Yunan Ji and Edward Kong. 6/24/2022. “
US Hospital Characteristics Associated With Price Transparency Regulation Compliance.” JAMA Health Forum, 3, 6, Pp. e221702.
Publisher's VersionAbstract
Introduction: As of January 1, 2021, the Centers for Medicare & Medicaid Services (CMS) required all US acute care hospitals to release the prices they negotiate with insurance plans to make price comparison across hospitals easier for consumers. We report data on compliance with this requirement for all 4484 acute care hospitals in the US as of December 2021 and explore the association between hospital characteristics and compliance.
Results: The final sample included 2892 hospital systems representing 4484 hospitals in 306 HRRs. The Table shows descriptive statistics at the hospital system level for 2892 hospital systems; mean (SD) compliance was 68% (46%). We found a negative association between compliance and market competitiveness; compliance was higher in less competitive HRRs (scaled effect size, 0.07; 95% CI, 0.03-0.10) and for hospital systems with greater market shares (scaled effect size, 0.08; 95% CI, 0.05-0.11) (Figure). Both associations remained significant when controlling for number of beds. Multihospital systems (effect size, 0.13; 95% CI, 0.09-0.16), for-profit hospitals (effect size, 0.05; 95% CI, 0.01-0.10), and teaching hospitals (effect size, 0.11; 95% CI, 0.03-0.20) had higher compliance. Government hospitals had lower compliance (effect size, −0.06; 95% CI, −0.10 to −0.02), but the association did not remain after controlling for integration into multihospital systems. Hospital systems with more beds had higher compliance (scaled effect size, 0.04; 95% CI, 0.02-0.07), whereas critical access hospitals (effect size, −0.03; 95% CI, −0.07 to 0.01) and those lacking intensive care units (effect size, −0.13; 95% CI, −0.16 to −0.09) had lower compliance.
Discussion: As of December 2021, 68% of hospitals had released payer-specific negotiated prices, more than 50% higher than rates reported earlier in the year.3-5 The higher compliance rate may be attributable to reporting delays from technical difficulties or pressure from the media and CMS.
The findings suggest that competition and hospital resources may have a role in determining compliance. Hospitals in the least competitive markets and those with greater market shares had higher compliance rates, consistent with safeguarding of negotiated prices in the presence of greater competition. A prior study5 found similar results as of June 1, 2021. In our study, the associations were found through the end of 2021, despite a significant increase in overall compliance.
Our results highlight factors associated with hospital compliance with price transparency regulation. A limitation is that we defined compliance based on availability of payer-specific negotiated prices and omitted other CMS requirements such as availability of a shoppable service tool. A more stringent definition would likely lead to lower measured compliance rates.