More than six months after the federal hospital price transparency rule went into effect, few facilities are fully compliant. Last week, The Washington Post published a report by advocacy group Patients Rights Advocate that showed only 28 of a random sample of 500 hospitals, or 5.6%, had complied with all of the transparency rule’s requirements.
The overwhelming majority were noncompliant and included some of the most prominent health systems in the country — NewYork Presbyterian, Cedars-Sinai Medical Center, Rush University Medical Center, Geisinger Medical Center and Intermountain Medical Center.
But, the 28 compliant facilities include large, well-resourced organizations, regional health systems and independent hospitals from all over the country. This indicates that size and location have little to do with the likelihood of complying with the rule. For a full list of compliant and non-compliant hospitals, click here.
Interviews with a few of the compliant hospitals revealed some commonalities: they started early, worked closely with technology vendors and persevered through the challenges that arose.
The rule states that hospitals must publically share the prices they negotiate with payers for at least 300 common services and items, such as MRI scans and kidney function panel tests. Hospitals are required to present the prices in two ways: as a machine-readable file with all items and services and a display of shoppable services in a consumer-friendly format.
For most of the organizations that spoke with MedCity News, finding the right technology partner and starting on efforts early were essential for ensuring compliance.
Cheyenne Regional Medical Center, a 206-bed hospital in Wyoming, started working to comply with the rule in 2019 after the proposed rule was published, said Christy Craig, the hospital’s assistant compliance officer, in an email.
“The most important step for our organization was selecting a software vendor that would meet all compliance requirements for this regulation,” she said.
The hospital worked with Health Catalyst to gather payer contract information, claim submission files and reimbursement files, and then compiled them for publication.
Both Memphis, Tennessee-based Baptist Memorial Health Care, which includes 21 affiliate hospitals, and Mass General Brigham in Boston, which is comprised of 14 hospitals, leaned on their existing Epic systems.
Baptist Memorial Health Care used a capability provided by Epic to pull together data from various sources including the health system’s chargemaster, said Ron Wachsman, vice president of revenue cycle, in a phone interview. The health system gathered a wide range of data, from patient accounting information to payer contract data.
Once the data was collected, the health system worked with Epic to assimilate and audit the data.
“We literally had millions of rows of data,” Wachsman said. “So if you think of all the different prices and our chargemaster, times the number of hospitals, times the number of contracts, it really got to be a huge project.”
Similarly, Mass General Brigham designed a technology solution around its Epic system, said Mary Beth Remorenko, vice president of revenue cycle operations, in an email.
“That work included identification of machine-readable file components, utilization of a consultant to build the big machine-readable file, adding all contracts to [the] Epic contract module to enable output of contracted rates by payer and significantly expanding the templates for our online patient estimates,” she said.
The health system also started working on its price transparency efforts early — before the proposed federal rule was released, in fact.
“When the requirements for the big file were released in 2020, we incorporated it into our plan,” Remorenko said. “While we were aware of the American Hospital Association lawsuit [which ultimately failed], we didn’t pause our implementation and wait for court rulings as some did.”
Despite the early start and technical support from vendors, ensuring compliance with the rule was not an easy task.
For Baptist Memorial Health Care, bringing together the different skill sets necessary within its internal team posed the biggest challenge, Vice President of Revenue Cycle Wachsman said.
Compliance involved working with a vast amount of data and auditing, as well as setting up the mandated machine-readable files and displaying shoppable services in a way that would make sense to consumers.
So, the health system had to draw on the expertise of people working in its IT, managed care, decision support and analytics, business office and registration divisions to achieve compliance, he said.
Mass General Brigham’s Remorenko echoed similar hurdles: the technology required to build and post the big file, which was advanced and beyond the scope of its in-house team, the additional internal and external resources needed and the level of subject matter expertise required to interpret some of the more generic aspects of the rules.
There was also the issue of the timing, she said. Healthcare facilities needed to work on price transparency efforts as the Covid-19 pandemic ravaged their resources.
“I think our internal commitment to this work and ability to partner with Epic and others contributed to our compliance,” Remorenko said.
But this type of commitment to price transparency appears to be rare among U.S. health systems. As a result, the government is taking a harder stance on enforcement. In a new rule announced three days after the Washington Post published the report, the Centers for Medicare & Medicaid Services proposed stringent penalties for non-compliance: fines ranging from $109,500 to $2 million per hospital per year.
Whether this will be enough to drive up compliance remains to be seen.
Photo: adventtr, Getty Images