Price Transparency Compliance Among Hospitals Caring for Disadvantaged Populations

 

1. Daphne Hao, BA¹; Vinay K. Rathi, MD, MBA²; Joseph S. Ross, MD, MHS^3,4,5,6
 
2. et al
   
   
   Introduction

   The Centers for Medicare & Medicaid Services (CMS) implemented the Hospital Price Transparency rule in 2021,¹ requiring hospitals to publicly disclose payer-negotiated prices or face maximum fines of $2 million per year.² While hospital price transparency has increased, compliance remains uneven³ and may be worse among hospitals with fewer resources, particularly those caring for more disadvantaged patients. These hospitals may be underresourced because of their patient populations or because they bring in less revenue for the same services. We used hospital- and payer-disclosed pricing data to examine compliance and pricing, focusing on 10 top oncologic surgical procedures because improved transparency may be associated with reduced financial hardship for patients receiving cancer care.

   Methods

   This cross-sectional study used publicly available, nonpatient data and was therefore exempt from institutional review board (IRB) review by Mass General Brigham IRB. It is reported in accordance with the STROBE reporting guideline. We included hospitals participating in the CMS Inpatient Prospective Payment System (IPPS) with available pricing data from Turquoise Health to determine overall compliance (yes or no), defined as price information being mostly or completely available as usable, machine-readable files (eMethods in Supplement 1).

   We characterized hospitals’ extent of care for disadvantaged patients using 2 metrics. First, we used the 2023 Lown Hospitals Index inclusivity score ratings, focused on racial and income inclusivity and categorized into 3 tiers: low (1-2), medium (3), or high (4-5).⁴ Second, we used CMS Disproportionate Share Hospital (DSH) patient percentage value from the fiscal year 2024 IPPS, categorized into tertiles (<22%, 22%-33%, and >33%).⁵

   We compared hospital quarterly price compliance from quarter 1 (Q1) 2022 through Q3 2023 by hospital inclusivity and DSH percentage using discrete-time hazards modeling. We identified payer-reported negotiated prices for 10 top oncologic procedures to compare compliant and noncompliant hospitals (required by CMS to be reported by payers since July 1, 2022). Prices were adjusted for hospital wage index, summarized as a median per procedure at each hospital, and compared between compliant and noncompliant hospitals using student t tests. We selected an α level of .05 for statistical significance; Benjamini-Hochberg adjustment for 16 tests reduced the significance threshold to .0375. Two-sided tests were performed using R version 4.5.1 (R Project for Statistical Computing). Data were analyzed from January 2022 through September 2023.

   Results

   Among 2464 hospitals (Table; eFigure in Supplement 1), those more inclusive of disadvantaged populations had lower compliance rates and were less likely to become compliant over time (Figure, A-C). For example, hospitals with low Lown race inclusivity had a higher hazard of becoming compliant over time (hazard ratio, 1.25; 95% CI, 1.05-1.48; P = .009).

   Table.  Hospital Characteristics

   View LargeDownload

   (opens in new tab)

   Characteristic	Hospitals, No. (%) (N = 2464)
   Part of multihospital system
   Yes	2226 (90.3)
   No	238 (9.7)
   Ownership type
   Nonprofit	1633 (66.3)
   For profit	483 (19.6)
   Government	348 (14.1)
   Beds, No.
   1-100	732 (29.7)
   101-250	924 (37.5)
   ≥251	808 (32.8)
   Teaching hospital
   Yes	1117 (45.3)
   No	1349 (54.7)
   Lown race index rating, No. starsa
   1	171 (6.9)
   2	238 (9.7)
   3	1737 (70.5)
   4	232 (9.4)
   5	86 (3.5)
   Lown income index rating, No. starsa
   1	133 (5.4)
   2	432 (17.5)
   3	1243 (50.4)
   4	462 (18.8)
   5	194 (7.9)
   Location
   Urban	1426 (57.9)
   Rural	1040 (42.2)
   Region
   Northeast	379 (15.4)
   Midwest	566 (23.0)
   South	1037 (42.1)
   West	482 (19.6)
   Wage index, mean (SE)	1.034 (0.004)
   Mean daily census, mean (SE)	150 (4)
   DSH, mean (SE), %b	0.314 (0.003)

   Figure.  Hospital Compliance Over Time and Negotiated Facility Fees

   View LargeDownload

   (opens in new tab)

   A-C, Hazard ratios (HRs) are calculated and reported with 95% CIs using the high-inclusivity group as the reference group. D, Mean facility fees for the top oncologic surgical procedures in quarter 1 (Q1) 2023 are presented. DSH indicates Disproportionate Share Hospital; error bars, standard errors.

