55% of U.S. hospitals not in compliance with new pricing disclosure rules in first five months

Dec. 15, 2021

A study led by researchers at the Johns Hopkins Bloomberg School of Public Health that examined U.S. hospital compliance with new rules requiring hospitals to disclose prices found wide fluctuations across states, with some states achieving 75 percent or higher compliance and others coming in at 25 percent or lower. Taken together, more than half—55 percent—of U.S. hospitals were not compliant with the new federal rule that went into effect January 1 this year, reported in a release.

The study ranked publicly available hospital compliance information for all 50 states, the District of Columbia, and 305 geographic regions in the U.S. The researchers based their analysis on files from more than 3,500 U.S. hospitals in the first five months of 2021, January 1 through June 1.

At least 75 percent of hospitals were compliant in the District of Columbia, Hawaii, Rhode Island, Indiana, and Michigan. In contrast, at most, 25 percent of hospitals were compliant in Delaware, Maryland, Washington, and Louisiana. The researchers also found that a hospital’s compliance status was strongly associated with the average compliance level of peer hospitals in the same regional market. A hospital would be 42 percent more likely to be compliant if all other hospitals in the same geographic region were compliant as well.

The study was published online December 9 in the Journal of General Internal Medicine.

“The findings suggest that hospitals do not make decisions in isolation, rather their decisions reflect market pressure from their peers,” says the study’s senior author, Ge Bai, PhD, CPA, professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and professor of accounting at the Johns Hopkins Carey Business School. “If the average compliance status in the same region is high, a hospital is more likely to comply.”

John Jiang, PhD, a professor of accounting and information systems at Michigan State University’s Broad College of Business, is the paper’s first author.

The Hospital Price Transparency Rule—managed by the Centers for Medicare and Medicaid Services—requires individual hospitals to provide clear pricing information online about the services they provide. The information must be posted in a file format that can be imported or read into a computer system, also known as a machine-readable file. Hospitals must also include standard pricing for at least 300 services, ranging from colonoscopies to CAT scans. Hospitals are not required to disclose prices for emergency services under the new rule.

The rule is designed to allow consumers to compare prices and estimated cost of services. It can also help patients make more informed decisions about care, increase hospital competition, and potentially drive down costs. Non-compliant hospitals can face steep penalties—up to $2 million a year until they share pricing information in compliance with the new requirements.

JHU release