Since January 2021, hospitals have been required to list online the prices for 300 common medical services, but new research has found that only 32% of hospitals have been fully compliant when it comes to knee and hip replacements.
"Although pricing information was generally available, it frequently did not meet requirements established by the [government] and was oftentimes difficult to access," said study author Dr. Atul Kamath, of the Cleveland Clinic Foundation. Kamath spoke in a news release from the journal Clinical Orthopaedics and Related Research, where the findings were published.
Under the Hospital Price Transparency Rule, the U.S. Centers for Medicare and Medicaid Services requires hospitals to provide five types of online price information for selected services. These are the total charge, the charges the hospital privately negotiated with insurers, the minimum and maximum negotiated charges, and the amount the hospital is willing to accept in cash.
Services must also be identifiable by any billing code the hospital uses. The information must be available in a machine-readable file and free of charge. No personal identifying information should be required for access.
The researchers chose knee and hip replacements for their search because the procedures are widely used, expensive and generally predictable in terms of cost.
They sampled 400 hospitals between Dec. 1 and Dec. 20, 2021. Only about 21% of hospitals provided all five types of information on knee replacements and 18% of hospitals for hip replacement.
About 36% of hospitals provided information on the total charge for knee replacement and 31% for hip replacement. About 13% of hospitals violated the rule by not providing machine-readable files. About 21% violated it by requiring users to provide personal information.
The research team noted that, though not required, the hospital websites also lacked consumer friendliness. Only 5% of websites provided price information in a language other than English. Only 33% of websites offered a phone number to call for assistance.
The researchers spent more than 15 minutes trying to find information on 17% of websites. About 6% of websites provided files that were very large in nontraditional formats that required additional software to read. About 4% of websites did not allow searches by keyword, procedure code or diagnostic code.
"It is possible that hospitals have delayed compliance with the hope that related requirements may change or that current delays in enforcement may continue," the researchers said in the release.
CMS has begun issuing penalties to hospitals for noncompliance. On June 7, they announced the first two such penalties. Penalties will range from $300 to $5,500 per day, depending on hospital size.
Healthcare.gov has more on health insurance.
SOURCE: Clinical Orthopaedics and Related Research, news release, June 24, 2022