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Trump Fought Secret Prices

On June 27, 2019, President Trump issued an Executive Order titled “Improving Price and Quality Transparency in American Healthcare to Put Patients First"

His order required hospitals to publicly post standard charge information, including charges and information based on negotiated rates and for common or shoppable items. 

The American Hospital Association fought the ruling on first amendment rights and lost. It was one of the best things Trump accomplished in his term. 

Hospitals Hide Pricing Data From Search Results

Most hospitals have partially complied with the transparency act but the penalty is so small that some haven't. 

Hospitals that published prices have a new tactic. They Hide Pricing Data From Search Results.

Hundreds of hospitals embedded code in their websites that prevented Alphabet Inc.’s Google and other search engines from displaying pages with the price lists, according to the Journal examination of more than 3,100 sites.

“It’s technically there, but good luck finding it,” said Chirag Shah, an associate professor at the University of Washington who studies human interactions with computers. “It’s one thing not to optimize your site for searchability, it’s another thing to tag it so it can’t be searched. It’s a clear indication of intentionality.”

Some hospitals that do post the data only do so partially. One tactic is to post only sticker prices, not prices paid to insurers. Others don't post cash rates. 

For example, Houston Methodist does not post negotiated rates. Houston Methodist claims that publishing negotiated rates would be confusing.

Allegedly hiding and distorting prices is not confusing. 

How Data is Hidden

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To identify webpages hidden from search results, the Journal wrote a program that read the contents of 3,190 disclosure pages whose addresses were provided by Turquoise Health Co., a startup working with the price-transparency data. The program searched for a tag in the pages’ background coding that instructs search engines not to index the page.

The Journal found 164 webpages hosting disclosure files for 307 hospitals that contained versions of that blocking syntax. Some pages include information for more than one hospital within a system. The code was removed from pages with data for 182 hospitals after the Journal contacted their owners.

UPMC, a 40-hospital system based in Pittsburgh, has placed the price lists on each hospital’s website, which can require seven clicks to reach from

UPMC says the blocking code was in error and that it now only takes 3 clicks to find the data. 

However, the Journal notes UPMC does not disclose negotiated commercial rates for insurers.

Blocking Hospitals

  • HCA Healthcare Inc., HCA
  • Universal Health Services Inc., UHS
  • University of Pennsylvania Health System and NYU Langone Health.
  • Some regional systems also had such code on their websites, including Michigan’s Beaumont Health and Novant Health in Winston-Salem, N.C.

Requirements and Penalties

Hospitals are required to post insurers' prices and cash prices. They are also compelled to ensure the prices are “are easily accessible and without barriers.”

The penalty for noncompliance is "up to $300 a day". 

Given the extremely small penalties, hospitals have no real incentive to disclose prices other than to claim they have done so. 

C-Section Can Cost Anywhere From $6,241 to $60,584

Please note that At One Hospital, a C-Section Can Cost Anywhere From $6,241 to $60,584

Given such pricing discrepancies, the $300 penalty for noncompliance is meaningless.