Medical costs have long been a mystery. It's why a report from a nonprofit is trying to add clarity in the hopes patients know how much you'll pay when you need health care.
Federal regulations on hospital compliance
The hospital price transparency rule started in 2021. The Centers for Medicare & Medicaid Services (CMS - link) determines whether a hospital is compliant. The law first established hospitals must post:
- standard charges for all items and services
- prices for the 300 most common services through something like a price estimator tool
In July of 2024, the rules were updated to add more format consistency and more information.
"Even for hospitals that are compliant, fully, by everyone's standard, it's still hard to shop around for medical care," said Chris Garmon, an associate professor of health administration at the University of Missouri-Kansas City.
He said the most important piece for patients to use and understand is the price estimator tool.
"That makes it a whole lot easier for you to search for the surgery you need and how much it's going to cost you," he said.
The nonprofit's study
PatientRightsAdvocate.org is a nonprofit that assesses the transparency of hospitals' online pricing.
The agency's most recent report was released in November of 2024.
They assessed 2,000 hospital websites across the U.S. Nineteen of those websites were hospitals in the greater Kansas City area.
It’s important to note: the nonprofit and the hospitals don't view the federal guidelines the same. The nonprofit puts an extra level of scrutiny on the federal guidelines.
"I would say we go further than a first-level look and we look at the entire file to see if every single insurance plan the hospital accepts is posted, and if the majority of prices are in the data field," Cynthia Fisher, PatientRightsAdvocate.org founder and chairman, said.
Patient takeaways
Garmon recommends patients look for those price estimator tools. But he also points to data that federal law and reports don’t conduct: the quality of your care.
"Are they five-star or four-star hospitals? What are the mortality rates and complication rates for the procedures you’re considering? Are they a high-quality hospital or not? And ask your physician, how many of these procedures have they performed in the last year?” Garmon said.
Here are links to pricing information for the largest hospitals in Montana:
