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Hospitals are not complying with price transparency rule, two studies find

June 22, 2021 / Susan Morse, Managing Editor

Recent studies published in the Journal of the American Medical Association and the American Journal of Managed Care show that most of the hospitals sampled are not complying with the January 1 mandate to post their negotiated rates with payers.

JAMA‘s report analyzed 200 samples. First they took a look at a random sample of 100 hospitals and then also analyzed the 100 hospitals with the highest grossing revenue in 2017. 

Of 100 random hospitals, 83 were noncompliant with at least one major requirement, the authors of the June 14 report said. Only 33 reported payer-specific negotiated rates and 30 reported discounted cash prices in a machine readable file. 

A total of 52 hospitals offered a price estimator tool for the required 300 shoppable services, of which 23 posted payer-specific negotiated rates in a machine readable file. All price estimator tools required personal health plan information while discounted cash prices did not.

Of the 100 highest revenue hospitals in the JAMA study, 75 were noncompliant with at least one requirement. Thirty five reported payer-specific negotiated rates and 40 reported discounted cash prices in a machine readable file. A total of 86 offered a price estimator tool, of which 34 posted payer-specific negotiated rates in a machine-readable file.

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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