(The Center Square) – As federal price transparency requirements for hospitals remain in effect and Virginia lawmakers worked to codify the rules into state law, hospitals and a patient advocacy group are disputing whether the commonwealth’s hospitals are in compliance.
According to the Centers for Medicare & Medicaid Services guidance, hospitals must provide a comprehensive machine-readable file with items and services and a display of shoppable services in a consumer-friendly format. A hospital can use a price estimator tool instead of a display of shoppable items if the tool complies with certain federal guidelines. The federal rules have been in effect for more than a year and Virginia lawmakers voted to codify these standards into state law by July of next year.
Last month, the Virginia Hospital and Healthcare Association unveiled an online tool, which allows patients to access price information from hospitals. The tool directs users to price estimators, files for shoppable services, standard charges and a listing of machine-readable files for hospitals. The tool is designed to allow patients to more easily navigate information that has already been published on hospitals’ websites.
According to the VHHA, the tool helps further price transparency in the commonwealth.
“Virginia hospitals and health systems have long taken steps to promote transparency and enhance public understanding of the health care delivery system in Virginia,” VHHA spokesperson Julian Walker told The Center Square. “One example of that is the recently published Virginia Hospital Price Transparency and Financial Assistance Policies Tool. VHHA published this tool, which pulls together existing hospital information resources available to patients, in one central location. This online resource includes links to hospital price estimator tools; hospital files of 300 shoppable services in lieu of a price estimate tool; a listing of hospitals’ machine-readable files that describe items and services, standard charges, and more.”
Although VHHA has stated that hospitals are complying, a patients advocacy group called PatientRightsAdvocate.org is alleging that the vast majority are not fully compliant. The group surveyed 45 hospitals in a new report and only found nine to be fully compliant with the federal standards.
“[The VHHA tool is] a baby step forward for transparency,” Cynthia Fisher, the founder and chairman of PRA told The Center Square.
Fisher alleged many hospitals are “gaming the compliance” by issuing machine-readable files that are missing “large swaths of pricing data.” She said many hospitals also neglect to identify information based on specific insurance plans.
“Every day a patient can’t get a price, hospitals are harming patients,” Fisher added.
To date, only two hospitals in the country received fines for failing to comply with the federal price transparency standards, both of which were in Georgia. Northside Hospital Atlanta was fined $883,180 and Northside Hospital Cherokee was fined $214,320. After being issued fines, both hospitals reformed their price transparency policies and PRA has recognized both as compliant.