Hospital Compliance Levels, Patterns Disappoint After Price Transparency Rule Implementation: Study Suggests Many Hospitals Cherry-Pick Measures for Compliance

By Gina Veazey

A new federal rule aiming to give health care consumers more meaningful information about the cost of care obligates hospitals to reveal certain negotiated prices and give consumers an interactive, shopable tool. But a new study, “Early Hospital Compliance With Federal Requirements for Price Transparency,” published in JAMA Internal Medicine, shows hospital compliance with the rule is disappointing. Researchers found only about 20 percent of hospitals were in full compliance as of March, following the January 1 compliance deadline. Moreover, researchers found that many high-revenue hospitals were sidestepping provisions that could help identify market distortions and inform negotiations and price analyses.

The rule, “Price Transparency Requirements for Hospitals To Make Standard Charges Public,”pulls back the curtain on hospital-insurer negotiated prices and is intended to give patients access to information about the market-based cost of care. It expands the information hospitals are required to disclose expands the information hospitals are required to disclose under section 2718 (e) of the Public Health Service Act. Hospitals had previously been able to satisfy those requirements by posting a chargemaster, which contains information that is of little value to consumers.

The new requirements give consumers access to the real-world prices that hospitals and health plans have negotiated as part of their contracts, as well as the hospital’s discounted cash prices. For consumers, these prices allow meaningful price comparisons and better planning for health outlays. The rule requires hospitals to post standard charges prominently on a publicly available website. It instructs hospitals to give patients a shoppable tool, allowing consumers to compare the costs of services like a colonoscopy or an MRI at different hospitals. It also instructs hospitals to post the pricing information in a machine-readable file (such as an Excel spreadsheet). And that’s where the researchers spotted issues.

In the study, researchers looked at compliance by 100 randomly sampled hospitals and the 100 highest-revenue hospitals. Beyond the high-level finding — a full compliance level of about 20 percent overall — they also found “selective” compliance. “Interestingly, the highest-revenue hospitals exhibited selective compliance — 86% provided prices to individual patients through price estimator tools, but only 35% reported payer-specific negotiated rates in a file. This limits any real impact on prices,” said Suhas Gondi, one of the study authors, in a June 14 Tweet thread.

Unlike the consumer-friendly tool, which serves up a discrete set of information specifically for a given consumer, a machine-readable file unlocks access to a complete dataset. Indeed, the prospect of gaining easy access to a treasure trove of hospital pricing data has itself been heralded as an important element of the rule, with implications for driving down cost, for market analysis, and for future price negotiations. “Because patient-oriented price estimator tools make prices visible only for a given patient and insurance plan and not to payers or the public, selective compliance may fail to expose abuses of market power, affect price negotiations, or support broad analysis of price variation to the extent intended by the transparency initiative,” the researchers wrote.

Enforcement Measures

The research ultimately suggests that the measures used for enforcement of hospital compliance are an insufficient counterbalance to market-based rewards for keeping pricing information private. In the Tweet thread, Gondi says the study authors believe that enforcement provisions are insufficient to drive meaningful compliance by hospitals. The monitoring and compliance plan promulgated as part of the rule lays out a series of three successive actions that the Centers for Medicare & Medicaid Services (CMS) can take in the case of noncompliance — a written warning notice, a request for a corrective action plan, and imposition of civil penalties. The penalty portion of enforcement tops out at $300 per day, an amount that Health Affairs mocks as trivial, noting that, even if a hospital were noncompliant for an entire year, the penalty would be just $109,500, or roughly the “equivalent to seven c-sections.”enforcement

Commentary: Price Transparency in the Balance

Although it is understandable that hospitals would want to keep specific elements of their negotiated pricing private, as Gondi says in the Tweet thread, “If price transparency is going to have any impact, hospitals need to play ball.”
Hospitals have long been vocal about the hardships their patients encounter as health costs rise. And, they have complained that the trend toward higher deductibles has put more patient debt on their books. By their own arguments, hospitals win when systemic costs of health care decline and when patients become part of that solution.

Genuine market-based pricing information is the missing link that is preventing patients from behaving like true health consumers. Price transparency may not be the solution hospitals would choose, but outright subversion of the rule isn’t a productive solution either.

