Hospitals are supposed to make public how much they charge for various procedures. But few do, shows a study done by former SMU student, Eman Haque and other researchers.
Adherence to a Federal Hospital Price Transparency Rule and Associated Financial and Marketplace Factors
The federal Hospital Price Transparency Final Rule aims to increase health care price transparency and facilitate patient price shopping online. Hospitals are required to disclose 5 types of standard charges for all services in an accessible file and provide a consumer-friendly display for at least 300 shoppable services.1 We evaluated adherence 6 to 9 months after the final rule effective date (January 1, 2021) across all US hospitals and its association with market- and hospital-level characteristics across acute care hospitals.
We collected data on hospital characteristics and adherence to the final rule between July 1 and September 30, 2021, for all US hospitals that were registered with the Centers for Medicare & Medicaid Services and with an identifiable website.2 We collected data on whether each hospital had posted all 5 required price types (gross charges, discounted prices, payer-specific negotiated prices, and minimum and maximum negotiated prices) in a machine-readable file, and a separate accessible display or price estimator for at least 300 shoppable items. Final rule adherence required that both conditions be met. Characteristics of all hospitals were compared between nonadherent and adherent facilities by calculating standardized differences, with values greater than 0.1 considered significant. Our measure of inpatient hospital market concentration, the Herfindahl-Hirschman Index (HHI), was collected for 185 of 929 core-based statistical areas using 2019 data.3 The HHI categories include unconcentrated, moderately concentrated, and highly or very highly concentrated, with greater concentration denoting fewer hospitals accounting for a larger share of admissions within a geographic region. Examination of characteristics associated with final rule adherence was restricted to acute care hospitals because different hospital types vary in characteristics and services provided. The missing indicator method was used for hospitals without HHI data. Information on hospital revenues based on 2020 Medicare Cost Reports and number of patient-days for acute care hospitals was obtained from the American Hospital Directory.4 Logistic regression analysis included total revenue quartiles, revenue per patient-day quartiles, HHI categories, urbanicity, hospital size, emergency services, and hospital ownership as independent variables. Statistical significance was defined as a 95% CI that excluded 1. Analyses were conducted with SPSS version 23 (SPSS Inc). See the eMethods in the Supplement for additional details.
Across 5239 total hospitals, 729 (13.9%) had an adherent machine-readable file but no shoppable display, 1542 (29.4%) had an adherent shoppable display but no machine-readable file, and 300 (5.7%) had both. There were 2668 hospitals (50.9%) without an adherent machine-readable file or a shoppable display. There was a significant difference in the proportion of adherent vs nonadherent facilities that were in unconcentrated and highly or very highly concentrated markets (Table 1).
There were 2783 of 3223 acute care hospitals (86%) with available revenue data. Total gross revenue had no significant association with final rule adherence (Table 2). In contrast, being in the first quartile (lowest) of revenue per patient-day was associated with greater rates of adherence than was being in other quartiles. Compared with being in unconcentrated markets, being in a moderately concentrated one (odds ratio, 0.58; 95% CI, 0.35-0.96) and highly or very highly concentrated one (odds ratio, 0.33; 95% CI, 0.19-0.56) was associated with worse adherence. Urban vs rural location was associated with better adherence to the final rule (odds ratio, 1.86; 95% CI, 1.08-3.17). Hospital size, emergency service capabilities, and hospital ownership were not associated with adherence.