94% of Hospitals Aren’t Compliant with Price Transparency Rule

A recent report found that 94 percent of hospitals are not fully compliant with the CMS’s Hospital Price Transparency Rule, which requires US hospitals to make their standard prices available to the public.

According to the report, the majority of hospitals are not yet prioritizing compliance, which is, among other things, a missed business opportunity. In this post, we’ll take a look at a couple of key takeaways from the report and highlight some ways compliance could benefit your institution.

Noncompliance Can Hurt a Hospital’s Reputation 

Right now, the cost of noncompliance fees is minimal – just $300 per day per hospital, or less than $110,000 a year, according to estimates made by the Department of Health and Human Services. Maybe not as insignificant to a small rural hospital as it is to a large urban facility, but still not the kind of eye-popping number that would force compliance to be a top priority.

But there may be hidden costs. A damaged reputation, for example, can hurt your bottom line more than noncompliance fees.


The report offers one example. It published a list of the 500 hospitals it surveyed, along with their compliance status. Of these, 472 were non compliant. The 28 that were in compliance were highlighted prominently – a great look for those institutions.

This got a lot of attention from media outlets, from the Washington Post and Mercury News to WFLA in Florida and WMTW in Maine.

As more and more consumers become aware of the Hospital Price Transparency Rule and learn which hospitals in their communities are and are not complying, they may very well turn to compliant hospitals (i.e., those with published prices), either so they can plan financially for care or simply because those institutions appear to be more trustworthy.

In a country where one in three families forgo medical care due to the cost, noncompliance may work against hospitals.

At the same time, showing that your prices are competitive with other local hospitals can help your bottom line and encourage patients to seek out your institution, particularly for elective services and screenings.

It’s also worth noting that patient advocate groups and the US government are calling for increased noncompliance fees of up to $2 million per year. We’ll keep you posted as news develops.

Partially Compliant Is Still Noncompliant

Many noncompliant hospitals were partially compliant: they made some effort to publish their prices but they did not meet all of the transparency rule’s guidelines.

Remember, the rule requires hospitals to make two types of information available to the public on their websites:

  1. A list of standard charges for all items and services – for all payer plans – in a machine-readable format that meets the five required criteria; and 
  2. A user-friendly display, such as a standard charge list or price estimator tool, for 300 of the most common shoppable services, including 70 required services.

The report determined that a hospital was noncompliant if one or more of the following was true:

  • One or more of the five required charge criteria were not met.
  • There was missing information in the data fields.
  • Negotiated payer rates were missing.
  • The user-friendly display did not show both negotiated rates and discounted cash prices.

The report indicates that 94.4 percent of the surveyed hospitals were noncompliant because they “did not post a complete machine-readable file.” Notably, more than 80 percent of surveyed hospitals missed this mark because they did not clearly match negotiated charges with the names of the third-party payer and plan.

Many hospitals (75.6 percent) attempted to post a user-friendly tool for the shoppable services, but they were still found noncompliant because they did not display all of the required information. For example, nearly 11 percent of hospitals with a shoppable services tool failed to allow users to view the discounted cash price.

View Your Hospital’s Compliance Score

In order to protect your reputation and your bottom line, it’s important to make sure you are fully compliant with the CMS rule.

We can help.

First, you can view your institution’s compliance score, which gauges compliance based on compliance metrics laid out by CMS. To view your compliance score, send us a message. We’ll get back to you within 24 hours.

Second, we can show you multiple views of your data (thanks to our analytics capabilities powered by Google Looker) so you can verify that what you’ve published is accurate. Our user-friendly display makes the information easier to process (and mistakes easier to find and correct).

Some hospitals have noted that the views and visualizations that we provide of their own data are better than what their own IT department currently offer.

We can also provide you with a view that shows your competitors’ pricing data, which can be helpful when it comes to negotiating your own prices with payers and confirming you are in line with local market rates.

If you’d like to learn more about achieving compliance or using our pricing transparency tool, don’t hesitate to reach out. We look forward to finding a solution that meets your needs.