Watchdogs, lawmakers aim to improve medical price transparency in Texas

AUSTIN, Texas - Efforts are underway to increase medical price transparency statewide. 

"I always think of it like going to the grocery store," said Cynthia Fisher, founder and chairman of PatientRightsAdvocate.org. "No one would tolerate being charged ten times more for a gallon of milk."

Giving power back to the consumer is the goal of Fisher’s nonprofit watchdog organization.

"Most people don't even know that they can get an MRI for $300 at a standalone imaging center compared to thousands, sometimes $3,000 to $6,000, within a hospital system that's not showing its prices," said Fisher. "That's a huge price difference."

In January 2021, the Hospital Price Transparency rule went into effect. It requires hospitals to provide machine-readable pricing files and a display of shoppable services in a consumer-friendly format.

Earlier this year, PatientRightsAdvocate.org looked at hospitals nationwide, finding 18% of the more than 200 Texas hospitals examined were in full compliance. 82% were not fully compliant, according to the report.

"When we say they're not compliant, they do have information in a file, but it's not usable to create a market economy in the US," said Fisher. "So that means that the tech world, such as Google search engines or software developers that want to create Priceline-type tools or airline-type shopping tools - to let us compare insurance companies having to compete as well as hospitals competing on price and quality - that means these developers are not able to create the comparative tools for all of us to go online and find all of these competitive prices."

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In Texas, Senate Bill 1137 was passed during the 2022 legislative session, essentially codifying federal law and adding stricter penalties for non-compliance. This session, there are more pieces of legislation that address price transparency, including HB 1973 and HB 711, which passed the House on Tuesday.

"We are paying twice as much for health care for the same results as the rest of the first world, and it is because of a lack of transparency, lack of competition and lack of patient involvement. We've got to have all three," said State Rep. James Frank in an interview with FOX 7 in March. Frank authored HB 711. "You need to know what the prices are, but you also need to have competition, and there's a lot of unlevel playing field and a lot of anti-competitive practices that are happening in health care."

FOX 7 reached out to St. David’s HealthCare, Baylor Scott & White Health and Ascension. 

The statements they provided are below. 

From St. David's HealthCare: 

"CMS is the agency that determines compliance with the federal regulations and CMS lists on its website hospitals that have been fined for non-compliance. Our hospitals implemented the federal requirements in January 2021. Since then our hospital websites have included a consumer-friendly Patient Payment Estimator tool that provides relevant information to help patients understand what their out-of-pocket responsibility may be for hospital care, including those that are uninsured. In addition, we have posted contracted rates with third party payers using one of the machine-readable file formats listed in the regulations to provide the five types of ‘standard charges.’"

From Baylor Scott & White Health:

"The study you are referring to includes incorrect information about our facilities. We believe that all of our facilities are in compliance, and we communicated that compliance with PatientRightsAdvocate.org.

The Centers for Medicare and Medicaid Services ('CMS') is the only entity that determines an entity’s compliance with the Federal price transparency rules. Baylor University Medical Center and Baylor Scott & White Medical Center – Temple have been found to be in compliance with Federal price transparency rules by CMS. Further, all remaining Baylor Scott & White facilities are in alignment with the facilities found to be in compliance by CMS.  

In addition, the Texas Health and Human Services Commission has reviewed all Baylor Scott & White facilities and found them to be in compliance with state price transparency rules. 

We appreciate you working on this story and including an accurate reflection of Baylor Scott & White facilities’ compliance status."

From Ascension:

"We’re proud to be a leader in price transparency - not only complying with the rule but going beyond it, to offer consumers tools to estimate costs and provide feedback. CMS itself has indicated that only a small number of hospitals across the country are not in compliance. We will continue to find ways to make sure consumers and patients have the most current information available to make an informed healthcare decision."