“90% of care is shoppable and non-emergent, so seeing actual real dollars-and-cents prices upfront allows patients to take control of their health and shop for the best quality of care at prices they know they can afford,” said Ilaria Santangelo, director of research for PatientRightsAdvocate.org, a nonprofit focused on price transparency in health care.
“The majority of Americans delay care due to fear of financial ruin because they don’t know the price,” she said.
Since 2021, hospitals are required to post their prices online in a machine-readable file, Santangelo said.
This requirement from the Centers for Medicare and Medicaid Services (CMS) says the machine-readable files should include prices for every item and service they provide, as well as the cost under every payer and plan, including the discounted cash prices, she said.
“What we’re finding in Ohio, almost four years in, is hospital compliance is pretty low,” Santangelo said.
Only about 13% of hospitals in Ohio are fully compliant, according to the analysis done by PatientRightsAdvocate.org, Santangelo said, or 10 hospitals out of the 80 they analyzed. The patient advocate group looked at 2,000 hospitals across the U.S.
“We compare the hospitals' machine-readable pricing to the regulation, and we make sure that the hospital file subscribes to the standard format and schema that’s required and has every data element that the rule requires,” Santangelo said.
Credit: Marshall Gorby
Credit: Marshall Gorby
Across the U.S., PatientRightsAdvocate.org found:
- Only 421 (21.1%) hospitals were fully complying with the rule.
- Only 335 (16.8%) hospitals were found to be sufficient in their disclosure of dollars-and-cents prices.
- Only 133 (6.7%) hospitals were found to be both fully complying and posting sufficient pricing data.
- Most hospitals — 1,579, or 78.9% — across the U.S. were found in total noncompliance, failing to pass the CMS Validator Tool; not following the CMS-mandated file name format; missing significant pricing data by payer and plan names; and/or not posting a compliant TXT file.
New law effective in April
The nonprofit said hospitals in Dayton, Springfield and other southwest Ohio areas were not in full compliance when it came to issues of formatting on the machine-readable files.
The hospitals disagreed on the issues of compliance, saying they work with CMS to confirm their accuracy.
Credit: Bill Lackey
Credit: Bill Lackey
“CMS has confirmed Kettering Health is fully compliant with all price transparency guidelines,” the health system said in an organizational statement. “Because we are committed to continuous improvement, we validate our work with a third-party expert who specializes in this area and shares best practices.”
Premier Health also said it is fully compliant with federal and state price transparency regulations.
“With the recent passage of Ohio’s HB 173, Premier Health will continue to review, update and publish any additional information required,” the health system said.
House Bill 173, which passed under the 135th General Assembly and will be effective on April 3, includes provisions on hospital price transparency that had stalled in a previous bill.
The price transparency provisions include:
- Hospitals will be required to publish a list of standard charges for at least 300 of the hospital’s shoppable services in a consumer-friendly list.
- It permits a hospital to fulfill the requirement of posting a list of standard charges for shoppable services instead by providing a qualifying internet-based price estimator tool.
- It prohibits a hospital from selling Ohioans' personal data gathered through those price estimators.
The Ohio Department of Health will be required to monitor noncompliant hospitals, imposing penalties or fines, as well as publishing a list of noncompliant hospitals.
In PatientRightsAdvocate.org’s testimony for House Bill 49 (the previous, stalled bill on this topic), the nonprofit said the forms of noncompliance it is seeing with Ohio hospitals includes hospitals are not listing plan names in their machine-readable files as required by law.
Hospitals are also “using an incomprehensible amount of N/As, hyphens, dashes, blanks, and various forms of non-pricing information, instead of actual prices,” Santangelo said.
In testimony opposing House Bill 49, the Ohio Hospital Association cited a 2023 report from CMS that said 70% of hospitals were fully compliant as of 2022, up from less than 30% in 2021.
“Stated another way, by 2022, there was a 133% increase in compliance,” the Ohio Hospital Association said.
How to find prices
Many of the machine-readable files for hospitals' prices are posted online in a JavaScript Object Notation (JSON) format, which is generally for large-scale data comparison and not for consumer use, the hospitals said.
PatientRightsAdvocate.org has compiled those machine-readable files into a format that can be downloaded in more consumer-friendly spreadsheets on its website at hospitalpricingfiles.org.
Patients can access Kettering Health’s bill estimator tool on its website to better understand health care costs for an upcoming visit, the health system said. The estimator tool can be found at ketteringhealth.org/billing-insurance/bill-estimate.
“This consumer-friendly tool provides a personalized estimate, including out-of-pocket costs, based on insurance and deductibles,” Kettering Health officials said. “Kettering Health also has customer service representatives available to answer questions related to billing, estimates and costs of services.”
More Kettering Health costs can be found at ketteringhealth.org/billing-insurance/patient-pricing, including links to some of the common charges at its hospitals.
CMS guidelines say hospitals should include a link to their price transparency page in the footer of its website’s homepage, which can usually be found by scrolling to the bottom of the homepage screen.
Mercy Health, which has locations in Springfield and Urbana, as well as in Butler County, said it is committed to fully complying with hospital price transparency laws, adding it is confident it is adhering to these regulations.
Credit: Bill Lackey
Credit: Bill Lackey
“Our pricing information has been reviewed and successfully passed the CMS Machine-Readable File (MRF) validator tool, ensuring that our data meets the required format and specifications outlined by CMS,” the hospital group said.
Mercy Health provides a price estimator online at mercy.com/pay-a-bill/estimate-your-cost. Those seeking information can also call 513-981-6445 from 7:30 a.m. to 6 p.m. Monday through Friday for individualized help.
Pricing tools for Premier Health can be found on its website at premierhealth.com. A Premier Health patient financial counselor can help with patient-specific estimates. The price line for Premier can be reached at (937) 499-7364, option 5, or toll-free at (855) 887-7364 from 8:30 a.m. to 4 p.m. Monday through Friday.
About the Author
