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Hospital Pricing Transparency: Are Comparisons Now Possible?

Price Transparency Rule

As this blog previously addressed, the price disclosure requirement issued by the Department of Health and Human Services emanated from the Affordable Care Act and requires hospitals to post price information on the internet in a machine-readable format. Starting on January 1, 2019 this became an affirmative obligation for hospitals.

The reaction so far is that the rules are a positive initial step toward price comparisons but with many more changes required to reach that capability.

The majority of information posted by the hospitals is in a non-universal format utilizing many abbreviations that are unclear and are quoting prices that are in effect “list’ prices for services.  As such, patients are unable to compare apples to apples.

If the true intent was disclosure to the public, that goal is a long way away.  Price comparisons between hospitals can’t presently be performed, as the cost of each procedure is particular to each patient. For many, the calculation of bottom line cost is reliant upon the level of insurance reimbursement for that procedure at that particular institution, as well as a patient’s deductible or in-network status. For the majority of the public, without standardized procedure descriptions and a method to apply the listed cost to that person’s insurance, the possibility of cost comparisons is a hope for the future.

There are currently no enforcement mechanisms if a hospital does not comply with the disclosure requirement.

The positive news is that this disclosure requirement may prompt dialogue between patients and hospitals and may eventually lead to a patient’s ability to actually compare cost of services at different hospitals prior to agreeing to a procedure.

If you have any questions about this post or any related matters, please contact me at dladelson@norris-law.com.