Sonenreich announced last year that his hospital would publish its negotiated prices online, but he said that plan was dropped because of opposition from insurers. Regency Healthcare, an outpatient surgical practice in New York, has begun posting its prices online, as has the Surgery Center of Oklahoma in Oklahoma City. Both facilities are doctor-owned, and the prices only apply if the patient pays in cash or has a check cut from their employer's self-funded insurance plan. No hospitals currently are known to publish their prices, and consumer groups report it's often difficult for patients to find out in advance what they will have to pay.
Some experts have criticized the Obama administration for talking a good game about transparency but not doing as much as it could. For example, CMS officials declined a request for comment from Modern Healthcare about why the government hasn't issued rules implementing the healthcare reform law's provision requiring hospitals to post their prices.
Some say the administration has shied away from enforcing that provision because it has its hands full implementing many other aspects of the law and doesn't want to anger hospitals and insurers, whose cooperation it needs to make the law work.
“Neither (Democrats nor Republicans) really likes it,” said Jonathan Gruber, a healthcare economist at the Massachusetts Institute of Technology who advised the Obama administration during the drafting of the reform law. “When you have a good public policy but both sides don't like the policy, it's hard to make it happen. I think it's going to happen, but it's going to be a slow process.”
A former Democratic congressional aide who worked on the drafting of the law in 2009 said the transparency section was written during negotiations as a sweetener for skeptical Republicans worried about cost control. “We started to have conversations very late about this issue,” said the former staffer, who did not want to be identified. “This whole transparency discussion is so important, it's so difficult, and it always gets short shrift. We spent more time making sure that illegal immigrants didn't get healthcare and that people couldn't get abortions than we did on this. Ten times more.”
But some observers say publishing hospital charges would have limited value because charges represent inflated retail rates that almost no one actually pays. That was the chief criticism last year when the CMS for the first time published rack-rate charges on the top 130 most common inpatient and outpatient services at 3,000 hospitals.
“Looking at charge data in isolation does not take into account a full picture of the complex reimbursement environment in which all hospitals must operate,” Health Management Associates, a Naples, Fla.-based hospital chain said in a written statement. “Realistically, all hospitals only collect a small percentage of charges.”