BUSI 304 Week 3 Discussion Board Forum 3 Example

Discussion Board Forum 3: Is the Hospital Price Transparency Rule Working?

BUSI 304 Introduction to Health Policy, Discussion Board Forum 3

Thread by [Student Name]

The classmates are composites; the textbook, Scripture and the peer-reviewed articles cited are real.

The Hospital Price Transparency Rule, which took effect in January 2021, obliges hospitals to publish a data file of their standard charges, including rates negotiated with each insurer, and a consumer-friendly list of prices for at least 300 shoppable services. Its goal was to let patients compare prices and to push prices down through competition. McLaughlin and McLaughlin (2015) remind analysts that a policy should be judged against its intended purpose, so the first question is whether hospitals are actually doing what the rule requires. Only then can we ask whether posted prices change what patients pay.

The evidence says largely not. Mead and Ibrahim (2024) compared the prices hospitals reported with the services they actually provide and found that 56% of hospitals offering at least one required shoppable service reported no prices at all, most of the rest reported only some, 12% reported prices for services they do not offer and only 6% matched completely. Among pediatric hospitals, Reimer et al. (2025) found that only 48.7% were fully compliant with both parts of the rule nearly three years after it began.

Why the gap? I see three possibilities. First, penalties have been too small to change behavior, as Mead and Ibrahim conclude. Second, the files are complex and formatted inconsistently, so even complete data are hard to use. Third, the rule assumes that patients will shop, but much hospital care is urgent or chosen by a physician. A patient having a heart attack does not compare prices, and a patient referred for surgery usually goes where the surgeon operates. If the third explanation is right, even perfect compliance would produce modest savings, and the rule's real value may lie elsewhere, in giving employers and insurers data to negotiate with.

Scripture tells believers to stop deceiving and to deal truthfully with one another (English Standard Version Bible, 2001/2016, Ephesians 4:25). A price that is technically posted but practically unfindable falls short of that standard. Transparency is not achieved when a price is published; it is achieved when a patient can find and understand it. I would recommend stronger, scaled penalties and a single required file format before judging whether price shopping can work.

Reply to Natalie

Natalie, you argued that once prices are visible, competition will bring them down. I would like that to be true, but the evidence so far is cautious. Reddy et al. (2025) analyzed more than a million commercial rates for common cardiovascular services and found that prices for the same service often varied two- to threefold within a region, and even within a single hospital across insurers. Visible variation is the first step, but it does not guarantee that anyone acts on it. They also found that nonprofit status and concentrated hospital markets were associated with higher commercial prices, which suggests that market power, not hidden information alone, keeps prices high. Desai et al. (2021) found that an advertising campaign in New Hampshire increased use of the state's price comparison website but did not increase use of lower-price providers. Patients looked, but they did not switch. The likely reasons are familiar: insurance shields many patients from price differences, physicians steer referrals and people trust the hospital they know.

Proverbs observes that the simple believe everything, while the prudent give thought to their steps (English Standard Version Bible, 2001/2016, Proverbs 14:15). Prudent policy would not assume that information alone changes behavior; it would test that assumption and adjust when the evidence comes in. Perhaps transparency will matter most for insurers and employers negotiating prices rather than for individual patients. Employers that pay claims directly have both the data and the incentive to steer employees toward lower-priced, high-quality hospitals. Do you think employers are better positioned than patients to use this data, and would that still count as the rule working?

Reply to Marcus

Marcus, as someone who works at a small rural hospital, you described how hard it was for your finance office to build the required files with no additional staff. That burden is real. A small hospital may have one person handling billing, contracting and reporting, and building a file with every negotiated rate for every payer is a project, not a task. Ogles et al. (2026) found that all 106 Alabama hospitals they examined had some price transparency feature, but formats varied widely, a third required personal information before showing prices and some offered only a charge sheet to save. Johnson et al. (2026) note that inconsistent formats limit the usefulness of the data and argue that transparency is a foundation for future payment reform even if it cannot fix structural cost drivers by itself.

Paul wanted his handling of money to be seen as right both by God and by the people watching (English Standard Version Bible, 2001/2016, 2 Corinthians 8:21). Clear prices are an honorable practice even when they are costly to produce, and patients in rural communities deserve them as much as anyone. A standard federal template and technical assistance for small hospitals might reduce the burden you describe. Enforcement could also be scaled so that a small hospital making a good-faith effort is treated differently from a large system that ignores the rule, which seems both fairer and more likely to improve compliance where it matters most. Penalties already vary with hospital size, but a clearer path to correction for small hospitals would help. Would a free template from CMS have helped your office?

References

Desai, S. M., Shambhu, S., & Mehrotra, A. (2021). Online advertising increased New Hampshire residents' use of provider price tool but not use of lower-price providers. Health Affairs, 40(3), 521-528. https://doi.org/10.1377/hlthaff.2020.01039

English Standard Version Bible. (2016). Crossway. (Original work published 2001)

Johnson, S. T., Cook, K., Dallmeier, J., Heuett, N., & Barker, K. (2026). Hospital price transparency: A primer. American Journal of Health-System Pharmacy, 83(14), 745-756. https://doi.org/10.1093/ajhp/zxag022

McLaughlin, C. P., & McLaughlin, C. D. (2015). Health policy analysis: An interdisciplinary approach (2nd ed.). Jones & Bartlett Learning.

Mead, M., & Ibrahim, A. M. (2024). Over- and underreporting of prices: Most hospitals are not compliant with the Hospital Price Transparency Rule. Health Affairs Scholar, 2(9), qxae099. https://doi.org/10.1093/haschl/qxae099

Ogles, C., Cooper, C., Dyess, G., & Menger, R. P. (2026). Compliance and barriers in hospital price transparency: A cross-sectional evaluation of Alabama hospitals with emphasis on spinal surgery. Cureus, 18(2), e104406. https://doi.org/10.7759/cureus.104406

Reddy, K. P., Mehta, S., Eberly, L. A., Khatana, S. A. M., Chatterjee, P., Fanaroff, A. C., Groeneveld, P. W., Giri, J., & Nathan, A. S. (2025). Inter- and intrahospital price variation for common cardiovascular admission diagnoses, diagnostic tests, and therapeutic procedures. Journal of the American Heart Association, 14(6), e038660. https://doi.org/10.1161/JAHA.124.038660

Reimer, E., Scanlon, M. C., Jereczek, A., & Maxwell, A. R. (2025). Compliance with price transparency rules in United States (US) pediatric hospitals. Journal of Hospital Medicine, 20(6), 588-591. https://doi.org/10.1002/jhm.13546