Virginia hospitals must show cost of care, according to new price transparency rule

A new state rule on hospital price transparency went into effect Saturday.

Del. Dan Helmer, D-Fairfax, introduced the bill in 2022 after hearing from patients and patient rights groups that many hospitals were not following the federal rule requiring hospitals to show prices as of the beginning of 2021. Hospitals were required to include pricing information online on Jan. 1, 2021, according to the Centers for Medicare and Medicaid Services.

“We hear from patients all over Virginia who delay care or don’t get the care they need because they don’t understand what it will cost them,” Helmer said. “And the results can be devastating.”

Less than 15% of hospitals were following the transparency rule across the country a year after it went into effect, according to a review of 1,000 hospitals released in February 2022 by PatientRightsAdvocate.org.

Dr. James Tinsely, a primary care physician in Newport News, said many people forego medical care because of the unknown or high costs.

“You wouldn’t go in to a restaurant, sit down and order off a menu and not see the prices and then get the bill six months later,” he said.

Almost four out of 10 Americans reported they or a family member had put off care in 2022 due to cost — a record high for the 22-year-old survey, according to a Gallup poll released in January.

“I think for people who work hard for their money every single day and just want to know that when they get sick that they’re still going to be able to take care of themselves and their family,” Helmer said. “This is a critical issue and one that I think Virginia needs to be a leader on.”

The bill, which received near unanimous and bipartisan support, also included a commission for a report on hospital price transparency from the Virginia Secretary of Health and Human Resources. The report, released earlier this year, included legislative, regulatory and operational recommendations.

Some of these recommendations included enforcement protocols from the Virginia Department of Health against hospitals that were not complying, that outpatient hospitals should also have to comply with the hospital price transparency rules and that VDH create an inspection process to ensure hospitals are complying.

“I’m hoping that in the future, I feel that if you are a hospital that doesn’t provide clarity on your prices, and somebody gets a procedure and the hospital charges them for something that is not in the actual price, they should have recourse,” Helmer said.

Last year, the Virginia Hospital and Healthcare Association launched a free online price transparency and financial assistance tool on their website.

A spokesperson for the VHHA said the group is in regular contact with CMS to ensure members are complying with the federal rules.

Ian Munro, 757-447-4097, ian.munro@virginiamedia.com