WASHINGTON – In response to the Center for Medicare & Medicaid Services’ (CMS) Request for Information (RFI) on hospital price transparency, Consumers for Quality Care (CQC) board member Donna M. Christensen — former Member of Congress and the first female physician to serve in the U.S. House of Representatives — released the following statement:

“As a former physician and policymaker, I know firsthand that hospital pricing should never be a mystery, especially to the patients whose lives and finances are on the line. Far too many families are blindsided by medical bills they didn’t see coming, and the lack of transparency only deepens the affordability crisis we’re facing.

Consumers for Quality Care is proud to advocate for stronger, clearer enforcement of hospital price transparency rules. Patients deserve accurate, complete, and understandable pricing data—not confusing estimates or hidden costs. We urge CMS to take bold action to hold hospitals accountable and ensure that consumers can access the information they need to make informed decisions about their care”.

Dear Secretary Kennedy and Director Oz:

Thank you for the opportunity to provide feedback on hospital price transparency, accuracy and completeness. Consumers for Quality Care (CQC) is a coalition of advocates and former policy makers partnering with health advocacy organizations to provide a voice for patients in the health care debate as they demand better care. 

Our nation’s families are experiencing a severe health care affordability crisis, driven in large part by hospital care, which is the single largest component of national health care spending. Every year, America’s nonprofit hospitals reap hundreds of millions, and in some cases billions, of dollars in tax breaks, due to their status as charitable organizations. Often, however, these same hospitals overcharge their patients while also hiding important pricing information from them. They also devote too few resources to charity care and other community benefits. Together, these practices leave many patients mired in debt, stuck with medical bills they can’t afford to pay.

CQC is a strong supporter of meaningfully transparent hospital pricing data that helps consumers know what to expect when it comes to the cost of their care.

1. CMS should specifically define the terms “accuracy of data” and “completeness of data” in implementing and enforcing the federal hospital price transparency regulation. CMS should clarify that, in order for data to be considered “accurate” and “complete,” and hospitals deemed in compliance with the rule, they are required to submit pricing data, including negotiated rates in dollars and cents, prohibiting them from obscuring such prices as estimates, including “expected allowed amounts,” percentages, or algorithms.

While the federal Hospital Price Transparency Rule has been in effect since 2021, Patient Rights Advocate has found that only 21.1% of hospitals analyzed are fully compliant with all requirements of the rule. If hospitals can generate a bill based off the negotiated rates for each item and service, then they should be able to share those prices with the actual purchasers of health care.

2. The pricing information that is most critical to achieving meaningful price transparency is the rate that is negotiated between specific payers and specific hospitals, referred to as the negotiated rate, reported in dollars and cents. That is the number that allows patients to identify how much they pay for care before a service has been delivered or a bill has been sent. When hospitals sidestep price transparency reporting requirements by providing values that are difficult to understand, patients lose.

3. Far too many hospitals fail to comply with the federal hospital transparency rule. Some hospitals have failed to post any negotiated rates at all. Others display incomplete information or post data in ways that are difficult for most people to understand, such as listing prices as a percentage of Medicare rates. Only 21.1% of our nation’s hospitals are considered in compliance with the federal hospital price transparency rule while only 17% of hospitals posted their negotiated prices in dollars and cents and the number of compliant hospitals is decreasing rather than increasing. This suggests that the civil monetary penalty of up to $2 million is not strong enough to achieve meaningful compliance.

4. While nonprofit hospitals are organized as charities to deliver affordable health care to those in their communities who need it most, many of America’s largest non-profits are making big money. Our nation’s families deserve affordable and high-quality medical care. 

5. Hospital prices vary widely across the country, and the highest and lowest prices for standard outpatient services can vary by nearly 300%. In order for patients to make informed decisions about their care, meaningfully transparent hospital pricing information must be available.

CMS must do more to strengthen implementation and enforcement of the hospital price

transparency rules, including by requiring hospitals to post actual negotiated prices, in dollars and cents, not estimates, percentages, or algorithms. Only the disclosure of negotiated rates in dollars and cents should be considered and defined as “complete” and “accurate” information for the purposes of enforcement of the federal hospital price transparency rule.