Under the authority of the Affordable Care Act (ACA), a federal hospital price transparency rule took effect January 1, 2021, requiring hospitals to post all prices online, easily accessible without barriers such as having to submit personal identifying information.

In July 2021, the PatientRightsAdvocate.org research team conducted its first review of hospital compliance and found widespread failure of hospitals to fully publish their prices across all payers and plans. It estimated that only 5.6% of the 500 random hospitals reviewed were compliant with the rule.

January 1, 2022 began the second year of the legal requirements for hospitals to post all prices online. This 2022 report assessed the compliance with the law by reviewing 1,000 U.S. hospitals out of the over 6,000 accredited hospitals in the country, including the original 500 hospitals it previously reviewed.

A team of four PatientRightsAdvocate.org research analysts assessed the websites for hospital compliance. Separately, an independent review and validation of the report using a substantial sample of the data were performed from January 19 to 28, 2022 for PatientRightsAdvocate.org by FireLight Health LLC, an independent healthcare price data company with expertise in hospital price transparency data.

Of the 1,000 total hospitals reviewed, it found:

– – Only 14.3% were complying with the transparency rule.
– – Only 37.9% of the hospitals posted a sufficient amount of negotiated rates, but over half were not compliant in other criteria of the rule, such as rates by each insurer and named plan.
– – Only 0.5% of hospitals owned by the three largest hospital systems in the country – HCA Healthcare, CommonSpirit Health, and Ascension – were in compliance.

Notably, only two of the 361 hospitals owned by these three hospital systems were compliant with the rule. Strikingly, for HCA Healthcare, the largest for-profit hospital system in the country, none of its 188 hospitals (0/188) were in compliance. In 2021, these three large noncompliant hospital systems’ combined total revenue approached $120 billion. The cost of compliance calculated in the rule is only $12,000 per hospital.

The most prevalent omission deeming noncompliance was non-posting or incomplete posting of all of the negotiated prices for each item and service clearly associated with all of the payers and plans accepted by the hospital.

Based on this review, it estimated that only 14.3% of the 1,000 hospitals (143/1,000), were in compliance with all of the price transparency rule requirements. It estimated that 85.7% (857/1,000) were noncompliant, because one or more price transparency requirements were not met. The largest hospital systems are effectively ignoring the law, with no consequences.