Gina Veazey is a writer and consultant focused on health care. As the former editor of the America’s Health Insurance Plansprint magazine, Coverage, her interests and experience are far-reaching and include topics in public health, consumer health engagement, precision medicine, health information technology, Medicare Advantage, and many others. She can be reached at

Mother’s Day. Everyday.

Ann lived to be 95, but in some ways she never was old. Her code of life was timeless: generosity, kindness, understanding, and empathy. There are people in this world who had the heart of saints. She was that person.

Her life’s mission was to give, spread joy, give again. She rooted for you like no one else. Her laughter echoed through a room, and her solemn prayers were songs to her.

She would whisper her prayers at different times of the day. Sitting on the couch. Standing in the kitchen.

As a young woman, she was the one you turned to about feelings. She listened and would offer the most soothing words imaginable. She hardly ever raised her voice, was understanding, and always wanting to help others. Ann’s mom was her best friend.

Ann’s devotion to her family was paramount. She always pitched in to help family members and especially doted on her grandchildren and great-grandchild. She was there for you. She was ready for the call to watch the kids. She helped prepare the dinners. She washed the dishes. Loads of laundry, she was there. She was chairwoman of the ironing board.

Ann never met a child who wasn’t adorable, sweet, someone who would brighten her eyes and dazzle her conversations. “Isn’t that baby beautifulllllllll,” she asked in enthusiastic exaggeration. There wasn’t any occasion she wouldn’t enthusiastically join in: shopping, dining out, music, theater, horse racing, and other social occasions. Whatever sports the kids were involved in, she was ready to cheer them on. She watched baseball and basketball games on TV and knew exactly who she was cheering for.

Ann spent much time crafting messages of love – cards, cards, cards. She loved greeting cards and would add her messages. She could have been in the Hallmark Hall of Fame. She loved putting everyone’s birthday or anniversaries on her calendars.

She was a bookkeeper and office manager. For several years she worked near the docks as she regaled family members with getting a ride by a distant relative so she could safely go to work one day and there could be trouble. She escaped any problem! Mom, mom, there were mobsters!

After her husband died at age 70, she maneuvered her own life, drew up the courage to move to move far away into her own condo, knowing and relying on a son and his family nearby.

Never enamored of animals, she did, however, take to the family pets. But don’t let insects or other “strange creatures” get in her path. When tiny lizards would make their presence known, she kept a wary eye on them, with a vacuum cleaner nearby.

Ann had quiet determination and turn-on-a-dime discipline. A non-smoker half her life, Ann took up smoking in her later years. But when she was stricken with an illness in her 80s, she quit, “cold turkey.”

As an octogenarian, she was walking a quarter-mile from her condo every day to see her son and his family. Sometimes people would see this elderly woman on the sidewalk and ask her if she wanted a ride. No, thank you.

That spirit of life helped her overcome many illnesses in her later years. She would get very very sick. And then bounce back, up to her old self.

The last time I spoke to her was probably a couple of weeks or more before she died. She was in the assisted living facility, ready to plan her day. She wanted to write checks. She wanted to go shopping. She wanted to get her hair done, all things she loved. Maybe get some chocolates. That was her plan, anyway. She would be a little upset when she saw her son unkempt in a video chat. “What’s up with your hair?” She asked. He had played tennis. “Did you win?” she asked. Yup, she was a bit competitive.

It is Mother’s Day weekend when we honor our moms. Ann was the embodiment of a Mom, and then some. – Joe Cantlupe, Health Data Buzz

Biden Takes Office, a President Familiar With Pain and Grief – “Democracy has prevailed”


Joseph R. Biden took the oath of office today as the 46th President of the United States, as a nation looks for hope despite armed guards filling the DC streets, with his predecessor Donald Trump leaving town, trailed by scandal, and outrage.

“Democracy has prevailed!” Biden said. He acknowledged the violence that hit the nation’s Capitol Jan. 6. “We’ll press forward with speed and urgency” with much to do, he added. Few people in this country have been more challenged than we are now, Biden said, noting the pandemic and the cry for racial justice. “I will always level with you,” he said.

“They healed a broken land,” Biden said he envisions future generations speaking of us today. He said he envisioned helping write a story of hope…love and healing…greatness.” It is a story Biden envisions “we answered the call of history, we met the moment.”

