Patient Rights Advocate

PwC is projecting an 8% year-on-year medical cost trend in 2025 for the Group market and 7.5% for the Individual market, driven by inflationary pressure, prescription drug spending and behavioral health utilization. We find it encouraging that according to the survey, "[e]mployers are seeking more transparency and better reporting to understand the outcomes and effectiveness of their health plans’ cost of care management efforts... "Additionally, employers’ demand to provide better value to their employees is incentivizing health plans to ensure demonstrated outcomes (e.g., independent validation73) from their vendors."

"Fewer than one in 10 New Jersey hospitals are complying with federal rules that require them to provide patients with price transparency for their services..." Patient Rights Advocate's findings are consistent with an independent review conducted by a January Asbury Park Press report that?found Monmouth and Ocean county hospitals provided prices unevenly. And many of their files were steeped in medical jargon and difficult for consumers to understand. Of course, the New Jersey Hospital Association points to the lack of CMS fines as evidence of New Jersey hospitals' compliance. That would be akin to claiming perfect tax compliance because the IRS stopped auditing returns. The absence of enforcement doesn’t prove adherence—it only underscores the failure to hold violators accountable.

Zero hospitals reviewed owned by Ascension, AdventHealth, Kaiser Permanente, Bon Secours Mercy, and Mercy were found to be fully compliant with the hospital price transparency rules. In Colorado specifically, all Intermountain Health and AdventHealth locations in the state (14 hospitals) were shown to have failed to meet the requirements. If CMS wants to use its resources efficiently, they should consider going after these MASSIVE systems for whom the $2M is chump change (as clearly evidence by their thumbing their nose at their legal obligations). Just imagine what sort of enforcement resources they could fund with non-compliance fines in Colorado alone ($28M)... just imagine if they were willing to go after big hitter health systems around the country that are flouting the law.

"Only 15 hospitals have been fined under the price transparency laws, and a couple of those cases are under review, according to?data?from the Centers for Medicare & Medicaid Services." The American Hospital Association continues to downplay the results of this report, noting that the latest report doesn't accurately reflect hospital compliance with federal regulations. It is worth remembering that in October, the?GAO confirmed that CMS does not actually review hospital files for completeness or accuracy, instead focusing on only the most “basic reporting requirements... [as this] … represents the most effective use of agency resources.”

In June 2023, Republican State Sen.?Mary Felzkowski?of Tomahawk introduced a bill requiring price transparency by hospitals in Wisconsin. The bill’s language was?very specific, requiring hospitals to publish their standard charge for 300 “shoppable services” on their website that “must be available at all times to the public in a machine-readable format.” The legislation called for fines for non-compliance of $600 per day for the smallest hospitals States are stepping up and stepping in where the Federal Government is behind on enforcement. In Wisconsin, a bill requiring price transparency by hospitals in Wisconsin was introduced and co-sponsored by six other state senators and 18 Assembly representatives. It was backed by Wisconsin Manufacturers & Commerce, the biggest lobbyist in the state Capitol, and the conservative Wisconsin Institute for Law and Liberty. And polls show Americans overwhelmingly support hospital price transparency, with?94% in favor. But after receiving a public hearing the bill died in the Senate, where Republican leaders never allowed it to be voted on. The?Wisconsin Hospital Association?(WHA)?opposed the law, arguing that “Wisconsin hospitals are national leaders in complying with federal transparency law” and the law’s penalties are “being rigorously enforced.” But as our most recent report found, just 49% of hospitals in Wisconsin were in compliance.

We were honored to bring together esteemed professionals from around the country to speak with Senate staffers about the need for strong health care price transparency.

Thr 7th Semi-Annual Hospital Price Transparency Compliance Report is out! Our new Report finds only 21.1% of hospitals reviewed are fully compliant with the federal Price Transparency Rule. Key takeaways: Just 21% of 2,000 hospitals reviewed were in full compliance with requirements to publicly post a list of prices for common treatments and services, the report found. 34.5% of hospitals complied with the regulations in February. Nearly 450 hospitals previously found compliant with the regulations become noncompliant since the last report. All 2,000 hospitals reviewed by Patient Rights Advocate for the report posted machine-readable files, yet 532 hospitals in the sample posted files that didn't pass CMS' validation tool. 415 hospitals didn't include all payer and plan names in their files, and 231 hospitals didn't post accurate minimum and maximum negotiated charges for items and services.

Worth a listen….

If UCHealth can overbill federal programs, they can overbill patients too. This $23M settlement highlights the need for price transparency—patients deserve to see exactly what they’re paying for. Let’s ensure fair, transparent billing that serves everyone, not just those footing government contracts. Marilyn BartlettKevin Morra Chris DeaconJulie HavlakMarni Jameson CareyMarsha Simon

Patient Rights Advocate has long advocated for transparency in healthcare pricing, and a recent report from the Office of Inspector General (OIG) underscores just how much work still needs to be done. According to OIG’s findings: ? Of a sample of 100 hospitals, 37 failed to fully comply with the Hospital Price Transparency (HPT) rule. ? 34 hospitals did not publish comprehensive, machine-readable files, hindering consumers’ ability to access complete pricing data. ? 14 hospitals did not display shoppable services in a way that was consumer-friendly. From this sample, OIG estimates that 46% of the 5,879 hospitals required to follow the HPT rule have not met the standard for making their pricing information publicly accessible. Why This Matters: Without full compliance, patients continue to face obstacles to understanding their healthcare costs upfront—a basic right that supports informed choices and competitive markets. It’s critical that enforcement measures are strengthened to ensure hospitals prioritize transparency for the benefit of all patients.