In a study reported in JAMA Surgery, Childers et al found that only one-third of hospitals with National Cancer Institute (NCI)-designated cancer center status were fully compliant with Centers for Medicare & Medicaid Services (CMS) price transparency requirements instituted in January 2021.
The investigators stated, “In an effort to increase competition and drive down prices, CMS initiated two policies in the last 3 years to increase hospital price transparency. Starting January 2019, hospitals were required to publish their chargemasters—a list of the nondiscounted prices for services provided. This effort has been criticized because charges rarely reflect the actual prices paid for a service and do little to spur competition. In response to this criticism, CMS expanded this mandate in January 2021 to require hospitals to publish a list of their negotiated rates with health insurers. In theory, this should more effectively increase competition between payors and hospitals and drive down rates.”
Study Details
In August 2021, the websites of all 63 hospitals with NCI-designated cancer center status were searched to assess whether they posted a list of negotiated rates.
Compliance was assessed for federal criteria including:
- A file is posted in a machine-readable format.
- The file must be free of charge without requiring registration or personal identifying information.
- The file must be named appropriately.
- The file contains a list of all items and services for which the hospital charges.
- For each item/service, the following five items must be available: gross charge (eg, chargemaster rate, no discount), payor-specific negotiated charge with the name of the payor, de-identified minimum negotiated charge, de-identified maximum negotiated charge, and discounted cash price (eg, for those without insurance).
Key Findings
Among the 63 hospitals, 42 (67%) provided some information on negotiated rates and 20 (32%) were fully compliant. The most common violations of compliance were failure to post the file in a machine-readable format (12 hospitals) and failure to provide all five price parameters for each item/service (10 hospitals).
Comprehensive cancer center–designated hospitals had higher compliance vs those with clinical cancer center designation (74% vs 33%, P < .01). Those in the West had numerically better compliance vs those in the South (86% vs 57%, P = .09).
In an analysis among hospitals that provided reimbursement information for specific diagnosis-related groups, minimum and maximum payor rates within and across hospitals were identified for surgery for stomach/esophageal, colon, and pancreatic cancers. Payor-specific diagnosis-related group payments for the gastrointestinal cancer surgeries were provided by few hospitals (range = 15–18 across three surgeries). A large variation in minimum and maximum payments for different payors was observed both within and across hospitals for all three diagnosis-related groups.
The investigators concluded, “In this cross-sectional study, only one-third of hospitals with NCI cancer center designation were fully compliant with the current CMS price transparency mandate to publish negotiated rates with payors. What is less easy to convey in a quantitative fashion is how cumbersome most websites or files were to navigate. Many files were several gigabytes large and required advanced coding and statistical experience to open or analyze…. The primary limitation of this analysis was the early evaluation of hospitals; compliance will likely increase over time as the federal government enforces the mandate.”
Christopher P. Childers, MD, PhD, of the Department of Surgery, David Geffen School of Medicine at UCLA, is the corresponding author for the JAMA Surgery article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