With many of us in pain over loss and despair, amid the year old pandemic that has cost 400,000 lives, Biden, once written off as a has-been contender, begins his blistery term amid with a monster set of goals and work ahead.

Vice President Kamala Harris took office, the first Black woman and Asian-American in that high-ranking position.

There was pageantry at the Capitol, amid the bands, the flags, the celebration, and yet two weeks ago, it was a place stained by rioters, egged on by the disgraced former president, who took off for Florida, without acknowledging the name of the person who succeeded him.

Amid it all, Biden reminds us: he has suffered and lost. And he came back to serve for more. Again and again.


Bye, Bye: President Terrible (He’s flying off to Florida)


We knew it was coming, didn’t we, a long time ago? No, not impeachment No. 1. No, not impeachment No. 2. I’m talking the arch of his character crash merely days before his final exodus. Did it begin in the 1970s in the Big Apple with rash and in your face developer Donald Trump, who talked trash against anyone, women especially. Or the last four years as he belittled anyone who opposed him, who failed repeatedly in carrying out promised policy, like healthcare, the futile mess of the coronavirus, and other ineptitudes, and thousands of falsehoods leading to the denial of losing the presidency, amid a cascade of untruths that the election was rigged, tainted and simply wrongly counted, in ways he roused his followers to destruction and death at the Capitol. In many ways, Trump stood in the mirror of his sharpest attacks against others: nasty, terrible, loathsome , despicable, no good, in the view of many.

When Trump wouldn’t disclose his tax returns, when he embraced the wrong side at Charlottesville, when he talked about hurricanes with a Sharpie, when he, when he, when he, ……….

Remember he was going to promulgate the greatest healthcare ever. Remember when he was going to knock the coronavirus on its collective butt, yet didn’t bother wearing a mask as even a symbol to help people, and when the number of deaths soared, he disappeared, and the logistics of vaccines vanished in the maze of this presidency. Speaking of vanishing — when — where were those taxes of his anyway?

Remember when he said would not lose votes even if he shot someone on Fifth Avenue.

Remember he’s the President of the United States who has made about 20,000 false or misleading statements, according to the Washington Post.

Remember he’s the guy who said “love you” to those who erupted and trashed through the U.S. Capitol, in a riot that left 5 people dead. When his Vice President Mike Pence could have been in danger from the hoodlums, extremists and zealots, – did Trump try to intervene, and say he was sad?

He’s the one-term who’s now been impeached twice, he is Super Hit 1 in the gallery of impeachments.

He’s Super Hit Worst President.

The sad thing is, he got away with his terribleness for too long, too many of his followers looked away, too many Republicans stood by his side, and the first Democratic led impeachment process a year ago was a fiasco in its too many bungled accusations buried in legalese, and trumped by former AG Barr.

This morning, Trump left for Florida, while incoming President Joe Biden attended a church service in Washington D.C. with congressional leaders. In his closing remarks and before, Trump never mentioned Biden’s name. However, Trump left a note for his successor, becoming the 46th president, according to CNN.

For the health of all of us, — yes even the 71 million who voted for Trump (what were they thinking?) – Today shines bright, a new day. A day that Donald Trump left the White House.

Joe Cantlupe – Health Data Buzz

A Shaken Country

America trembled tonight.

This evening, inside the Capitol in Washington D.C. as lawmakers tried again to count the electoral college votes to reaffirm Joe Biden as the next President of the United States, there was oratory from the mouths of lawmakers covered with masks.

They were shaken. The turmoil of the Trump presidency is not flagging. Through Trump’s entreaties, chaos ruled today as his supporters attacked and rushed inside the Capitol, causing destruction, resulting in injury and even a death.

The stain on our democracy won’t be erased, said Minority Leader Chuck Schumer, senator of New York.

Too many people believed in Trump over truth, said Sen. Corey Booker of New Jersey.

There was no theft of the Trump presidency as his mob of supporters thought. Instead, Trump is stealing our soul.

We live in the shadow of the COVID-19, which reached its highest daily death count yesterday. The crowds will result in even more illness and death.

Today, even covid seemed secondary.

Our mental health, our psyche was cracked by this attack in DC.

