How much do medical procedures cost in California? These hospitals hid prices, study says

SACRAMENTO, Calif. — If you need to have a medical procedure done at a California hospital, you might have trouble finding out how much it costs.

Nearly 21% of California hospitals fully complied with a federal rule designed to protect patients by revealing what health care facilities charge for drugs, surgeries and other services, according to a recent study by Patient Rights Advocate.

That’s despite recent polling by the nonprofit patient rights group showing that 98% of Americans support health care price transparency.

The federal Hospital Price Transparency Rule, which took effect in 2021, requires hospitals to post all prices online in machine-readable files.

These include the costs for “every item and service the hospital offers — from the colonoscopy to the Band-Aid,” said Ilaria Santangelo, director of research at Patient Rights Advocate.

Do California hospitals have transparent patient pricing?

In its seventh semi-annual Hospital Price Transparency Compliance Report, released in November, Patient Rights Advocate looked at a total of 2,000 hospitals across the United States.

Nationwide, about 21% of hospitals — 421 in total — posted their prices in machine-readable files as federally required, the report said.

That’s down from a hospital compliance rate of 34%, as reported in Patient Rights Advocate’s previous price transparency report released in February.

Out of the 177 California hospitals the group reviewed in November, only 37 fully complied with the federal hospital price transparency rule.

Although Patient Rights Advocate examined at hospital price transparency at about 20 of the largest health care systems in California, “We don’t have the resources to look at every single hospital in California,” Santangelo said.

How do hospitals comply with medical costs rule?

In order for a hospital to be considered compliant, it needs to have a complete machine-readable file of standard charges for “all items, services and drugs for all players and plans,” Patient Rights Advocate said.

That could include a consumer-friendly shoppable services list or an online price estimator tool, the group said.

For instance, a hospital might post a text file on its website with a link of its standard charges file, along with the name and email address for a hospital contact.

Hospitals must use an online Centers for Medicare and Medicaid validator tool to develop machine-readable files that conform to federal regulations.

The online validator tool will display a list of “errors,” representing requirements that were enforced beginning July 1, and “warnings,” representing requirements that were enforced started Jan. 1, according to The Centers for Medicare and Medicaid website.

Which hospitals aren’t transparent about pricing?

In California, hospitals that complied with the price transparency rule included French Hospital Medical Center in San Luis Obispo, Mercy General Hospital in Sacramento and UC Davis Medical Center, according to the Patient Rights Advocate report.

The report said a total of three Fresno hospitals failed to meet price transparency requirements: Community Regional Medical Center Fresno, Kaiser Permanente Fresno Medical Center and Saint Agnes Medical Center.

According to Santangelo, Kaiser Permanente, Fresno Medical Center was not considered compliant with the price transparency rule because it did not follow specific naming conventions.

Jordan Scott, media relations representative for Kaiser Permanente Fresno, questioned Patient Rights Advocate’s claim that the hospital didn’t follow the rules — describing the group’s report as “irresponsible and misleading to vulnerable consumers.”

“Kaiser Permanente believes that price transparency is one tool that our members and the public may use to inform decisions about the costs of their health care,” Scott said.

“That’s why we have shared our prices online for years — both for our health plan and hospital services,” he added, noting that Kaiser Permanente made its cost estimator tool on KP.org available to members “long before any regulations required it.”

Scott said its Kaiser Permanente hospital posts “one machine-readable file with prices for all health care services and one shoppable services file with the prices for common services ... as required by the regulations.”

Community Regional Medical Center did not meet the standards set by the Centers for Medicare & Medicaid Services for data reporting, quality measures, or price transparency requirements, Patient Rights Advocate said, and didn’t put a link to the price transparency file on the footer of its homepage.

“Those are easy fixes,” Santangelo said.

According to the Patient Rights Advocate report, California hospitals that failed to comply with the price transparency rule included:

•Doctors Medical Center in Modesto

•Kaiser Permanente Sacramento Medical Center

•Memorial Medical Center in Modesto

•Sierra Vista Regional Medical Center in San Luis Obispo

•South Sacramento Medical Center

•Sutter Medical Center in Sacramento

Why is it important for hospitals to keep costs public?

“By keeping their prices hidden, hospitals continue to block American consumers from their right to compare prices and protect themselves from overcharges.” Cynthia Fisher, founder and chairman of Patient Rights Advocate, said in a news release

“On behalf of all American healthcare consumers, PatientRightsAdvocate.org strongly urges policymakers to strengthen and enforce the hospital price transparency rule immediately,” Fisher added.

____