On January 1, 2021, the federal government began requiring US hospitals to maintain clear, accessible online price lists for 300 common services, including total hip and total knee arthroplasty.
Under the Hospital Price Transparency Rule from the Centers for Medicare & Medicaid Services (CMS), hospitals must provide 5 types of online price information for these services:
- Total charge
- Charges the hospital privately negotiated with insurers
- Minimum negotiated charges
- Maximum negotiated charges
- Amount the hospital is willing to accept in cash
Each service must be identifiable by any billing code the hospital uses, and the information must be available in a machine-readable file, free of charge without any personal identifying information required for access.
As of January 1, 2022, however, hospitals seem to have done a poor job of complying: A study from Cleveland Clinical Foundation reports that only 32% of the hospital websites they sampled were fully compliant with transparency in pricing for total hip and total knee arthroplasty.
“Although pricing information was generally available, it frequently did not meet requirements established by the [government] and was oftentimes difficult to access,” the study authors wrote in their paper, published online ahead of print by Clinical Orthopaedics and Related Research.
Study Methodology and Findings
The researchers used total hip and total knee arthroplasty for their test case because these procedures are commonly performed, expensive, and generally predictable in terms of cost.
The Hospital Compare database from CMS, which includes more than 5300 hospitals that accept Medicare patients, was used for the study. The researchers excluded children’s hospitals, psychiatric hospitals, Veterans Affairs hospitals, and active military base hospitals. They also excluded low-volume hospitals – in this case, hospitals at which fewer than 100 total joint arthroplasty procedures were performed annually.
That left 1719 hospitals, of which the researchers selected 400 hospitals for their sample. The researchers examined the websites of these hospitals between December 1 and December 20, 2021, and found that:
- 32% provided all 5 types of information required by CMS
- 21% of hospitals provided all 5 types of information for total knee arthroplasty
- 18% of hospitals provided all 5 types of information for total hip arthroplasty
- 36% of hospitals provided the total charge for total knee arthroplasty
- 31% of hospitals provided the total charge for total hip arthroplasty
- 13% of hospitals violated the CMS rule by not providing machine-readable files
- 21% of hospitals violated the CMS rule by requiring users to provide personal information to access the data
Although not required by the government, many hospital websites were also lacking in consumer friendliness:
- 5% of websites provided price information in a language other than English
- 33% of websites offered a phone number to call for assistance
- 17% of websites made it difficult to find pricing information, taking the researchers more than 15 minutes to locate the information
- 6% of websites provided large files (more than 3 GB) in non-traditional formats that required additional software to read
- 4% of websites did not allow searches by keyword, procedure code, or diagnostic code
Penalties for Non-compliance
The researchers urged hospitals to take these findings seriously and update their website information on pricing accordingly.
“Given the potential influence compliance and price sharing may have on empowering patients’ healthcare decisions and reducing healthcare expenditures, hospitals should use our analysis to identify where their compliance is lacking and to understand how to make their pricing information more readily available to their patients,” they wrote.
The researchers emphasized that hospitals should provide this information, “in easy-to-understand formats,” and make “related services identifiable across all levels of health literacy.”
Although hospitals have been slow to comply, possibly hoping that enforcement will be put on hold, they should be paying attention now: On June 8, CMS announced that it had issued its first 2 penalties to hospitals in Georgia for non-compliance with the price transparency rule.  Penalties will range from $300 to $5500 per day depending on hospital size, CMS said.
Burkhart RJ, Hecht CJ II, Acuña AJ, Kamath AF. Less than one-third of hospitals provide compliant price transparency information for total joint arthroplasty procedures. Clin Orthop Relat Res. 2022 June 23. doi: 10.1097/CORR.0000000000002288. Online ahead of print.
- Centers for Medicare & Medicaid Services. Enforcement Actions. https://www.cms.gov/hospital-price-transparency/enforcement-actions. Accessed June 27, 2022.