Hospitals serving more disadvantaged patient populations lagged on complying with price transparency regulations, according to recently published research covering the first quarter of 2022 to the third quarter of 2023.
Prior data on the federal government’s initial price transparency requirements—which went into effect in 2021 and threaten fines for noncompliance—has outlined inconsistent hospital compliance, particularly among facilities with fewer resources.
An analysis published Friday in JAMA Network Open takes it a step further, warning that the purported benefits of easily available payer-negotiated prices are likely out of reach for those who could most benefit.
“Given that racial minority and low-income groups are more likely to experience health care–related financial stress, our findings reveal a harmful paradox: less transparent information available for disadvantaged patients, who have the greatest need to make financially informed decisions,” researchers wrote in the journal.
The researchers’ cross-sectional study reviewed Medicare hospitals’ quarterly price compliance using data from healthcare pricing company Turquoise Health. To determine a hospital’s care for disadvantaged patients, they looked to the Lown Institute’s hospital indices for race and income, as well as whether a hospital had a Disproportionate Share Hospital designation.
Across their sample of 2,464 hospitals, facilities determined to have more disadvantaged patients near-uniformly showed significantly lower price transparency compliance rates, and were less likely to become compliant with the requirements over the course of the study period.
Additionally, the researchers found evidence challenging “a common assumption that hospitals may be noncompliant to avoid disclosing high prices that could harm brand or market position.” Namely, by looking at the payer-reported negotiated prices for 10 oncologic procedures between the hospitals, they found that price transparency-compliant hospitals had significantly higher average negotiated facility fees for six of those procedures than the noncompliant hospitals.
“For example, the mean negotiated facility fee for a prostatectomy at compliant hospitals [of $9,594] was $1,677 higher than that of noncompliant hospitals [$7,917],” the researchers wrote.
Taken together, the researchers said their findings suggest that the federal government should consider policy alternatives to “regressive financial penalties” for hospitals serving disadvantaged patients. To date, the Centers for Medicare and Medicaid Services have publicized enforcement actions against 28 hospitals over price transparency noncompliance.
“Instead, policies should promote capacity to help patients make financially informed care decisions with increased technical support or targeted funding for information technology modernization,” the researchers wrote.
Price transparency policies have been pushed forward by multiple administrations, with requirements around the types and formats of data published by hospitals as well as payers steadily increasing.
Most recently, a late 2025 final rule went into effect April 1 that requires the publication of median allowed amounts as well as 10th and 90th percentile allowed amounts. Per Turquoise Health, over 2,700 hospitals had published machine-readable files that correctly match the new format and nearly 2,000 had populated the new median allowed amount field.