Federal officials required hospitals nationwide this year to post their "list" prices online. But it's not yet clear how many are doing it, even as the government has taken the rare step of asking consumers to monitor hospital compliance.

Most hospitals appear to be complying with the rule, according to hospital officials and a small sampling of websites.

However, federal officials acknowledge that they are not yet enforcing the rule, industry groups are not monitoring compliance, many hospitals are burying the information on their websites and debate continues about whether the price lists create more confusion than clarity among consumers.

The rule took effect Jan. 1, after a yearlong controversy about its necessity and usefulness. It requires every hospital in the country — about 6,000 — to post its full price list online.

The lists, known in the industry as "chargemasters," present prices for the thousands of individual services and products for which a hospital may bill.

The problem is that services and products are identified in obscure abbreviations, billing codes and medical terminology that even doctors or nurses often don't understand.

Additionally, the lists rarely reflect final billed charges because insurers and the government generally negotiate significantly lower prices. In most cases, the posted rates are the highest a hospital would ever charge per service.

“I think transparency is always a good thing. The more transparency, the better it is for consumers," said Antoinette Kraus, executive director of the Pennsylvania Health Access Network. "It could go further, and we see some of that with a database and other things that help consumers shop around.

“I think folks still need to call the hospital. It’s still hard for individuals to navigate this and to figure how this matches with your situation," she said, adding that a specified charge for a colonoscopy won't necessarily reflect the final bill if something else, like a biopsy, is completed during the procedure.

Geisinger Holy Spirit Hospital also said in its announcement of its MyEstimate tool that hospital charges do not include physician charges, which are billed separately.

Even so, officials at the Centers for Medicare & Medicaid Services said full public disclosure was a logical first step in a transparency initiative aimed at eventually encompassing physician and prescription drug prices.

The CMS contends that the listings will help patients compare facilities, spur competition among hospitals to lower prices and prompt software developers to build tools that consumers can use to comparison-shop.

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"We think this information will empower patients," said Seema Verma, the CMS administrator. "And we look forward to seeing consumers continue to drive the demand for hospitals to provide greater price transparency."

Verma has enlisted the public in an unusual effort to monitor whether hospitals comply. In appearances, opinion pieces and through social media, she has urged consumers to check their local hospitals' websites to see if chargemaster lists are posted and let the agency know if they are not.

While putting off enforcing the law, CMS has instead invited hospitals and the public to weigh in on possible enforcement mechanisms and suggest future price transparency measures. Hundreds of comments have been submitted.

Under the agency-initiated Twitter hashtag #WheresthePrice, a dialogue has ensued. In one case, a Texas man, Matt Kleiber, checked 31 hospitals and medical centers in Houston and found one health system, Memorial Hermann, which operates 16 hospitals, not in compliance.

After a reporter's inquiry, Kathryn Williams, a spokeswoman for Memorial Hermann, said in early February that the hospital system was complying. She said they interpreted the government's rule as allowing a shorter, easier-to-understand price list to be posted.

Subsequently, in late February, the hospital posted its full chargemaster list, as the regulation requires.

"What we posted (initially) was much easier for our patients to understand," Williams said. "We don't think the chargemaster list is helpful ... and we stand by our position that the information we have had posted on our website since Jan. 1 is consistent with CMS' guidance."

Other reports of noncompliance at #WheresthePrice appeared to be the result of incomplete website explorations by consumers. A check of the websites of six cited hospitals showed that the price lists were posted. On all but one of the sites, however, the information was not prominently displayed.

About a dozen hospital websites reviewed by Kaiser Health News included an accompanying — and often prominent — disclaimer saying the information doesn't reflect typical final charges and is difficult to understand.

Accompanying its chargemaster list, for example, UPMC Pinnacle posted, "It is important to note that the standard charge is not the amount that a patient is expected to pay for receiving health care services."

UPMC Pinnacle lists a charge description master for each of its hospitals, Geisinger Holy Spirit offers a 262-page pdf of its possible charges, and Penn State Health offers a searchable database with a note encouraging patients to reach out to "financial navigators" to get a more accurate estimate.

The Sentinel contributed to this report.

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