   As of Q1 2023, compliant hospitals had significantly higher mean negotiated facility fees for most oncologic procedures (6 of 10 surgery types [60.0%]) compared with noncompliant hospitals (Figure, D). For example, the mean (SD) negotiated facility fee for a prostatectomy at compliant hospitals ($9594 [$256]) was $1677 higher than that of noncompliant hospitals ($7917 [$367]; P = .001).

   Discussion

   In this cross-sectional study, hospitals serving more disadvantaged populations were less compliant with the Hospital Price Transparency final rule over time between Q1 2022 and Q3 2023. Given that racial minority and low-income groups are more likely to experience health care–related financial stress, our findings reveal a harmful paradox: less transparency information available for disadvantaged patients, who have the greatest need to make financially informed decisions.

   Our findings also challenge a common assumption that hospitals may be noncompliant to avoid disclosing high prices that could harm brand or market position.⁶ Broad-reaching, payer-disclosed pricing data revealed that compliant hospitals often had higher facility fees compared with noncompliant hospitals.

   Study limitations include that we were unable to ascertain certain granular data, such as hospital payer mix or patient out-of-pocket costs, which vary across plan designs. Additionally, prices for these 10 oncologic procedures may not be generalizable to other services. Nevertheless, our findings suggest that CMS should consider policies to avoid regressive financial penalties² on hospitals caring for disadvantaged populations. Instead, policies should promote capacity to help patients make financially informed care decisions with increased technical support or targeted funding for information technology modernization.
   
   https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2847641

CMS to Improve Patient Care Experience and Lower Costs for Hip, Knee, and Ankle Replacements

Proposed Expansion Would Improve Care, Lower Costs for Medicare Beneficiaries


Medicare beneficiaries undergoing knee, hip, and ankle replacements, among the most frequent surgeries for people with Medicare, could soon experience more coordinated care and lower costs under a new Centers for Medicare & Medicaid Services (CMS) proposal. CMS is looking to implement these improvements by expanding the Comprehensive Care for Joint Replacement (CJR) Model nationwide through the Fiscal Year (FY) 2027 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) proposed rule.

“Every year, Medicare funds thousands of knee, hip, and ankle replacements that help seniors keep up with their speedy little grandkids,” said CMS Administrator Dr. Mehmet Oz. “This proposed expansion of our successful joint replacement pilot program would better align financial incentives with improved health outcomes—protecting taxpayer dollars while ensuring patients get the care they need before, during, and after surgery.”

From April 2016 through December 2024, the CMS Innovation Center tested the CJR Model to improve care for Medicare patients undergoing joint replacement procedures. During that time, the model generated significant Medicare savings while maintaining quality of care for beneficiaries. Under the CJR Model, hospitals were held responsible for Medicare spending for the joint replacement surgery, the hospital stay, and the first 90 days of recovery, including follow-up care such as physical therapy.

Based on evaluation of the CJR Model, the CJR Expanded (CJR-X) Model would create strong incentives for hospitals to coordinate care more effectively, avoid unnecessary services like avoidable re-hospitalization and emergency care, and focus on delivering the best outcomes for patients. It would specifically encourage better communication with post-acute care providers to support recovery. Beginning October 1, 2027, CJR-X would be required for most hospitals, making it the first mandatory, nationwide test of an episode-based payment model.

“Patients would have a more seamless, better care experience through the CJR-X Model, allowing them to focus on recovery instead of acting as the go-between for their own care,” said CMS Innovation Center Director Abe Sutton.

Medicare beneficiaries would benefit from earlier communication and planning, and smoother transitions between care settings. They would continue to choose their doctors and receive the care they need without disruption or added complexity.

