Pittsburgh Business Times: Hospitals defend against claims of pricing transparency failures

A new report on hospital price transparency claims that many hospitals and health systems — including some of the region’s biggest names — aren’t compliant with federal rules requiring details on their website. But some of the hospital systems that are listed in the report, including UPMC, pushed back on the report and said they complied with the report.

The report by PatientRightsAdvocate.org said that only 24.5% of 2,000 hospitals studied meet the hospital-price transparency standards that have been imposed in stages by the federal government. Those require hospitals to provide to consumers how much a service or item will cost in a clear and accessible way. CMS since January 2021 have been auditing hospitals and health systems and how they comply with the Hospital Price Transparency Final Rule. Two hospitals in the country have received notices for noncompliance of the rules, both in 2022, none in Pennsylvania.

PatientRightsAdvocate said that compliance rates have gone up, with 489 compliant hospitals out of 2,000 reviewed, an increase from the 319 compliant hospitals out of 2,000 in August 2022. But the others’ are mostly incomplete.

“This noncompliance obstructs the ability of patients, employer and union purchasers, and technology developers to comparatively analyze prices, make informed decisions, and have evidence to remedy errors, overcharges and fraud,” according to the report.

The report said that UPMC, one of the nation’s largest hospital systems, had no compliant hospitals out of the 33 that it reviewed. UPMC told the Business Times that PRA’s data was inaccurate.

“We have seen inaccurate analysis from this organization before. The PRA website is (and has been for some time now), wrong,” said a UPMC spokeswoman. “PRA completely misses that the appropriate pricing information has been available to the public on UPMC’s hospitals’ websites for more than the past year.”

UPMC said that PRA uses its own criteria for compliance, which is different from what the federal regulators, CMS, use. UPMC said it’s in compliance with CMS regulations. And it pointed to concerns from the American Hospital Association about the differences between CMS and others looking at the data.

The same was true for WVU Health System, whose J.W. Ruby Memorial Hospital in Morgantown and WVU Medicine Wheeling Hospital were reported as “noncompliant.” Spokesman Anthony Condia said the Centers for Medicare and Medicaid Services has notified WVU Medicine that their hospitals were in full compliance with the price transparency.

But PRA told the Business Times that the files analyzed were downloaded on Jan. 13, 2023.

“The majority of the UPMC hospitals included in our Fourth Semi-Annual Compliance Report have one point of failure: Standard Charges File fails to adequately identify specific plans for all commercial payer,” PRA said. CMS requires each payer-specific negotiated charge to be clearly associated with the third-party payer and plan.

Other hospitals in the region listed as noncompliant are Allegheny General Hospital in Pittsburgh, AHN Jefferson Hospitals in Jefferson Hills, and Excela in Greensburg. Excela said it was looking at the report and AHN said it meets all CMS regulations with transparency.

Only one in the region, St. Clair Hospital in Mount Lebanon, were ranked as compliant. That’s due in large part to the focus under the administration of former CEO Jim Collins. St. Clair said that it was one of the first in the country to implement the pricing transparency online in 2016, five years before it was required.

“We remain committed to promoting price transparency to not only take the mystery out of health care costs but also provide high value to our patients,” said Eric Luttringer, SVP and CFO.