Module Two Short Paper: Hospital Price Transparency
Samantha Gilchrist
Southern New Hampshire University, Department of Nursing
IHP 610: Health Policy and Law
Dr. James Dockins
June 19,2022
Rule Enforcement Strategy
Price transparency is an important feature within the healthcare system to allow
consumers peace of mind in getting the healthcare for which they are paying. It helps Americans
determine the price of the services they want or require before receiving it (Consumers). Price
transparency is designed to allow consumers to shop around and compare prices of services at
various hospitals to facilitate informed decision making (Consumers). The Center for Medicare
and Medicaid Services (CMS) is a federal agency designed "to provide oversight of Medicare,
the federal portions of Medicaid and CHIP, and the Health Insurance Marketplace, and to engage
in quality assurance activities," (Jones & Bartlett, 2020). CMS enforces hospital compliance with
price transparency in auditing hospitals and investigating complaints submitted (Consumers). In
relying on the complaints, CMS gives hospitals the opportunity to remediate deficiencies and
resubmit before consequences are imposed (Wheeler & Taylor, 2021). In combination of auditing
hospital websites and relying on consumer complaints, the CMS will enforce the price
transparency rule for hospitals.
Legal Risks and Liabilities
Hospitals are required to comply with CMS price transparency rules and regulations or
risk federal consequences. Covid 19 has posed an exceptional barrier to acquiescence with
initiation of machine-readable price descriptions and calculators (Miller et al. 2022). CMS holds
the responsibility of auditing hospitals' compliance, and often will allow the facility to remediate
to meet the standards set forth by the CMS (Wheeler & Taylor, 2021). If noncompliance
continues, hospitals may face lack of accreditation or fines of $300 per day or $109,500 per year
(Wheeler & Taylor, 2021). Public knowledge of noncompliance can be made accessible by CMS
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-- hospitals have an obligation of transparency to consumers and accuracy of reported
information.
Hospital Compliance Preparation
Standard charge information is the premise of price transparency to which CMS is
requiring hospitals to comply with. CMS requires that hospitals provide easily accessible
information to consumers regarding standard prices for services. This may be presented in two
ways -- "a comprehensive machine-readable file with all items and services" or "in a display of
shoppable services in a consumer-friendly format," (Consumers). The required display includes
machine readable files and shoppable services exhibited in a consumer-friendly format
(Consumers). Federally owned and operated hospitals are exempt from complying with the price
transparency rule as they are deemed to already be following CMS standards (The Federal
Register). CMS considers omission to federally funded hospitals supplying information on price
transparency. For areas where internet access cannot be obtained, hospitals would seek aid from
marketing departments and local programs to distribute this information to the general public.
Additionally, hospitals should have this information readily available within the facility to
allocate to those requesting it.
Impact on Overall Healthcare System
Overall, the healthcare system is competing with prices, services provided, satisfaction,
amongst other factors -- healthcare has become