More than half of hospitals still not fully compliant with price transparency rules: report

Dive Brief:

• The number of hospitals complying with price transparency rules is increasing. But more than half of facilities still aren’t posting full information about the cost of their services, according to the latest analysis from PatientRightsAdvocate.org.
• About 51% of U.S. hospitals aren’t fully complying with the rules, despite them taking effect more than half a decade ago, according to the patient advocacy group’s latest scorecard of 2,000 hospitals.
• Still, the roughly 49% of hospitals in compliance is up significantly from the last time PRA analyzed the industry in 2024, and is the highest rate since the group began tracking the issue in 2021. PRA chalked the improvement up to regulators stepping up enforcement.

Dive Insight:

The first Trump administration issued a number of price transparency rules meant to help patients shop for care and drive down medical costs, including one targeting hospitals that went into effect in 2021.

Under the rule, hospitals are required to publicly post their prices in two ways: a machine-readable file of standard changes, including gross prices, payer-specific negotiated rates and discounted cash prices; and prices for the 300 most common shoppable services.

Regulators thought that visibility into prices would spur a more competitive and efficient market for medical treatment. But compliance has been shoddy, with hospitals pointing to the steep upfront investment, ongoing maintenance and technical complexity of sharing the data.

Republicans and some researchers have blamed the Biden administration for being too lax with hospitals not complying with the rules. Since taking the reins over a year and a half ago, the Trump administration has doubled down on price transparency, tightening what hospitals must display and heightening enforcement.

The CMS has now fined 28 hospitals for failing to comply, up from 15 at the time of PRA’s last report in November 2024. In June, the agency issued warnings to more than 500 hospitals, including requests for corrective action. Hospitals that don’t come into compliance could face fines of up to $2 million per year.

Heightened enforcement has helped bring more hospitals into line, PRA said. Nationwide, 988 of the 2,000 hospitals analyzed were fully compliant, up 28% from the previous report. 

But there’s still significant room for improvement, the group said. More than 1,000 hospitals are noncompliant, posting files that are missing data or include information neither machine-readable nor in CMS’ required format.

Moreover, even the compliant hospitals are sidestepping true transparency, posting vague algorithms instead of actual dollars-and-cents pricing information, PRA said.

Of the compliant facilities, only 360, or about 18%, actually posted dollar-and-cents prices for at least half of the items and services in their files, according to PRA. That’s allowed under current regulations, but limits consumers’ ability to easily compare the cost of care across different hospitals.

PRA called on the CMS to consider crafting additional guidance specifying what type of information hospitals need to disclose.

“CMS has made progress enforcing its hospital transparency rules, but this report shows that most hospitals still owe patients clear, usable dollars-and-cents prices they can look up before receiving care,” Cynthia Fisher, the founder and chairman of PRA, said in a statement.

For example, 85% of HCA Healthcare’s hospitals were fully compliant with the price transparency rules, but none met PRA’s criteria for publishing dollar-and-cents pricing data, according to the report. Seventy-three percent of CommonSpirit Health’s hospitals were fully compliant, but only about one-fourth met the price sufficiency rating.

Meanwhile, no hospitals owned by Bon Secours Mercy Health, Ochsner Health and ScionHealth were fully compliant with the rules.

There’s some interest in Congress for tightening price transparency, with senators introducing a bill last year, called the Patients Deserve Price Tags Act, which would codify the price transparency regulations into law and expand the types of providers subject to the disclosures.