Hospitals face greater demands for price transparency

Hospitals are feeling more heat from the federal government, and the American public, over price transparency.

President Trump’s administration sent warning letters to more than 500 hospitals this month, saying they were falling short of providing pricing information, the Associated Press reported last week. The AP also obtained the list of hospitals receiving warning letters. Members of Congress have also criticized hospitals over their costs and what they have deemed insufficient transparency in pricing.

Carol Skenes, chief of staff and principal regulatory strategist at Turquoise, tells Chief Healthcare Executive® that it’s clear that the federal government is sending a message to hospitals.

“I think it's also an indication that price transparency is here to stay,” Skenes says.

The letters don’t necessarily specify where hospitals are being asked to do better. Skenes says she would have liked to have seen more information on what hospitals are being asked to address.

But Skenes says the administration is pressing hospitals to do better.

“Certainly, it means that the government is paying attention,” Skenes says.

Casey Mulligan, chief economist and chief regulatory officer of the U.S. Department of Health & Human Services, said in a panel discussion at the HFMA 2026 Conference last week that the administration is going to be focused on price transparency. Mulligan said that’s being viewed as a step toward more affordability.

“One of the things that we've done is say, look, here's the standard. When you publish your prices, here's a standard way to publish them, so that consumers and employers and plans can compare,” Mulligan said.

Calls for better transparency from health systems are growing beyond politicians and regulators. Consumers want better information.

Ann Jordan, president and CEO of the Healthcare Financial Management Association, said at the HFMA conference that health systems must be focused on affordability and helping consumers understand costs more easily.

“The public is no longer asking politely for transparency and better pricing,” Jordan said. “They are demanding it with the same consumerism expectation they bring to every other industry that competes for their trust.”

Most hospitals are complying

Trump issued an executive order in February 2025 calling for hospitals and health insurance companies to make it easier for consumers to see and compare prices.

Hospitals have had to meet new price transparency requirements from the Centers for Medicare & Medicaid Services. Hospitals are required to publish a list of hundreds of shoppable services and procedures in a display that can be easily read by consumers or with a price estimator tool. Health systems were required to update machine-readable files outlining prices for procedures by April 1.

Hospitals can be fined up to $5,500 for each day out of compliance, or a maximum of $2 million annually.

Still, few hospitals have been fined under the Trump administration, just as only a handful were penalized under the Biden administration. To date, 28 hospitals have been issued fines for violating price transparency rules, according to data from the Centers for Medicare & Medicaid Services.

Even as the administration’s warning letters to hospitals have garnered national attention, Skenes notes that hospitals aren’t being penalized.

“The advantage of getting a warning letter instead of being hit immediately with a fine or civil monetary penalty, it allows the hospitals who are trying to do the right thing, a chance to shore up the files and be in full compliance,” Skenes says.

Ashley Thompson, senior vice president for policy for the American Hospital Association, says hospitals are working to comply with the federal rules.

“Hospitals and health systems have long supported meaningful price transparency because we believe patients deserve clear, accurate information about what the care they receive will cost,” Thompson said in a statement.

“The majority of hospitals are complying with these new federal requirements that went into effect earlier this year,” she added. “At the same time, we also know the current system is not working as well as it could for patients which is why we continue to work with our members, policymakers, and the Administration on ways to strengthen and improve the pricing information and transparency tools that are available.”

Industry analysts say most hospitals have complied with the federal rules.

But they also say that it’s not easy for consumers to see if a procedure is less expensive at one hospital compared to another in their region.

“These files, by nature, are machine readable, and so the expectation is not that the average patient, as a consumer, should even need to go download a file,” Skenes says.

“I think the challenge is on the industry innovators, payers, providers, other stakeholders to say what kind of a grouped episode of care experience can we give to patients as consumers,” she adds.

Mounting criticism

Lawmakers have been vocal in their criticisms of hospitals in terms of the cost of care and saying health systems aren’t making enough progress in price transparency. Members of Congress are also calling out hospitals for not doing enough to keep costs affordable.

Rep. Jason Smith, a Missouri Republican who chairs the Ways and Means Committee, chided hospitals on their pricing at a committee hearing in April.

“Simply put, hospitals are charging an insane amount for care,” Smith said.

Sam Hazen, CEO of HCA Healthcare, the nation’s largest hospital system, told lawmakers at a House Ways and Means Committee hearing in April that hospitals must work to keep care affordable and more transparent.

“We are working to give patients better information about the cost of their care, while recognizing that true transparency requires coordination across the entire system,” Hazen said.

Health systems have faced criticism from business leaders on price transparency. Elizabeth Mitchell, president and CEO of Purchaser Business Group on Health, told Chief Healthcare Executive® in an April 2025 interview that greater transparency would help give employers more information by allowing them to compare prices, thus driving down costs.

“We understand that it's burdensome and expensive,” Mitchell said. “But you know, our current healthcare system is burdensome and expensive to its users.”

AI and transparency

Greater price transparency won’t matter too much when Americans are going to hospitals for an emergency. Those suffering a heart attack aren’t going to stop and shop around before heading to the nearest hospital.

Analysts have said that employers may benefit the most from price transparency rules. The pricing data could be valuable to employers and purchasers in evaluating prices and reviewing their benefits.

“If employers have centers of excellence where they're sending their employees, then it allows this conversation around cost and quality to be much more meaningful,” she says. “If they have access to understanding where their negotiated rates fit in the market, and they can understand whether or not that rate and the negotiated amount that they're paying is in line with a high quality outcome, then they know that they are acting as good fiduciary responsibilities, and that their employees are getting the best care for a fair rate.”

Still, Skenes says some patients are using AI tools to try and get information to compare hospital prices.

“We see some patients using AI to try and have that kind of conversation now,” she says. “They're inputting in plain language: I need this procedure. I have this insurance. How much is it going to cost me? So, I think that is the behavior that we now need to take all this rate data and create a solution for.”

Skenes says the public demand for transparency is also adding more urgency to the issue.

“With everything else being more expensive, patients need to weigh their options of when to get care and how much that care is going to cost them,” she says.