Only actual hospital prices, displayed as dollars and cents, not estimates, formulas, or algorithms, protect patients from outrageous bills and hold hospitals accountable for overcharges, errors, and fraud. Accepting CMS’ or other substitutes instead of actual prices undermines broader efforts to make hospital price transparency a reality for American patients and healthcare consumers.

About 36% of U.S. hospitals are in compliance with CMS’ price transparency rule, up from 24.5% in February, according to a new report. This progress will remain slow unless CMS can do a better job of effectively enforcing its rule, the report declared.

As of January 1, employer-sponsored Group Health Plans and Health Insurance Issuers must make make the prices of 500 medical services available via an Internet-based tool. The Transparency in Coverage final rule gets even tougher on January 1, 2024, when the prices of all medical services must be made available via an Internet-based tool.

Here are the top 10 hidden facts about hospital prices that answer questions about why it is so expensive and why the bills are so complicated.

Amid the difficult healthcare environment, it’s important to note that there have been some wins for employers, said Katy Spangler, senior advisor of the American Benefits Council, during the Midwest Business Group on Health conference held Tuesday. These wins include the No Surprises Act and price transparency rules.

CMS recently fined two hospitals for alleged violations of its price transparency rule. These fines are only the third and fourth penalties issued by the agency since the rule took effect on January 1, 2021. These fines may become more common — CMS also announced that it is updating its enforcement process for the rule.

As a first step to move toward greater hospital price transparency and lower costs, CMS can immediately issue $2 million fines on the 30% of American hospitals it concludes are noncompliant. If CMS takes enforcement seriously, the hospital industry will respond by quickly coming into compliance.

It’s not enough to be hopeful that hospitals with the right tools—and incentives will put prices out there on a menu for all to see. Luckily, for employers and employees who want to access affordable healthcare, new and emerging solutions are empowering them with information and options.

Aneesh Chopra, president and co-founder of CareJourney, predicted accelerated enrollment in value-based care models in 2024 and 2025. He thinks this will greatly increase healthcare transparency for a few reasons, including making data more available and influencing more primary care doctors to act as health information fiduciaries on behalf of their patients.

Price transparency has come a long way over the past couple of years, with insurance companies and hospitals now required to publicly disclose their prices. The more pressing issue is that there is no mechanism in place to make this information easily digestible, personalized to each patient, and placed in context with competitors’ prices.

Transcarent wants to transform the digital pharmacy benefit experience, enabling self-insured employers and their staff to make more informed choices.

Payers and providers face different challenges when it comes to compliance. The volume of price transparency data that hospitals must disclose online amounts to about 3 terabytes — compared to the whopping 630 terabytes of data that payers have been tasked with posting.

Price transparency data has revealed there is a high degree of price variance for healthcare procedures depending on patients’ insurance carriers and the location in which services are delivered. Jaewon Ryu, Geisinger’s president and CEO, said that the only way this variability can be addressed is by getting decision makers on the payment side much more aligned with the care delivery side of things.

The healthcare industry is still building software to can handle its complex and vast pricing data, so it still has a few more years to go before price transparency information actually becomes useful. Once software development cycle matures, this data can infiltrate the way providers and payers negotiate contracts and affect the way patients shop for care.

TALON was recently crowned winner of the Pitch Perfect contest at MedCity’s Invest Digital Health conference in Dallas. The company offers a suite of solutions to help stay compliant with the Transparency in Coverage Rule.

The question elicited predictable and unexpected responses from panelists that included a senior executive from CVS Caremark and executives from startup companies working to change the pharmacy benefits landscape.

Virginia-based Careviso recently raised $17 million in Series B funds. The company — which is focused on improving transparency and access for diagnostic testing — will use the funds to enhance its platform’s price transparency tool and deploy it in physician offices so it can be used at the point of care.

The patient financial experience in the U.S. is poor — patients have a hard time understanding pricing data and they often face exorbitant prices for care and medications. This problem will only get better if the healthcare industry rids itself of price-gouging middlemen and closed-door price negotiations held by businesspeople, according to a recent healthcare innovation panel.

The drive to “fix healthcare” is ingrained in our society. Politicians speak about it regularly, consumers struggle to understand it, and yet the “how” of fixing it is delivered with ambiguity and jargon. With increased urgency to improve healthcare, everyone is now laser focused on this topic. But, over time, the term “healthcare” itself has lost the part about care. So how do we fix it?

How is the patient journey impacted when individuals have an estimate of care costs before […]

Last year’s price transparency laws were an important step for the industry, but there is still much work to do. The only way we can ensure a better functioning healthcare system is to create clear pricing. We need to base that pricing on consistently-defined and well-communicated healthcare service units.

In a rapidly changing and expanding healthcare environment, the secure exchange of health information and price transparency enabled by real-time benefit tools is critical to improve patient safety, lower costs and ensure quality care.

Removing barriers to care won’t be easy, and it won’t happen overnight, but by having a consumer-driven health mindset, we can make health care more equitable.

Experts believe CMS’ price transparency rule is flawed in its design because the highly complex billing data it is asking hospitals to post is too confusing for consumers to understand. The complicated structure of the healthcare system — from care variance to deductibles to billing codes — means that producing an accurate price estimate is virtually impossible. To improve compliance, hospitals will need health tech companies to step in.

By improving billing and payment systems, healthcare providers can help ease what is a common, anxiety-inducing burden for many patients.

Pulling back the curtain on healthcare pricing is easier said than done, acknowledged Chris Severn, the company’s co-founder and CEO. That’s exactly why the investment is so important.

Solv Health launched ClearPrice that compiles data from more than 5,000 providers so consumers can evaluate the cost of various services before they are rendered and decide if they want to pay cash or use insurance.

While hospitals are slow to comply with the price transparency rules, full compliance will eventually mean hospitals provide “machine readable files” with thousands of lines of pricing data.

There are a few ways to make it easier on hospitals to accomplish price transparency and some common mistakes they can avoid so they don’t have to pay excessive fines.