY 2020 hospital outpatient PPS policy changes and payment rates and ambulatory surgical center payment system policy changes and payment rates. Price transparency requirements for hospitals to make standard charges public;Department of Health and Human Services;Fed Regist.,2019

2. Adherence to a federal hospital price transparency rule and associated financial and marketplace factors;Haque;JAMA,2022

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