Only 30% of Wisconsin Hospitals Obey Federal Price Transparency Rules

Ascension Columbia St. Mary’s Hospital in Milwaukee. Coburn Dukehart / Wisconsin Watch

Across the nation and in Wisconsin hospitals are failing to provide transparent pricing, as required by federal law.

So says the latest report by the nonprofit consumer group Patients Rights Advocate (PRA), which found that just 21% of 2,000 hospitals it reviewed were fully compliant with federal Hospital Price Transparency Rule enacted into law in 2021.

In Wisconsin only 12 of 40 hospitals reviewed — or 30% — were fully complying with the rule.

The law was “intended to empower healthcare consumers –patients, employers, and unions as purchasers – with ease of access to compare prices,” the report notes.

But nearly four years after the federal law was passed, “the overwhelming majority of hospitals reviewed are still not complying with the rule requiring them to publish their discounted cash prices and all negotiated rates,” noted PRA Founder and Chairman Cynthia Fisher. “By keeping their prices hidden, hospitals continue to block American consumers from their right to compare prices and protect themselves from overcharges.”

The only hospitals fully compliant in Wisconsin were 12 hospitals run by Aurora Medical Care, now part of the national Atrium Health chain. That includes five of its hospitals in the metro Milwaukee area.

The 28 hospitals in the state violating the rules included 15 run by the huge Ascension chain, many of which are located in metro Milwaukee. Nationally, not one Ascension Hospital was fully compliant with the federal rules.

Other Wisconsin hospitals that were not in compliance included Froedtert Hospital in Wauwatosa.

Compliance with the federal law is supposed to be monitored by the federal Centers for Medicare & Medicaid Services, but the CMS “permits hospitals to obfuscate their prices behind estimates, averages, and algorithms, while still being deemed compliant,” the report found. “Because these changes hinder consumers’ ability to access and compare actual prices, we also assessed each hospital for its ‘Pricing Data Sufficiency’ based on the availability of actual, dollars-and-cents prices found in the files.”

The report found that only 335 (16.8%) of 2,000 hospitals nationally were sufficient in their disclosure of dollars-and-cents prices. All told, only 133 or 6.7% of hospitals nationally were found to be both fully complying with federal law and posting sufficient pricing data.

The CMS is doing a poor job of monitoring hospitals, the report found. “Our analysis also showed that 449 hospitals that were found to be compliant in our February 2024 report are now found to be noncompliant. These findings imply that minimal, lenient enforcement by CMS has led most hospitals to continue to either disregard the rule or fail to adhere to all of its requirements, blocking consumers from being able to compare prices, benefit from competition, and lower their costs.”

The new President of the Wisconsin Senate, Republican Mary Felzkowski of Tomahawk, has said she plans to introduce a bill to require hospital price transparency in Wisconsin in the next legislative session.

Felzkowski previously introduced such a bill in 2023. The bill’s language was very specific, requiring hospitals to publish their standard charge for 300 “shoppable services” on their website that “must be available at all times to the public in a machine-readable format.” The legislation called for fines for non-compliance of $600 per day for the smallest hospitals and up to $10,000 per day for the largest hospitals.

The bill was backed by Wisconsin Manufacturers & Commerce, the biggest lobbyist in the state Capitol, and the conservative Wisconsin Institute for Law and Liberty, two of the most important Republican advocacy groups. And polls show Americans overwhelmingly support hospital price transparency, with 94% in favor. But after receiving a public hearing the bill died in the Senate, where Republican leaders never allowed it to be voted on.

Urban Milwaukee reached out to the Republican leaders of the Wisconsin Senate and Assembly and to the minority Democratic leaders of both houses, asking why the bill died in 2023 and whether they would support such a bill in 2025.

Only Senate Minority Leader Dianne Hesselbein, the Democrat from Middleton responded, saying she served on the Health Committee in 2023, and did not favor the bill because “it was largely duplicative of an existing federal requirement and seemed to be a solution in search of a problem as no Wisconsin hospitals had been fined for non-compliance with the federal requirement.”

That echoes the argument of the Wisconsin Hospitals Association, whose president and CEO Eric Borgerding claimed that “Wisconsin hospitals are national leaders in complying with federal transparency law” and the law’s penalties are “being rigorously enforced” by the federal government.

Borgerding is paid $1.25 million to advance the interests and arguments of Wisconsin’s hospitals, who enjoy the fourth highest medical care prices in the nation, as a recent Rand report found.

A recent study estimated that true price transparency could reduce medical costs by 40% or up to $80.7 billion nationally, with the biggest impact in the Midwest.

These reports, along with the latest PRA study showing 70% of Wisconsin hospitals were violating the federal price transparency rules, make Hesselbein’s contention that Wisconsin has no problem to solve look a bit silly. But it also suggests that lobbying by hospitals on this issue had considerable success with lawmakers in both parties. Proponents of reform, it appears, have their work cut out for them in next year’s legislative session.