Earlier this month, OIG’s Office of Audit Services released its latest report on providers’ compliance with the Hospital Price Transparency Rule (the HPT Rule). The HPT Rule requires hospitals to make public (1) a machine-readable file containing a list of all standard charges for all items and services the hospital provides, and (2) a consumer-friendly list of standard charges for a limited set of shoppable services. OIG’s report titled, “Not All Selected Hospitals Complied With the Hospital Price Transparency Rule,” found—as the title suggests—that over a third of selected hospitals for the audit did not comply with the HPT Rule. The report extrapolates the sample results and estimates that forty-six percent of the 5,879 hospitals required to comply with the HPT Rule are out of compliance.
Methodology
OIG identified 5,879 unique hospitals that were both required to comply with the HPT Rule and had Medicare inpatient claims for hospital stays with ending dates of service from January 1, 2021, through June 30, 2022. These hospitals were then separated into two categories. The first category included hospitals from the three largest hospital systems, which represented 375 hospitals. The second category included the remaining 5,504 hospitals, The audit sample consisted of thirty hospitals from the first category and seventy hospitals from the second category. OIG accessed the websites of the sampled hospitals and obtained the machine-readable files and shoppable services files from those websites during searches conducted between January 17, 2023, and March 14, 2023. If a hospital did not have a shoppable services file on its website, OIG analyzed its price estimator tool.
OIG’s Findings
The report found that not all of the selected hospitals made their standard charges available to the public as required under the HPT Rule. Of the 100 sampled hospitals:
- Sixty-three complied with the HPT Rule requirements; and
- Thirty-seven did not comply with one or more of the HPT Rule requirements.
- Thirty-four hospitals did not comply with one or more of the requirements associated with publishing comprehensive machine-readable files.
- Fourteen hospitals did not comply with one or more of the requirements associated with displaying shoppable services in a consumer-friendly manner.
- Several of the selected hospitals were out of compliance with both requirements.
During the audit process, OIG contacted each of the sampled hospitals and sought comment about each hospital’s experience with its efforts to implement and comply with the provisions of the HPT Rule. According to the report, many concerns generally addressed confusion or uncertainty that hospitals and their staffs had experienced in their understanding of the specific requirements. Some smaller hospitals (fewer than 100 beds) said that their own limited resources, as well as inadequate assistance from contractors, contributed to their difficulties in complying with the HPT Rule.
OIG’s Recommendation
The report recommends that CMS take the following actions:
- Review noncompliant hospitals associated with OIG’s findings and, if CMS determines that the hospitals are noncompliant, execute CMS’s enforcement measures, to include issuing warning notices, corrective action plans, and/or civil monetary penalties as applicable;
- Use the information in the report and consider implementing changes suggested by hospitals, including providing written guidance clarifying the definition of “shoppable services” and developing a training and compliance program that is tailored for smaller hospitals; and
- Continue to strengthen its internal controls, to include allocating sufficient resources to maintain a robust program of reviews of the hospitals and their compliance with the HPT Rule.
CMS responded to each of the recommendations. First, CMS said that it had begun its own compliance review of the noncompliant hospitals identified during OIG’s audit. Second, CMS said that it had already published guidance related to its definition of “shoppable services.” CMS also stated that it would “conduct additional outreach to hospitals to educate them on [this] definition . . . .” Third, CMS stated that the updated HPT Rule finalized in November 2023 strengthened its controls and review process. (For a detailed summary of the latest changes to the HPT Rule, see the November 6, 2023 Edition of Health Headlines).
Guidance for Providers
Given the continued and increased scrutiny of compliance with the HPT Rule, hospitals should remain mindful that CMS has published several helpful tools on its website to aid compliance. For example, CMS has created two tools that test a hospital’s machine-readable file against the required CMS template layouts and specifications.
- Online Validator: CMS recommends this tool for nontechnical users.
- Command-Line Interface Validator: CMS recommends this tool for technically-proficient users validating multiple files simultaneously or integrating the validator into a software pipeline.
CMS has confirmed that both tools use the same underlying code and will produce the same errors and/or warning for a machine-readable file. Also, if a hospital comes under a compliance review by CMS, the agency will use the validator tool to assess compliance.
A comprehensive list of resources, including the tools listed above, is available here. OIG’s report is available here.
