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As of early June, CMS had issued 352 warning notices to hospitals and 157 corrective action plan requests, the agency said in an email. More than 170 hospitals have received case closure notices, meaning issues have been resolved.
Meanwhile, some states have implemented laws. Colorado, for instance, has banned hospitals from using debt collection agencies if they don’t follow the price transparency law. Texas implemented a law last year that layers state-administered fines on top of the federal penalties.
“You could increase the penalties, and they don’t have to just be financial, they could be tied to accreditation or bonus payments,” said Michael Lutz, a senior consultant at Avalere Health. “But I am not a fan of that approach because I think we should be building relationships rather than penalizing stakeholders. I am skeptical a lot of behavior is going to change until consumers have access to appropriate and detailed-enough tools and use them.”
Over the last several months, an increasing number of hospitals have posted more of their data online, even if it doesn’t satisfy the law, said Kelly Arduino, healthcare leader at the accounting and consulting firm Wipfli.
“States are being more threatening around penalties, and I think that is what is going to move the needle,” she said.
Many hospitals still hope the law will go away, said Eric Hargan, former deputy secretary of Health and Human Services and company advisor for Amino Health, which offers price transparency software.
“But, with the majority of hospitals not complying, the penalties and fines may continue to be increased by the department until hospitals can’t afford to simply not comply anymore,” he said in an email.
The researchers compared the size, revenue, market concentration, ownership and service lines across hospitals to better determine which hospitals are complying and which are not. Hospitals with relatively lower revenue per patient-day, in markets with a lower hospital concentration, and those in urban areas, were more likely to be transparent, they found.
“It would make sense that urban hospitals are more likely to comply because they likely have more IT capacity,” said Morgan Henderson, principal data scientist at the Hilltop Institute at the University of Maryland. “Perhaps a hospital with a lot of market share doesn’t feel the need to comply because there are fewer competitors.”
Regulators and health policy experts believe that once third parties aggregate pricing data across all U.S. hospitals, consumers will force high-priced providers to adjust. But there is some skepticism in the current iteration of the law that the data will be valuable to consumers.
“This (law) is not currently a particularly good way of accomplishing that (consumerism) aim,” Henderson said. “Consumer cost-sharing varies based on what plan they have, and this price transparency data doesn’t touch on that at all.”
Hospital executives are concerned about the administrative work required to set up the database, their rivals undercutting them on publicly disclosed prices and the legal ramifications if a patient bill doesn’t match the data. Low compliance levels have illustrated that some hospitals don’t have a grasp of their rates and reimbursement structure, industry observers said.
“Part of the hope is that the employers and payers designing coverage networks get more insight into why their spending is high,” said Lovisa Gustafsson, vice president of the Commonwealth Fund’s controlling healthcare costs program. “Employers and payers could push for more narrow networks that prioritize high-value, lower-cost providers.”
The price transparency law for insurers, which takes effect next month, could lay more of the groundwork of how to best disseminate and analyze the data, experts said.
“CMS offered much more guidance about the exact structure of the data files for the insurer price transparency law, which could offer a good model going forward,” Henderson said.
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