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The federal Hospital Price Transparency Rule, which took effect on January 1, 2021, requires hospitals to post all prices online, easily accessible and searchable, in the form of (1) a single machine-readable standard charges file pricing for all items, services, and drugs by all payers and all plans, the de-identified minimum and maximum negotiated rates, and all discounted cash prices, as well as (2) prices for the 300 most common shoppable services either as a consumer-friendly standard charges display listing actual prices or, alternatively, as a price estimator tool.

Combined with requirements for disclosure of systemwide prices and historical claims in the Transparency in Coverage Rule and the Consolidated Appropriations Act of 2021 respectively, the Hospital Price Transparency Rule is intended to empower healthcare consumers – patients, employers, and unions as purchasers – with ease of access to compare prices.

The nonprofit Patient Rights Advocate (PRA) released its fifth semi-annual report, which found that only 36 percent of 2,000 surveyed hospitals were in complete compliance with the rule.

Its latest review was published on July 20, 2023, two and a half years after the Hospital Price Transparency Rule took effect. It analyzed the websites of 2,000 U.S. hospitals and found only 36% of them (721) to be fully compliant with all requirements of the rule.

Although the majority of hospitals have posted files, the widescale noncompliance of 64% of hospitals is due to most hospitals’ files being incomplete or not having prices clearly associated with both payer and plan.

In this report, 69 of the hospitals reviewed had no usable standard charges file.

Compliance varied widely among the largest hospital systems it reviewed.

– – None (0%) of the hospitals it reviewed which were owned by HCA Healthcare, Tenet Healthcare, Providence, Avera Health, UPMC, Baylor Scott & White Health, and Mercy were found to be fully compliant.
– – Consistent with prior reports, none of the hospitals owned by the largest hospital system in the country, HCA Healthcare, were found to be in full compliance, with a significant amount of its hospitals posting illegible, nonconforming files.
– – Substantial improvements since its last report include: 88% of hospitals owned by CommonSpirit Health, 97% of hospitals owned by Community Health Systems, and 98% of hospitals owned by Kaiser Permanente were found to be in full compliance.

The Health and Human Services (HHS) Department’s Centers for Medicare and Medicaid Services (CMS) are responsible for enforcing the rule. In June of 2022 (eighteen months after the rule’s inception), CMS imposed its first two civil monetary penalties (CMPs) on hospitals for not complying with the rule.

Both hospitals immediately came into compliance with exemplary files to date.

In February of 2023, CMS acknowledged in a blog post that 30% of hospitals (approximately 1,800) were still noncompliant. Yet, in April of 2023, only two more hospitals were fined. Both were still found to be noncompliant in this review.

As of the time of this report, a total of four hospitals have been penalized, 0.2% of the hospitals that CMS recognized as noncompliant. Clearly, CMS is not strongly enforcing the rule.

“Unfortunately, our findings show that the majority of hospitals across the country are still failing to comply with the Hospital Price Transparency Rule,” said Cynthia Fisher, Founder and Chairman of

“When hospitals hide behind estimates or don’t post all real prices, they are leaving consumers in the dark. Making all actual prices available upfront will empower patients, employers, and unions to choose the best care at prices they know they can afford, and protect all Americans from overcharges, errors, and fraud.”