“A house divided against itself cannot stand,” said Abraham Lincoln.

It can’t.

— Joe Cantlupe, Health Data Buzz

2021: Walking Backward

It’s over, done, but I never knew as 2020 slogged on, the pandemic year, that I would want to hold on to it, a bit more.

When many people think of 2020, it may have been a bit easier to think of gratitude and less so of happiness.

Happiness seems to crush the reality of 2020, it seems for many many people, especially those who lost loved ones because of COVID-19.

For me, too, not because of covid. My wife died a few weeks ago of cancer and yet I hold on to 2020. Only weeks before, I was drafting a story to write off 2020 as a complete disaster. Now I miss most of 2020, of course.

In her journals over the years, and in her life, Michele, an education writer, held on to moments of gratitude and happiness that she searched and lived for, and embraced with her many friends and family members. These are things I’m trying to learn.

A decade ago, she wrote: “Happy New Year and New Decade!!!!”

“I have so much to be grateful for. I can walk, jog, think, talk, connect, sing, I can learn,” she wrote.

She mentioned about being grateful for her family and even a 22-inch snow, and to “be able to shovel snow from that snowfall!”

“Today, I’m grateful for too much work because that means I have some!” I can see her excitement in the curls of her words, the exquisite penmanship.

In a Happiness Project journal, several years later, walking still brought and continued to deliver much joy for her. “I know I shouldn’t keep writing about my walks,” Michele wrote, but they were certainly a highlight.

For me, I’m grateful for those in healthcare who worked like crazy not only for my wife but for others, during this pandemic. I’m also grateful for the cascade of cards and letters, from people who expressed sympathy and echoed reminders of the joys of being together, with her.

On a national level, I’m grateful for the glimmer of hope in the presidential election as the harsh mirage of Donald Trump eventually escapes as the pandemic will itself, and the vaccines take hold. Grateful.

Happiness, well, I’m not there.

“Times does not heal,” observed a former colleague, a wise editor who lost his wife 33 years ago. “ If anything time numbs the memories.”

As Michele would say, it’s time for a walk. – Joe Cantlupe, HealthDataBuzz

No Goodbyes

I knew I was running late, and nearly sprinted to the doctor’s office, on the second floor. I had a small card, a symbol of thanks, in my hand. I wanted to see the doctor and tell her, just to look into her eyes as my wife did for years, looking for hope, even the illusion of it, which I had none.

The doctor’s office was closed, and I was despondent and headed to the elevators. Then the door opened slightly, and I recognized the secretary, who let me in. I was welcomed into the waiting room where I sat down and saw the doctor and she waved that she would come by soon.

They all tried, for a long time. My wife didn’t want extraordinary measures at the end, and waved off the doctors. There was a small oxygen mask, and the breathing ritual still haunts me, it seems like she needed to work too hard.

The metastatic breast cancer moved seemingly everywhere, the liver, the brain. When it hit the brain, the constant light of confidence in Michele’s eyes noticeably dimmed. My wife became more frail as the months went on, but she kept working, and even wondered herself why she did. She held her laptop and wrote away, until she was too tired for another word.

I still need to process all that went on, her battle with cancer over the years, how it went away and we were so joyous for that time, and how it returned and did so with a vengeance. She had these pains in her back and thought it was rheumatoid arthritis, and scans showed differently, the cancer had spread. “Devastating,” she said. Still, she didn’t fold. The end came, last Saturday.

As cancer works its march, the headlines over the past year turned to the major healthcare concern of 2020, the COVID-19 pandemic, that still drops bombs everywhere.

A month ago, she was a cancer patient facing the prospect of not only being in the hospital, there was the concern and worry over treatments, and the haunting spectacle of the coronavirus was there. There were rumors, then whispers that someone on the staff had the virus and had to stay away from work. A patient down the hall had it too.

So that confounded the fears, certainly, about the cancer sickness. Was covid also part of the growing concern? It was not, inevitably, but there was worry and stress.

In her final hours, as she struggled to talk, no words came out, just a flurry of gestures. Her grip remained strong, and that gave me hope, silly me. The nurses were remarkable, checking on her comfort levels, talking to her gently, asking if she needed anything. They were doting, loving friends to her, even at the end. It could have been another day and they would be having coffee.

