~20 percent of hospitals provide CMS-compliant pricing information for two CPT codes and two DRG codes
TUESDAY, June 28, 2022 (HealthDay News) — Most hospitals do not provide total joint arthroplasty (TJA) price estimates on their websites or are noncompliant when presenting related information, according to a study published online June 23 in Clinical Orthopaedics and Related Research.
Robert J. Burkhart, from the Cleveland Clinic Foundation, and colleagues examined whether hospitals are compliant with federal rules mandating transparency in pricing for primary TJA and whether these data are being provided in a user-friendly format in a cross-sectional retrospective analysis using the Centers for Medicare & Medicaid Services (CMS) Hospital Compare database. The database included information for 5,326 Medicare hospitals; after a selection process, 1,719 hospitals remained. Pricing information was obtained from Dec. 1 through 20, 2021, to assess compliance in the first year since implementation of price transparency legislation.
The researchers found that only 32 percent of 400 sampled hospital websites were compliant with all six requirements under the CMS rule for pricing transparency. On classification by individual procedures, 21, 18, 18, and 19 percent of hospitals provided CMS-compliant pricing information for CPT codes 27447 and 27130 and DRG codes 469 and 470, respectively. The corresponding rates of pseudocompliance were 36, 31, 34, and 50 percent for each of the included codes. At least some of the pricing data were provided in a user-friendly format for most included hospitals.
“Despite legislation aimed at reducing national rates of surprise billing and increasing the affordability of health care, recent data have demonstrated noncompliance with price transparency mandates at the national level,” the authors write.
Several authors disclosed financial ties to the medical device and other industries.
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