# Compliance and Barriers in Hospital Price Transparency: A Cross-Sectional Evaluation of Alabama Hospitals With Emphasis on Spinal Surgery

## TL;DR

This study evaluates how well Alabama hospitals comply with federal price transparency rules, focusing on spinal surgery pricing.

## Contribution

The study provides a detailed cross-sectional evaluation of hospital price transparency compliance in Alabama, emphasizing spinal surgery centers.

## Key findings

- All 106 hospitals provided some form of price transparency, but only 54.72% offered an online cost calculator.
- Only 20.75% of hospitals did not require personal information to access pricing information.
- Most hospitals did not fully meet all CMS guideline elements for price transparency.

## Abstract

Objective: Hospitals have been required to provide price transparency through various acceptable formats under federal regulatory guidance. Our objective was to assess levels of compliance among hospitals in Alabama, with an emphasis on centers performing spine surgery.

Methods: This cross-sectional policy evaluation utilized the Alabama Hospital Association (AHA) website to identify 124 hospitals in the state. Psychiatric and Veterans Affairs facilities were excluded, resulting in 106 hospitals for final analysis. Hospitals were dichotomized by pricing accessibility in accordance with the Centers for Medicare & Medicaid Services (CMS) guidelines. The presence of cash-discount pricing was assessed using each hospital’s online pricing tool.

Results: All hospitals (106/106) had a price transparency feature available. An online cost calculator was provided by 54.72% (58/106), while 44.34% (47/106) used a generic charge sheet or downloadable file. One hospital (0.94%) required a phone call to obtain pricing information. Personal information was required for access by 33.96% (36/106) of hospitals, whereas 20.75% (22/106) did not require personal information. Among hospitals requiring personal information, 19.44% (7/36) did not provide an available charge sheet. Among hospitals not requiring personal information, 81.82% (18/22) provided cash discount information, 45.45% (10/22) performed elective spinal surgery, and 54.55% (12/22) did not require personal information to obtain an insurance-based price estimate.

Conclusions: Most hospitals in Alabama are compliant with CMS price transparency requirements. However, substantial variation exists in the depth and accessibility of pricing information, with only a minority of hospitals meeting all CMS guideline elements. These inconsistencies represent ongoing barriers to effective price transparency and may limit the intended impact of CMS regulations on price sensitivity and competition within healthcare markets.