When I saw the doctor, she told me how they had a nickname for her, the “little sparrow,” how she continued to bring joy and meaning with every visit, as she became more frail.

The great French singer, Edith Piaf, had that nickname. It was a culture and language that Michele embraced. “Non, je ne regrette rien,” Piaf sang, “no regrets.”

Joe Cantlupe, Health Data Buzz

Health care officials’ plea for Trump to share vital COVID-19 info with Biden team to save “countless lives.” Sorry, busy tweeting..

President Donald Trump goes to his bunker, his twitter account. He crows about the election, I won, damn it, I won.

Trump keeps tooting his unmusical tunes. Now 250,000 Americans have died because of COVID-19, which is ravaging the country. President Elect Joe Biden’s transition team is trying to coordinate with the White House to begin getting a handle on this virus. He’s being shut out.

Trump stays out of sight unless on the golf course. His team is shying away from being responsible, from officials of the Department of Health and Human Services to the General Services Administration.

Concerned health advocates are asking the Trump Administration to share “all critical COVID-19 information” with Biden’s transition team, which it has refused to do. Typically whiny kindergartners, some of the Trump bunch. Give me my candy, give me my candy.

A letter from the American Medical Association (AMA), American Hospital Association (AHA) and American Nurses Association (ANA) expresses “fears about the rising number of COVID-19 cases, hospitalizations and deaths that will increase greatly through the holiday season.”

“Confronting the challenges of the pandemic is imperative to saving American lives,” they wrote to the Trump administration. “Real time data and information on the supply of therapeutics, testing supplies, personal protective equipment, ventilators, hospital bed capacity and workforce availability to plan for further deployment of the nation’s assets needs to be shared to save countless lives.”

Haunting chants before Thanksgiving, a day of sharing and giving.

Our country was built on that premise. In 1863, President Abraham Lincoln proclaimed a national Thanksgiving holiday in the midst of a terrible Civil War.

Again, we are at war, against the virus. Sorry, the president is busy tweeting. — Joe Cantlupe, Health Data Buzz

Unmasked Man Hiding in ‘The People’s House’

The White House is also known as the “People’s House,” – us, the U.S., Americans. We vote the presidents in, and then we vote them out.

We voted Trump out. He’s dilly-dallying. It’s been days now, and he can’t get around to saying he lost. It’s just not in him. He can’t do it. The longer it takes, I would think the harder it would be. He’s in some hole. It’s like when Clarence Thomas didn’t say anything year after year on the Supreme Court. At what point, what’s that key moment where you jump in, and say, “Hey, I’m here.” It’s almost like the kid in geography class who sat in the back, ducked being called on, never raised his hand, and then suddenly emerges and says, “I know the capital of Alaska! You know?!!!!”

Remember Trump wore a mask sometimes after he came down with COVID-19. It didn’t seem he liked it much. He often went to events over these last nine months not only not wearing a mask, but mocking the idea of having to cover one’s face with one.

The thing is, there are people who respect leaders like the President and follow his example, no matter how wrong it is. Too many people don’t wear masks when they are close to other people, and that fosters the spread of COVID-19.

More than 242,000 people have died in the U.S., and there are more than 10 million cases. Today, the U.S. Centers for Disease Control and Prevention predict there will be 260,000 to 282,000 coronavirus deaths by Dec. 5.

Tonight, I got this message from “Trump, Pence Make America Great Again!”

“Joseph, As I have long said, the success of a coronavirus vaccine would only be announced after the Election.”

“Pfizer and the others probably didn’t have the courage to to make this HISTORIC announcement before Nov 3rd, because they hoped it would keep me from WINNING BIG.”

“The truth is if Joe Biden were president, you wouldn’t have the vaccine for another four years….”””……….

lalalalalalalaalalalaal and on and on.. garbage.

President -Elect Biden is starting to put a team together to deal with COVID-19 as a top priority. Trump is having trouble getting out of the people’s basement.

Trump can help save people. He can’t save face by winning another term. But he can save people. Tell people to cover their faces with masks.

“People, wear a mask,” he can say. — Joe Cantlupe, Health Data Buzz

Photo by Anna Shvets from Pexels