Hospital Price Transparency Compliance Drops to Four-Year Low Despite Federal Requirements

Major health systems continue to flout pricing disclosure rules as enforcement remains minimal

Nearly four years after federal regulations required hospitals to publicly disclose their pricing information, compliance has fallen to its lowest point since the rule took effect, according to a new report released in November 2024.

Only 21.1% of the 2,000 hospitals reviewed by PatientRightsAdvocate.org were found to be fully compliant with the Hospital Price Transparency Rule, marking a significant decline from the 36% compliance rate observed in July 2023. The federal rule, which became effective January 1, 2021, mandates that hospitals post comprehensive pricing data online to help patients, employers, and insurers compare healthcare costs.

Widespread Noncompliance Among Major Systems

The report reveals particularly troubling patterns among the nation's largest hospital systems. Several major healthcare networks showed zero compliance with the transparency requirements, including Ascension, AdventHealth, Kaiser Permanente, Bon Secours Mercy, and Mercy health systems.

HCA Healthcare, the largest for-profit hospital operator in the country, achieved 56% compliance among its facilities but failed to meet pricing data sufficiency standards at any of its 180 reviewed hospitals. Meanwhile, CommonSpirit Health, one of the nation's largest Catholic health systems, reached 45% compliance with only 32% of its facilities providing sufficient pricing detail.

"These findings imply that minimal, lenient enforcement by CMS has led most hospitals to continue to either disregard the rule or fail to adhere to all of its requirements," the report states.

Technical Failures and Data Gaps

The analysis identified several key areas where hospitals are falling short:

• Validator Tool Failures: 532 hospitals (26.6%) posted files that failed the Centers for Medicare & Medicaid Services (CMS) validation system
• Missing Pricing Data: 415 hospitals (20.8%) failed to include comprehensive payer and insurance plan information
• Format Violations: 393 hospitals (19.7%) used incorrect file naming conventions required by federal standards
• Insufficient Detail: Only 335 hospitals (16.8%) provided adequate dollar-and-cents pricing information for meaningful comparison shopping

Perhaps most concerning, the report found that 449 hospitals that were previously compliant have now "backslid" into noncompliance, suggesting that maintaining transparency requirements remains challenging even for facilities that initially met standards.

Regulatory Rollbacks Complicate Enforcement

The compliance challenges have been compounded by recent regulatory changes that critics argue have weakened the original transparency requirements. New rules implemented in 2024 allow hospitals to:

• Post percentages and algorithms instead of actual dollar amounts
• Use estimated averages rather than specific negotiated rates
• Employ "tall format" files that are difficult for consumers to interpret
• Utilize JSON formatting that isn't human-readable

"Formulas, percentages, and algorithms are not useful to consumers seeking to find prices nor technology developers working to aggregate the data," the report emphasizes.

Limited Federal Enforcement

Despite widespread noncompliance, federal enforcement has remained minimal. CMS has issued civil monetary penalty notices to only 15 hospitals since the rule's inception, with just one penalty notice issued in 2024. This light enforcement approach stands in stark contrast to the hundreds of hospitals identified as non-compliant in successive reports.

A recent Government Accountability Office review criticized CMS for lacking "assurance that pricing data hospitals report are sufficiently complete and accurate," and recommended stronger assessment and enforcement measures.

Industry Bright Spots

The report did highlight exemplary compliance from several facilities, including Taylor Regional Hospital in Kentucky, Adventist Health Sonora in California, and Memorial Hospital in Illinois. Among larger health systems, Prime Healthcare achieved a 90% pricing sufficiency rating, while Baylor Scott & White reached 68% and Sanford Health attained 59%.

These successful implementations demonstrate that comprehensive price transparency is achievable, even within complex healthcare delivery systems.

Consumer Impact and Economic Implications

The persistent lack of price transparency continues to hamper healthcare consumers' ability to make informed financial decisions. Without access to clear, comparable pricing information, patients remain vulnerable to unexpected bills and cannot effectively shop for more affordable care options.

Healthcare costs currently represent 17.3% of the U.S. gross domestic product, and transparency advocates argue that improved price disclosure could help reduce these expenditures by fostering competition among providers.

Reform Recommendations

PatientRightsAdvocate.org has called for several policy changes to strengthen transparency requirements:

• Reversal of recent regulatory rollbacks that allow estimates instead of actual prices
• Mandatory executive attestation of data accuracy and completeness
• Standardized file formats that are both machine and human-readable
• Expanded transparency requirements for all healthcare providers, including ambulatory surgical centers
• Immediate enforcement actions against hospitals failing basic validation requirements

Looking Forward

As healthcare affordability continues to challenge American families, the hospital price transparency debate reflects broader tensions between regulatory intent and industry compliance. With a new administration taking office and healthcare costs remaining a national priority, the effectiveness of current transparency policies may face renewed scrutiny.

The report's authors emphasize that "only true transparency in the form of all prices in dollars-and-cents across all payers and plans will enable a robust competitive market, giving patients the ability to access upfront prices at their fingertips."

Whether federal regulators will strengthen enforcement or hospitals will voluntarily improve compliance remains an open question as the healthcare industry grapples with persistent calls for greater pricing transparency.