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Report finds more than two dozen Iowa hospitals not in compliance with federal price transparency rules

A new report has found more than two dozen hospitals are not complying with federal price transparency rules.
Arseny Togulev
A new report has found more than two dozen hospitals are not complying with federal price transparency rules.

A new report has found more than two dozen Iowa hospitals are not fully compliant with federal price transparency requirements.

The non-profit Patient Rights Advocate released the report last month reviewing 43 Iowa hospitals and found 26 hospitals, or 60% percent, are non-compliant with the Hospital Price Transparency Rule.

The federal rule, which went into effect at the beginning of 2021, requires hospitals to post actual prices of every procedure and code they offer.

The semi-annual review, which is the organization's sixth report, looked at 2,000 hospitals nationwide and found the overall non-compliance rate to be 65.5%, which is higher than Iowa's rate.

It also found the nationwide non-compliance rate has increased compared to its last review of those hospitals issued in July 2023.

Cynthia Fischer, the founder and chairman of Patient Rights Advocate, said the rule is important because the price of procedures can vary widely between hospitals and insurance plans, and patients have no way of knowing if hospitals don't post the required information.

"We know that when we all can pull back the curtains and see these prices, no one would tolerate being overcharged 10 times more," she said.

The rule went into effect under the Trump administration as a way to increase competition and lower healthcare costs at a time when medical debt has soared. Around 180,000 Iowans, or 8% of the population, have medical debt in any given year, according to a report by the Peterson Center on Healthcare and KFF.

When hospitals don’t comply with the price transparency requirements, Iowans could miss opportunities to lower the price of their care by double checking their bills, going to cheaper facilities, or even paying a lower cash price, Fischer said.

"The hospitals that were not fully compliant were missing significant amounts of the information that would help people be able to make sure their bills were right or shop upfront," she said.

Fischer points to enforcement as one of the main reasons many hospitals still aren't up to speed yet.

The Centers for Medicare and Medicaid Services has issued fines to 14 hospitals nationwide for non-compliance since the rule's inception. None are in Iowa.

The Biden administration increased the maximum annual penalty to $2 million in 2021, and bipartisan legislation introduced in December would raise maximum fines to $10 million and require hospitals to post actual prices for all services by next year.

The American Hospital Association has pushed back on criticism, saying since the rule's inception, hospitals have had to prioritize response to the COVID-19 pandemic over posting costs and non-compliance estimates from non-profit reports, like Patient Rights Advocate, greatly vary.

Molly Smith, the group vice president for public policy at the American Hospital Association, told WBUR's On Point last month, that the focus should be on making sure everyone has comprehensive healthcare coverage to pool costs and make medical care affordable for everyone.

"The hospitals can provide information and patients can make that choice," she said. "But at the end of the day, the negotiation there is really with the insurer, and we should be focused on really simplifying the copay experience for the patient."

Natalie Krebs is IPR's Health Reporter