As part of expansion, CMS would implement certain refinements based on experience and stakeholder feedback, including updates to payment policies.

Models previously expanded nationwide include the Medicare Diabetes Prevention Program, the Pioneer ACO Model, the Home Health Value-Based Purchasing Model, and Prior Authorization of Repetitive, Scheduled Non-Emergent Ambulance Transport.

To learn more about the CJR-X Model, including independent evaluation reports, visit: https://www.cms.gov/priorities/innovation/innovation-models/cjr-x

For FY 2027, CMS is proposing that the payment rate for inpatient and long-term care hospitals under this rule would increase by 2.4%. These updates reflect the latest available data on hospital costs.

The FY 2027 IPPS and LTCH PPS proposed rule can viewed on the Federal Register at: https://www.federalregister.gov/public-inspection/current.

For a fact sheet on FY 2027 IPPS and LTCH PPS proposed rule, visit: https://www.cms.gov/newsroom/fact-sheets/fy-2027-hospital-inpatient-prospective-payment-system-ipps-long-term-care-hospital-prospective.

https://www.cms.gov/newsroom/press-releases/cms-improve-patient-care-experience-lower-costs-hip-knee-ankle-replacements

Stenting Eases Hard-to-Treat Venous Disease After Deep Vein Thrombosis

• The efficacy and safety of endovascular therapy in patients with moderate or severe post-thrombotic syndrome and iliac-vein obstruction was evaluated in the C-TRACT trial.
• The intervention, a combination of stenting and enhanced antithrombotic therapy, resulted in less severe post-thrombotic syndrome and better health-related quality of life at 6 months.
• Of note, the intervention did result in excess bleeding overall, though major bleeding remained rare.

Stenting and enhanced antithrombotic therapy together reduced the severity of post-thrombotic syndrome in the phase III C-TRACT trial -- albeit with patients left at higher bleeding risk.

There was a significant improvement in disease severity and quality of life in patients who were randomized to the intervention as opposed to usual care for their moderate or severe post-thrombotic syndrome and imaging-confirmed iliac-vein obstruction, reported Suresh Vedantham, MD, of Washington University School of Medicine in St. Louis, and colleagues.

At 6 months, there were observable between-group differences in terms of:

• Post-thrombotic syndrome severity scored: mean scores 8.1 vs 10 points on the Venous Clinical Severity Score tool with a range of 0-30 (P=0.001)
• Venous disease-specific quality of life: 62.8 vs 48.6 points on a scale of 0-100 on the Venous Insufficiency Epidemiological and Economic Study Quality of Life questionnaire (P<0.001)
• Overall quality of life: 56 vs 49.9 points on a scale of 0-100 on the Medical Outcomes Study 36-Item Short-Form Health Status Survey physical component summary score (P<0.001)

Overall, the trial confirms prior signals of endovascular therapy's effectiveness, now with a larger study focused on post-thrombotic syndrome as opposed to mixed venous disease. The downside: an increase in bleeding in the endovascular therapy group (11.% vs 3.6%, P=0.03), according to the 225-person C-TRACT report in the New England Journal of Medicine. The study was presented at the Society of Interventional Radiology annual meeting in Toronto.

"For patients with severe, refractory post-thrombotic syndrome and a risk of hemorrhage that is deemed to be acceptable, this trial offers a credible basis for incorporating endovascular therapy into individualized care," commented Ronald Luiz Gomes Flumignan, MD, PhD, and Luis Carlos Uta Nakano, MD, PhD, both of Universidade Federal de São Paulo, in an accompanying editorial.

Post-thrombotic syndrome is a common complication after deep vein thrombosis (DVT). Veins that remain damaged, despite treatment of the blood clot, can result in symptoms like pain, itching, and swelling. By eliminating chronic venous obstruction, endovascular therapy was hypothesized to help relieve the severity and symptoms of post-thrombotic syndrome in C-TRACT.

"These findings highlight the value of iliac-vein outflow after DVT, which is in alignment with the open-vein hypothesis," Vedantham's group wrote. "Although most of the episodes of bleeding were nonmajor and occurred months after endovascular therapy, an increased risk of bleeding associated with enhanced antithrombotic therapy is a clinical trade-off of adopting a stent placement strategy."

