Report alleges some Georgia hospitals are noncompliant with federal price transparency rule

According to CMS, they’ve issued approximately 1,237 warning notices to hospitals nationwide that were considered out of compliance with the Hospital Price Transparency requirements. Their records show only two Georgia hospitals have been penalized: Northside Hospital Atlanta and Northside Hospital Cherokee, both in June 2022.

However, an advocacy group claims that of the 2,000 hospitals that were reviewed nationwide, 36 hospitals in Georgia are reportedly not sharing that information. The group Patient Rights Advocate released its latest report in February 2024. It’s being met with much criticism from several of the hospitals named in the report.

Cynthia Fisher, the founder and chairwoman of Patient Rights Advocate, joined show host Rose Scott on “Closer Look” to discuss the report.

Officials from the Healthcare Financial Management Association also joined the conversation.

Brad Dennison, the director of healthcare finance policy, and Shawn Stack, the director of editorial and policy affairs, called PRA’s report “irresponsible.” Turquoise Health, which rates hospitals on their price transparency, gave several five-star ratings to hospitals PRA declared non-compliant.

The Georgia hospitals that are fully complying with the Hospital Price Transparency Rule, according to Patient Rights Advocate: Washington County Regional Medical Center, Augusta University Medical Center, Bacon County Hospital, Children’s Egleston Hospital, CHI Memorial Hospital Georgia, East Georgia Regional Medical Center, Grady Memorial Hospital, St Francis Emory Healthcare

The Georgia hospitals that are not complying with the Hospital Price Transparency Rule, according to Patient Rights Advocate:
• AdventHealth Gordon, AdventHealth Murray, AdventHealth Redmond
• Atrium Health Floyd, Atrium Health Floyd Polk Medical Center, Atrium Health Navicent Baldwin, Atrium Health Navicent Peach, Atrium Health Navicent The Medical Center
• Appling Healthcare System
• John D Archbold Memorial Hospital
• Emory Decatur Hospital, Emory Saint Joseph’s Hospital, Emory University Hospital, Emory University Hospital Midtown
• Doctors Hospital of Augusta
• Fairview Park Hospital
• Memorial Health Meadows Hospital, Memorial Health University Medical Center, Memorial Satilla Health
• NGMC Gainesville
• Northside Hospital, Northside Hospital – Cherokee, Northside Hospital Forsyth, Northside Hospital Gwinnett
• Piedmont Athens Regional Medical Center, Piedmont Atlanta Hospital, Piedmont Augusta Hospital, Piedmont Columbus Regional Midtown, Piedmont Henry Hospital
• Southern Regional Medical Center
• St. Mary’s Good Samaritan Hospital, St. Mary’s Hospital and Medical Center, St. Mary’s Sacred Heart Hospital
• WellStar Cobb Hospital, WellStar Kennestone Hospital, WellStar West Georgia Medical Center

The federal government and Georgia hospitals issued the following responses to “Closer Look”:

Centers for Medicare & Medicaid Services:

“CMS is committed to ensuring consumers have the information they need to make fully informed decisions regarding their health care. We appreciate the overwhelming support for CMS price transparency initiatives, which include Hospital Price Transparency (HPT), Transparency in Coverage (TIC), and the No Surprises Act (NSA).

We believe that price transparency can stimulate provider competition, empower healthcare consumers, and result in lower healthcare costs, and that transparency in healthcare pricing is integral to supporting a transition to value-based care.

Under the Hospital Price Transparency regulations, hospitals are required by law to make public the hospital’s standard charges online, and we expect hospitals to comply with these requirements. CMS has actively and robustly enforced hospital price transparency requirements since Jan. 1, 2021, and we are encouraged by the significant increase in hospital compliance that we have witnessed since implementation of the regulations, as noted in this Health Affairs article.

CMS does not comment or speculate on external reports, however, CMS is aware of several different outside efforts to assess hospital compliance, with findings of alleged compliance ranging from approximately 5% to nearly 85%, depending on the organization’s methodological approach. We regularly review such reports which are used to inform our enforcement. Additionally, the public is invited to submit a complaint on the CMS website related to alleged noncompliance so that CMS may perform a comprehensive compliance review, make an official determination, and take enforcement actions as necessary.

Consistent with our regulation, the HPT final rule indicates that once CMS issues a Civil Monetary Penalty (CMP), CMS will make public the CMP notice on a CMS website. You can find these notices here: cms.gov/priorities/key-initiatives/hospital-price-transparency/enforcement-actions.

Additionally, under The Freedom of Information Act (FOIA), the agency has released information to the public related to its HPT enforcement activities multiple times since the Jan. 1, 2021, effective date of the original HPT requirements. The agency has therefore determined that CMS HPT enforcement activities for closed cases have become, or are likely to become, the subject of subsequent requests for substantially the same records in the future. Thus, per FOIA, the inaugural data disclosed by CMS includes actions taken for cases closed before Jan. 1, 2024. These data can be found here: data.cms.gov/provider-characteristics/hospitals-and-other-facilities/hospital-price-transparency-enforcement-activities-and-outcomes. These Public Use Files contain the following information:

• Hospital or Hospital Location Name;
• Hospital ID number assigned to the hospital by the HPT initiative;
• Hospital or Hospital Location Street Address;
• Hospital City;
• Hospital State/Territory;
• Action taken by CMS following an HPT compliance review (e.g., Met Requirements, Warning Notice, Request for Corrective Action, CMP Notice, Closure Notice); and
• Date of Action.

