Benefits Byte

September 20, 2021

Council Supports Enforcement of Hospital Price Transparency Rules, Urges HHS to Address Health Care Inequities

The American Benefits Council is urging the U.S. Department of Health and Human Services (HHS) to go further in addressing price transparency requirements for hospitals and health care inequities. This was the message of the Council’s comment letter responding to proposed rules issued in August as part of the Medicare Outpatient Prospective Payment System (OPPS) rule for 2022.

While the OPPS rule primarily addresses Medicare-specific topics, it also proposes to increase penalties for hospitals not complying with price transparency requirements and expand the quality data reported by Medicare entities to include race and ethnicity.

Beginning in 2021, hospitals have been required to publicly disclose their standard charges (including negotiated rates) in machine-readable files and a consumer-friendly format. To address widespread reports of noncompliance by hospitals, HHS has proposed increasing the penalties for noncompliance (which are currently $300 per day) and adding a scaling factor based on bed count. Under the proposal, the penalty for mid-size hospitals would be $10 per bed per day and for large hospitals it would be $5,500 per day (the penalty would remain at $300 per day for small hospitals). HHS also clarifies the standard for “findability” for this data to address reports that hospitals are making the data hard to find.

The Council’s September 17 comment letter reiterates our support for the hospital price transparency rules as an important element of efforts to increase transparency to support lower-cost, higher-value care. The Council previously supported HHS increasing the penalties for noncompliance in a June 28 letter (see the July 23 Benefits Byte). However, in the comment letter we note that the increase in penalties may still be insufficient, so we have urged HHS to continue to monitor the issue and to clarify that it may continue to increase the penalties for noncompliance if the issue persists. We also express our support for ensuring that stakeholders can easily locate and access the files when the hospitals release them.

Additionally, the preamble to the proposed rules describes the inequities that exist in the health care system and notes that HHS is working to address those issues in the programs overseen by HHS, including Medicare. HHS currently requires certain quality data reported by Medicare entities to be stratified by dual-eligibility status (i.e., by those who are eligible for both Medicare and Medicaid) and the proposal expands those efforts to also encompass race and ethnicity.

In the Council’s comment letter, we expressed support for efforts to address health care inequities in Medicare, including through stratified reporting of quality data. Furthermore, we asked HHS to consider additional data that may be useful to incorporate in quality reporting to support health care equity. We urged HHS to require that this information be made public when it is reported, including self-reported data regarding race and ethnicity so that it can help plans and consumers outside of Medicare as well.

The Council’s letter also includes a request that HHS consider expanding its rules that support a site-neutral payment policy. These rules provide that hospital-based off-campus outpatient office visits will be reimbursed under the Medicare equivalent to what a standalone physician’s office will be reimbursed, to correct prior rules under which hospital-based visits were paid more under Medicare. The Council has been supportive of these efforts because they help to lower health care costs and to address provider consolidation. Although the proposed rules do not address site-neutral payment reform, the Council has asked HHS to consider future expansions to the policy, such as including other items and services beyond just evaluation and management office visits and to other settings such as on-campus provider offices and emergency departments. 

Also submitting comments on the OPPS rule was Consumers First, a diverse coalition of health policy stakeholders, of which the Council is a steering committee member. Consistent with the Council’s comment letter, the Consumers First comment letter expresses support for the increase in penalties for violation of the hospital transparency requirements and urges that the penalties be further increased. Consumers First also support HHS’s efforts to address health care inequities and provides a number of specific comments, and also encourages HHS to consider expanding its site-neutral payment policy.   

For more information contact Katy Johnson, senior counsel, health policy.