FAH Hospital Policy Blog

Perspectives on health policy affecting America's hospitals and the patients we serve.

Transparency | FAH Policy Blog Team

Cooperation is key to achieving price transparency, helping patients understand costs

Hospitals are working very hard to ease the anxiety that comes with medical bills by making sure patients understand their out-of-pocket costs before getting care.

We believe that everyone deserves transparent, easy to understand information explaining their cost sharing responsibility so you can make more informed decisions on your health care. You should know what is covered by your insurance plan – or more concerning, what isn’t covered.

New regulations from CMS are pushing these efforts forward as well – making even more pricing information available for patients.

The price transparency regulation that went into effect at the beginning of 2021 requires that all hospitals list “shoppable services” online through patient payment estimators. For years FAH members have been working to perfect these tools to help people understand the real cost of their care. And thanks to an increased amount of data available, these tools are becoming more accurate.

The second part of the CMS regulation is more vague, less helpful, and confusing to patients. It requires hospitals to make available large, machine-readable files of all the rates negotiated with insurance companies. It is a complex, costly process for care providers and, the truth is, it does little to help patients get what they want most – an accurate estimate of what they will have to pay out-of-pocket.

Despite these challenges, hospitals are acting in good faith to abide by these new rules.

This is a fact being ignored by some outside, dark-money groups who have made up their own standards of compliance – standards that have wide ranging and misguided results.

One group, Patient Rights Advocate, claims only 16% of hospitals are compliant. In contrast, analysis by the consulting firm Milliman found a compliance rate of 68%. Both are far lower than what CMS has found in its review. The problem is these groups used vastly different standards for analysis to reach their vastly different and misleading results. In fact, the group who found lower compliance rates used skewed methodology.  They deemed a hospital non-compliant if just one of the hundreds of data fields was left blank. This leads to inaccurate results that only further confuses patients and misrepresents the true actions of hospitals.

The fact of the matter is that CMS is the true arbiter of a hospital’s compliance. The agency has been auditing hospital data and investigating complaints for more than a year, and at last check it found only 160 hospitals not complying – a small fraction of the thousands of facilities nationwide, and much smaller than the outside groups found in their analysis.

It’s time for these groups to stop misleading patients and placing false blame on health care providers. Hospitals remain committed to helping patients know their out-of-pocket costs before treatment and will continue working with CMS to achieve this goal.