Improving Hospital Price Transparency in Pennsylvania

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JUST 1 IN 5 PENNSYLVANIA HOSPITALS ARE COMPLIANT WITH FEDERAL HOSPITAL PRICE TRANSPARENCY REQUIREMENTS.

WHY THIS MATTERS 

• Prices for healthcare services can vary greatly by location. As just one example, the average cash price for a routine colonoscopy is $313.00 at St. Vincent Hospital in Erie, PA, while the average cash price at West Penn Hospital in Pittsburgh is $1,051.50. 
• A patient could save over $700 by driving two hours to a different location for this procedure. 

NEXT STEPS TO IMPROVE COMPLIANCE IN PENNSYLVANIA 

• State policies can encourage greater compliance with federal requirements, giving patients more control over their care and wallets. 
• The Department of Health and Human Services finalized a rule in November 2019 that requires hospitals to publish prices. As of January 2021, hospitals are required to publish a machinereadable file of five types of standard charges for all items and services. They are also required to create a consumer-friendly, shoppable list of 300 items and services, including 70 identified by the Centers for Medicare and Medicaid Services (CMS). 
• Full compliance with the federal rule, as defined by CMS, remains low nationwide. A Patient Rights Advocate report from February 2024 estimates that just over one-third of hospitals nationwide are fully compliant. 
• Just 20% of hospitals surveyed (18 out of 90) in Pennsylvania are fully compliant. 

HOSPITAL PRICE TRANSPARENCY WOULD HELP PENNSYLVANIANS SAVE MONEY 

• It would require hospitals to publish all standard charges for items and services, including gross charges, negotiated rates with insurers, and cash prices, in a machine-readable format on their websites.  
• It would mandate hospitals to maintain a consumer-friendly list of charges for at least 300 "shoppable" services, including any ancillary services. 
• It would create additional state monitoring and enforcement mechanisms, including monetary penalties for non-compliant hospitals. 
• It would prohibit hospitals from initiating or pursuing debt collection actions against patients for items or services provided when the hospital was not in compliance with the price transparency requirements. 
• It would allow patients to initiate civil actions against non-compliant hospitals that pursue debt collection.