ATLANTA — A new report by PatientRightsAdvocate.org (PRA) found several Georgia hospitals are not complying with a Federal Hospital Price Transparency law. The law took effect in January 2021 as part of the Affordable Care Act. It requires all U.S. hospitals to post the costs of many of its services online. This allows the consumer to shop around for the lowest price and make sure they’re not getting overcharged.
The report released by PRA claims that only 14 of 44 hospitals in Georgia are complying with the Federal Hospital Price Transparency Rule.
PRA Founder and Chairman, Cynthia Fisher said this is holding Georgia back.
“Being that over 68% of the Georgia hospitals are making it difficult to find prices, not completing the pricing data, or not showing all of their payers or plans, and cross-referencing different rates, that makes it impossible, for having a market economy in Georgia to be able to lower the cost of care, by allowing us to go on to Google and search where to get an MRI for $300 versus paying over $3,000,” Fisher said.
11Alive focused on three major healthcare systems PRA said are not complying in the metro area.
The hospitals listed as non-complaint are:
- Grady Memorial Hospital
- Emory Decatur Hospital
- Emory Saint Joseph's Hospital
- Emory University Hospital Midtown Fairview Park Hospital
- Wellstar Cobb Hospital
- Wellstar Kennestone Hospital
- Wellstar West Georgia Medical Center
According to PRA, these locations are not fully complying with the law for a number of reasons, ultimately blocking a consumer from seeing a full list of the pricing information.
PRA released the following statement on Grady Memorial Hospital:
“It appears that there is just one issue that underlies the reason for our assessment: a lack of plan names in the machine readable file.
A key part of the federal rule requires that both the "name of the third-party payer and plan" be identified (Sec. 180.50(b)(3)). For some of the payers in the file, only payer names are identified, and not plan names. As an example from the file, “Aetna/Coventry,” “Cigna,” and “Humana.” These payers may offer several commercial plans (PPO, HMO, POS), but it is not possible from the file to determine which plans the prices disclosed correspond to. We deemed them noncompliant due to the lack of plan names as required by the rule."
PRA also released the following statement on Wellstar Cobb Hospital, Wellstar Kennestone Hospital and Wellstar West Georgia Medical Center:
“These hospitals only post de-identified minimum, maximum, and negotiated rate prices for DRG codes, not all billing codes. Page 133 of the Hospital Rule states that hospitals must post 'Any code used by the hospital for purposes of accounting or billing for the item or service, including, but not limited to, the CPT code, HCPCS code, DRG, NDC, or other common payer identifier.
We recognize that CMS is the only entity that makes legal determinations of compliance. CMS has not made its standards of review available to the public, so we cannot speak to the details of CMS’ compliance assessments. We stand behind our findings that these three hospitals are not in full compliance because they only posted prices for DRG codes, not all codes.”
Additionally, PRA provided this statement on Emory Decatur, Emory Saint Joseph’s and Emory University Hospital Midtown:
“These hospitals only post de-identified minimum, maximum, and negotiated rate prices for DRG codes, not all billing codes. Page 133 of the Hospital Rule states that hospitals must post 'Any code used by the hospital for purposes of accounting or billing for the item or service, including, but not limited to, the CPT code, HCPCS code, DRG, NDC, or other common payer identifier.’ We stand behind our findings that these three hospitals are not in full compliance because they only posted prices for DRG codes, not all codes.”
So which hospitals are complying? According to PRA, Northside Hospital Atlanta and Northside Cherokee in Canton are gold standards.
This came after Northside Hospital Atlanta was fined $883,180 and Northside Hospital Cherokee was fined $214,320 by the U.S. Department of Health and Human Services (HHS) for not making standard charges public.
According to PRA, they are the only two hospitals in the nation that have received fines in connection with the Federal Hospital Price Transparency Rule.
To check for prices, look for a section on a hospital’s website called “pricing transparency information.” In this area, you should be able to find standard prices for a number of services.
Wellstar sent 11Alive the following statement in response to this report:
“We have written notification from the Centers for Medicare & Medicaid Services (CMS), which reviewed and audited the public Wellstar.org website for transparency and found us to be fully compliant with all Hospital Price Transparency regulatory requirements.”
Grady sent 11Alive the following statement in response to this report:
"Grady Health System has not received any notice from CMS stating that we are non-compliant. Further, a comprehensive audit was conducted by a third party that demonstrated we are in compliance with price transparency regulations."
11Alive reached out to Emory Hospital for a statement but has not yet received one.
PRA said they stand by its report and are calling on HHS to take action and issue fines to all U.S hospitals that are not complying with the law.