Back in 2019, the federal government created rules to increase the transparency of healthcare prices. But over the years, those rules were not fully followed. Now, the new administration in Washington is bringing back the Windex.
In late February, President Trump signed a new executive order requiring three federal agencies to “rapidly and immediately enforce” healthcare price transparency regulations that he previously established during his first term. The reader will recall that in 2019, the government mandated that hospitals publicly disclose prices that patients and health plans “actually pay” for services. The point of this mandate was to provide patients with enough information to allow them to “shop around” for their healthcare services.
However, according to a November 2024 report by the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (HHS), compliance with the transparency rules has been less than exemplary. It was determined that only 21.1 percent of the hospitals reviewed were in full compliance with the rules, down from 34.5 percent in a previous review. Similar findings were reported by patient advocacy group Patient Rights Advocate. That organization’s founder, Cynthia Fisher, stated the following:
Consumers have long been left without the ability to see upfront prices, or to have remedy or recourse for overcharges, hidden fees, and surprise medical bills. This opacity has allowed healthcare costs and insurance premiums to skyrocket, and medical debt collections to soar.
Based on the OIG report, the president issued an order that calls upon the Departments of the Treasury, Labor and HHS to develop a framework to enforce the 2019 executive order on price transparency within 90 days.
According to a report in HealthcareDive, “Hospitals will be required to disclose actual prices of services, not estimates, and post information in a standardized fashion that is easily comparable across hospitals and health plans.” Specifically, hospitals will be required to list pricing information for up to 300 shoppable services and provide a machine-readable file with negotiated rates for every service the hospital provides. Health plans will also be required to post their negotiated rates with providers, as well as their out-of-network payments.
Reportedly, only a “small fraction” of non-compliant hospitals received fines for failing to comply with the transparency rules during the previous administration. More than likely, that is set to change with this renewed push to enforce the 2019 rules. Accordingly, hospital administrators may want to break out their bottle of Windex. Keeping it dim and dingy is no longer a good option.