But what happens when the definition of what is and what isn't transparent is somewhat murky? Judging from a new report that alleges a large number of Texas hospitals, including many in Dallas-Fort Worth, are not practicing proper transparency, it’s hard to tell just how clear a hospital’s pricing is legally required to be.
A new report from Patient Rights Advocate (PRA), a nonprofit devoted to hospital price transparency, highlights what it views as a considerable lack of compliance among Texas hospitals with the Hospital Price Transparency Rule. The report, which analyzed 2,000 hospitals across the nation, arrived in our inbox with a splashy claim that only 37% of hospitals in Texas are fully complying, despite the regulation’s implementation over three years ago.
When reached for comment on their inclusion in the PRA report, representatives from many North Texas hospitals were quick to dispute their placement, with some going as far as to say the survey was “flawed,” while describing why their hospitals were, in their words, “compliant” with current hospital price transparency regulations.
Who Is Right and Who Is Wrong?
Ilaria Santangelo, PRA's director of research, talked about the implications of the report’s findings and the ongoing struggle to get hospitals to comply with price transparency standards. "Knowing actual prices upfront paves the way for creating a fair market price," she said.Recounting her own experience as a patient, Santangelo said, "I was able to find an alternative by being able to compare and look into the pricing files and shop. So that's what access to real dollars-and-cents pricing can do for consumers."
Santangelo explained that her group advocates for systemwide healthcare price transparency, while also stressing the urgent need for stronger enforcement and expanded transparency measures.
"Penalties do work,” she said. “CMS should increase the penalties and have stronger enforcement to get hospitals to come into full compliance."
Additionally, Santangelo noted the potential impact of bipartisan legislation, such as the Braun Sanders Senate Health Care Price Transparency Act 2.0, which aims to improve transparency and affordability in healthcare. She thinks the act emphasizes the importance of actual dollars-and-cents pricing over estimates, saying, "Estimates are not real prices... Most hospitals post a price estimator tool, which is not great."
Medical expenses often leave patients burdened with unexpected bills, a condition that as much as anything else has led to transparency rules and legislation. Unsurprisingly, most Americans want to know what they’re in for before they get hit with the bill upon discharge. PRA’s polling states that 94% of Americans support the notion of healthcare price transparency.
It’s not just the specific hospitals called out for alleged noncompliance that disagree with PRA’s take on things. According to the American Hospital Association challenges persist as third-party organizations like PRA "intentionally" mislead the public on hospital compliance rates, as outlined by CMS, the official arbiter of transparency rule compliance.
“All Methodist Health System facilities are in compliance with the standards set by Centers for Medicare and Medicaid Services and Texas Health and Human Services Commission,” Ryan Owens, the assistant vice president of public relations for Methodist Health System, wrote in an email. His company has several locations deemed noncompliant in the PRA report. “In addition, our facilities have been deemed 5-star compliant in pricing transparency through Turquoise Health, another patient advocacy group,” he added.
Corey Koif, director of community and public relationship at Medical City Frisco, one of the hospitals cited in the PRA report as noncompliant, took exception to how his location was listed. According to Koif, Medical City hospitals have implemented the federal requirements since January 2021, as evidenced by features such as a consumer-friendly Patient Payment Estimator tool on their websites.
Is Hospital Pricing in North Texas Transparent or Isn't It?
For its part, CMS recently revealed notable progress in hospital compliance, with 70% of hospitals meeting both display and file requirements in 2022, a substantial increase from previous years.PRA's recent report found only 24.5% of hospitals compliant with all transparency requirements, contrasting sharply with CMS's assessment. CMS clarified several inaccuracies highlighted by PRA, including misconceptions regarding the use of formulas, missing data fields and file sizes.
“I would encourage you to rely on information from CMS for reporting on this topic rather than a group that does not determine compliance,” Koif from Medical City added. The Observer reached back out to PRA for a response to the criticisms of its reporting we have received. Santangelo wasn't moved by the blowback.
"We stand by the findings of our latest report. PatientRightsAdvocate.org's methodology was developed to test compliance per every regulation in the Hospital Price Transparency Rule under the Centers for Medicare and Medicaid Services," she wrote in an email. "Of those we reviewed in Texas, we applaud the 84 hospitals fully compliant with the rule and transparent with patients and healthcare consumers. We urge the 144 Texas hospitals that remain noncompliant to come into full compliance. Estimator tools and approximate costs are no substitute for actual upfront prices, and do not represent compliance as a whole. Hospitals putting them forward as alternatives are failing to meet full compliance."
Well, that just about clears things up, doesn't it? No, it doesn't.
Cynthia Fisher, PRA’s founder and chairwoman, wrote a letter to President Joe Biden, highlighting the need for the type of transparency PRA advocates for while also underlining the discrepancy between her group’s findings and that of the CMS.
"Our comprehensive study of 2,000 hospitals indicates nearly two-thirds (65.5%) of hospitals reviewed continue failing to fully comply with the rule," the letter read. "Yet the CMS has only fined fourteen hospitals for noncompliance out of the thousands found to not be meeting all of the rule’s requirements.”
Owens from Methodist Health suggests you don’t have to take his word for it, nor should you take the PRA’s word. No one is in a hurry to give most hospitals too much credit in terms of fair or transparent pricing, we should add. But as noted earlier, the topic of just how hospitals in North Texas can and should go about being transparent with their pricing isn't terribly clear and might just depend on whom you ask.
“The report by PatientRightsAdvocate.org includes incorrect information about our facilities’ pricing transparency machine readable files,” Owens said. “And [it] is misaligned with the current federal and state regulatory guidelines around pricing transparency machine readable file requirements.”
