A new report fromPatient Rights Advocate suggests that only 55% of North Carolina hospitals are fully in compliance with the federal hospital price transparency rule.
The law went into effect in January 2021 and is enforced by the Centers for Medicare & Medicaid (CMS). It requires price transparency from hospitals across the country.
“We find only 25% of the largest hospitals in the country are in full compliance with the law,” said Cynthia Fisher, founder of PatientRightsAdvocate.org.
The law requires that hospitals provide “clear and accessible” pricing information through a machine-readable file with all items and services, and a consumer-friendly platform allowing patients to see prices of procedures.
“This price transparency from hospitals is so transformative it will revolutionize the healthcare industry because it shifts the power to the consumer, the patients, the employers,” Fisher said.
Patient Rights Adovocate's hospital price transparency report lists several North Carolina hospitals it says are out of compliance, including Mission Health and AdventHealth Hendersonville.
“When we pull back the curtains and shine the light and see prices, it gives power to the consumer to be able to shop for healthcare in advance of care and it also helps prevent overcharges and erroneous billing,” Fisher said.
A spokesperson for AdventHealth sent News 13 the following statement regarding the online report:
"AdventHealth is committed to price transparency and providing information to consumers that will help them make informed decisions before receiving elective services. We provide an online price estimator tool for consumers to calculate their out-of-pocket costs for shoppable services. In addition, as required by the CMS Price Transparency Rules, we have published a machine-readable file online containing payer-negotiated rates for all payers and plans for AdventHealth Hendersonville."
A spokesperson for HCA Healthcare sent News 13 the following statement regarding the report:
"As you likely know, CMS is the agency that determines compliance with the federal regulations and CMS lists on its website hospitals that have been fined for non-compliance. Our hospitals implemented the federal requirements in January 2021. Since then our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured. In addition, we have posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of “standard charges” which can be found here.”
A spokesperson for CMS said they do not release the names or status of hospitals until after a civil monetary penalty has been issued. As of February 2023, CMS has issued nearly 500 warning notices to hospitals found to be out of compliance with hospital price transparency regulations.