As of January 1st, all US hospitals are required to prominently display on a publicly available website prices privately negotiated with payers for 300 services, under CMS’s Hospital Price Transparency Rule. Hospital “charges” have been available to patients but not the actual prices paid by insurers. CMS requires both a “display of shoppable services in a consumer-friendly format” and a “comprehensive machine-readable file with all items and services.”
Checking this week, negotiated price information is not available on fourteen of 27 Connecticut hospital websites. The quality of the information on the other sites varies considerably. Many are not available in a “consumer-friendly” format, in plain language, or in a machine-readable file, a required. One hospital requires patients to provide personal and insurance information to get price estimates. Only three advise patients about the costs of commonly associated services such as anesthesia or room/board charges.
The new regulation was developed to lower healthcare costs and avoid surprise billing by helping patients shop for care before they need it. However, the evidence is mixed on the impact of price lists and cost estimators in changing consumer behavior or in lowering costs. In some cases, they can raise costs if lower-cost competitors raise prices in response. In a consolidated market, like Connecticut’s, opportunities to shop for care are limited.