As of Feb. 29, 2024, CMS has performed comprehensive compliance reviews on approximately 2,000 hospitals that were alleged by the public to be noncompliant. Over 600 hospitals that were alleged to be noncompliant were found to be compliant with the Hospital Price Transparency requirements and CMS took no action. CMS has issued approximately 1,237 warning notices to hospitals that have been determined to be out of compliance with the Hospital Price Transparency requirements. CMS has also issued 720 requests for corrective action plan to hospitals that previously received warning notices but have not yet corrected deficiencies or were found to be egregiously noncompliant upon initial review, and 975 hospitals have received case closure notices after having addressed previous deficiencies.

CMS strongly encourages individual consumers to avail themselves of hospital and payer price estimator and comparison tools, and to seek out ‘good faith estimates’ from hospitals which, to comply with separate requirements implementing the No Surprises Act, may provide up-front pricing that can be used to dispute final charges that are substantially more than the up-front amounts for uninsured or self-pay consumers. More information for consumers about disputing a bill under this process can be found here: cms.gov/medical-bill-rights/help/dispute-a-bill and cms.gov/medical-bill-rights.”

Emory Healthcare:

“Emory Healthcare supports efforts that increase transparency for patients and accountability for health care providing organizations. Advocacy organizations that generate reports, scorecards and related items must ensure the information is accurate and follow the Centers for Medicare & Medicaid Services’ (CMS) Hospital Price Transparency Rule to maintain transparency and avoid confusion for consumers.

In compliance with the CMS Hospital Price Transparent Rule, information for all Emory Healthcare hospitals can be found at this link. The price estimator, as well as the machine-readable files posted on the webpage, demonstrate that Emory Decatur Hospital, Emory Saint Joseph’s Hospital, Emory University Hospital and Emory University Hospital Midtown are in compliance with the Hospital Price Transparency Rule and have all information posted.

Emory Healthcare has put significant effort into making pricing information more accessible to help consumers make better informed decisions about their health care. Our goal is to have a website that is both compliant and useful to patients and industry stakeholders in a manner consistent with the intent and purpose of CMS’ Hospital Price Transparency Rule.”

Northside Hospital:

“Northside takes our transparency reporting seriously and we believe we are in compliance with the current requirements, including the recent updates that took effect on Jan. 1. Indeed, PatientRights found Northside to be “exemplary” in its July 2023 report. We have reached out to them to understand how they calculated their recent findings for Northside, as a review of our data shows we are compliant under the methods set forth in the latest report.”

Piedmont Healthcare:

“The report is the work of an advocacy group, which is estimating compliance based on a review of files from a snapshot of time. Piedmont has complied with all government notifications regarding any corrections needed to its files. The data and new government rules do change over time and we are in the process of updating our files to meet the new requirements and those effective dates.”

Wellstar:

“We have been and continue to believe that Wellstar is fully compliant with all Hospital Price Transparency regulatory requirements. As a point of information, this organization incorrectly listed these Wellstar hospitals on their list last year.”

Atrium Health:

“Health care delivery is an extraordinarily complex, heavily regulated business that requires contracts with thousands of partners, suppliers, manufacturers and private sector insurers, as well as Medicare and Medicaid. Since the inception of the federal hospital transparency requirements, Atrium Health has been diligent in its efforts to meet both the spirit and the letter of the law. It’s unclear what the group’s true intent is in publishing this list, but it is clear its analysis is flawed. As we use the same files across our footprint, it’s not possible for some to be in compliance and others not. We confirmed our files were uniform when this group erroneously published its list this past summer.

“In its Nov. 22, 2023, OPPS Final Rule, The Centers for Medicare and Medicaid Services (CMS) confirmed that “only CMS can make a determination as to a hospital’s compliance with the HPT (hospital price transparency) requirements.” To publish ad hoc lists of this nature fundamentally misrepresents the existing rules and serves only to advance misinformation – often solely to further the publishing organization’s preferred narrative.

“Since the beginning, Atrium Health has made compliance with federal hospital price transparency a priority and has made a good faith effort to publish information that meets CMS’s current regulations. We are continuing to monitor for any changes in the requirements at either the federal and state levels, but are proud to be in compliance with the existing regulations.”

HCA Healthcare:

“As you likely know, CMS is the agency that determines compliance with the federal regulations. Our hospitals implemented the federal requirements in January 2021. Since then our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured. In addition, we have posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of “standard charges.”

I would encourage you to rely on information from CMS for reporting on this topic rather than a group that does not determine compliance. I would also suggest reaching out to the American Hospital Association(AHA) and/or Federation of American Hospitals(FAH) for an industry perspective. AHA released a statement addressing the information being produced by groups like Patient Rights Advocate (PRA), and recently the Healthcare Financial Management Association (HFMA) has pointed out that PRA’s reports are ‘misleading, incomplete and incorrect.'”

Memorial Health Meadows Hospital:

Memorial Health Meadows Hospital, Vidalia, GA is compliant with the requirement. You may select the website [via this hyperlink] and then select the “Pricing Transparency” link in the upper right-hand corner to view our information.