Patient rights group: Work to be done with price transparency law compliance
In January 2021, a federal law was passed requiring all hospitals to post their pricing online, but according to a new report issued by a patient advocacy group earlier this month, only 16% of the 2,000 hospitals reviewed are fully compliant.
According to the third semi-annual report, Utah is doing pretty well at complying with the law. However, several hospitals are still deemed noncompliant by the group because much of the pricing data provided, it said, was missing or incomplete.
The hospital price transparency rule requires hospitals to post online a readable file, much like a spreadsheet, that is easy to access and includes estimated pricing for 300 of the most common procedures and services, so consumers can navigate the best deals.
“Just like going to the grocery store or booking an airline ticket or a hotel room, people have the right to shop and compare prices and they deserve to have transparency,” said Cynthia Fisher, founder of PatientRightsAdvocate.org. “People should know where they can go to get an MRI for $250 to $400 versus $3,000 and employers have the right to know where they can get the best coverage and quality of care at the best price.”
PatientRightsAdvocate.org is a nonprofit, nonpartisan organization focusing on patient and employer rights to access transparent information about hospital prices.
Fisher said 90% of hospital procedures and stays are planned, so there is no reason why people shouldn’t have the true price upfront before they go in.
“Too many people are facing financial ruin because of outrageous medical bills and hidden costs. This law gives the patients the right to be able to shop and lower their price of care and to make sure they aren’t being overcharged or fraudulently billed,” she said.
Her group lists 14 hospitals in Utah that it claims are not in compliance with the federal law, including several hospitals operated by MountainStar Healthcare, including Timpanogos Regional Hospital in Orem, Mountain View Hospital in Payson and Lone Peak Hospital in Draper.
MountainStar spokesperson Brittany Glas disputed the claim and said all of its hospitals implemented the federal requirements in January 2021.
“For nearly a year and a half, (MountainStar’s) hospital websites have included a consumer-friendly patient payment estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured,” Glas said.
That statement mirrored an earlier response issued by HCA Healthcare, MountainStar’s corporate parent.
In addition, Glas said, MountainStar has posted contracted rates with third-party payers using one of the machine-readable file formats listed in the regulations to provide the five types of standard charges. When asked for further clarification about the claims disputed by PatientRightsAdvocate.org, Glas said, “We don’t comment on a third party that doesn’t have regulatory purview over us.”
According to PatientRightsAdvocate.org, most Intermountain Healthcare hospitals in Utah are in compliance with the law, including Utah Valley Hospital, but Sanpete Valley Hospital in Mount Pleasant was flagged as noncompliant.
The Centers for Medicaid and Medicare Services determines compliance with the federal regulations. So far, only two hospitals in the nation have been fined for being noncompliant, but Fisher said more needs to be done to enforce the law and issue fines, which can add up to $2 million.
On its website, the American Hospital Association states that while CMS is the federal agency responsible for enforcing the law, some outside groups are taking the opportunity to mischaracterize what is happening in the field.
“Patient Rights Advocate, for example, claims only 14% of hospitals are compliant, while a Milliman analysis found a compliance rate of 68%,” the June 16 statement reads. “CMS, the only true arbiter, has indicated about 160 hospitals remain out of compliance, a much smaller number than either the Patient Rights Advocate or Milliman reports suggest.”
Fisher said only two hospitals in the nation have been fined so far, but that’s because of delays in enforcement by the U.S. Department of Health and Human Services. She recently wrote a letter to President Joe Biden asking that his administration move more swiftly in enforcing the law.
“There is a wide variation in the same hospitals for the same services,” Fisher said. “This is real and enforcement by fines work. We need to continue to remedy this problem and have recourse against overcharging. This law shifts the power to the patients. The hospitals didn’t want this. They sued, but they lost in the lower and appellate court.”
Fisher said she encourages the public to shop wisely and to demand prices in advance of care.
“Patients now have the right to know all prices in health care to save their own money,” she said. “They have the right to shop and avoid overcharged and hidden medical bills. Unfortunately, most of the hospitals in the country are not compliant and are disregarding the law in making it easy for patients to get easy access to better prices.”
Fisher said she encourages people to write to HHS demanding enforcement of the law.
PatientRightsAdvocate.org’s hospital compliance reports are issued every six months on its website.