Notably, the intervention group had also received enhanced antithrombotic therapy, making it "impossible to disentangle the independent contributions of each component," according to Gomes Flumignan and Uta Nakano.

They stressed that the optimal antithrombotic regimen after stenting remains unanswered, as is the question of the durability of stenting.

"Metallic venous stents are permanent implants, yet the C-TRACT trial captures outcomes for only the first 6 months ... Data at 12 to 24 months that would link patency trajectories to symptom outcomes are needed before stenting can be incorporated into routine guideline recommendations. Cost-effectiveness analyses remain outstanding," Gomes Flumignan and Uta Nakano wrote.

"Pending those data, the C-TRACT trial provides the strongest available evidence that endovascular therapy leads to a reduction in the severity of post-thrombotic syndrome and improvement in quality of life in carefully selected patients with moderate or severe disease and confirmed iliac obstruction. Shared decision-making should integrate patient preferences, individual bleeding risk, access to experienced operators, and the realistic magnitude of expected benefit," they stated.

The phase III trial was conducted in 29 centers in the U.S. From 2018 to 2025, investigators enrolled patients with moderate or severe post-thrombotic syndrome -- the individual having substantial limitations in daily activities or work capacity owing to venous symptoms in the ipsilateral leg following an instance of DVT at least 3 months prior -- and iliac-vein obstruction on imaging.

Participants were randomized to one of two groups: the intervention group receiving iliac vein stent placement and enhanced antithrombotic therapy with usual care, or those getting usual care alone (e.g., compression stockings, anticoagulant therapy, lifestyle guidance, and referral to wound care clinics).

The endovascular procedure was performed with the treating physician's choice of access vein, method of crossing the obstructed veins, and the type of commercially available stent. Catheter venography and intravascular ultrasounds were required before veins were predilated and stents deployed. After endovascular therapy, the use of therapeutic anticoagulants and aspirin (81 mg daily) was recommended for at least 6 months if the patient had no contraindications to either.

There were 225 patients randomized, approximately 47% of whom were women with an average age of 55. Also, 24% were Black and 12% Hispanic or Latino.

The proportion of iliac veins deemed patent (flow present with <50% stenosis) at 6 months was 62.5% versus 36.6% between the endovascular therapy and control groups, respectively, though vein status was unknown for another 17% and 39.3%.

Procedure-related serious adverse events included stent deformation in one patient (corrected during the procedure with balloon angioplasty) and groin pain resulting in hospitalization in one patient.

Major bleeding occurred in four patients in the intervention group and one in the control group. No episodes of bleeding were fatal or led to open surgical therapy.

Of note, the C-TRACT trial had undergone a sample size reduction because an interim analysis had found the numbers of crossovers and losses to follow-up to be lower than expected.

Disclosures

C-TRACT was funded by grants from the NIH and Canadian Institutes of Health Research. Compression garments were donated by Medi USA.

Vedantham reported institutional grants from Medi USA and the National Heart, Lung, and Blood Institute.

Flumignan and Nakano disclosed no relationships with industry.

Primary Source

New England Journal of Medicine

Source Reference: Vedantham S, et al "Endovascular therapy for post-thrombotic syndrome -- a randomized trial" N Engl J Med 2026; DOI: 10.1056/NEJMoa2519001.

Secondary Source

New England Journal of Medicine

Source Reference: Gomes Flumignan RL and Uta Nakano LC "Stenting for post-thrombotic syndrome -- a step forward" N Engl J Med 2026; DOI: 10.1056/NEJMe2603048.

https://www.medpagetoday.com/cardiology/venousthrombosis/120757

Taiwan Helium Imports Rapidly Shift From Qatar To U.S. As Global Energy Flows Are Rewired

 We've been tracking the global rewiring of energy flows from the start, including identifying who stands to emerge as the net beneficiary of the U.S.-Iran conflict and the resulting disruption across the Gulf theater. Early in the conflict, we cited energy research firm Criterion, which noted that Qatar had been dethroned as the "LNG king" as the U.S. seized the throne, reshaping the future of global gas markets.

None of this should come as a surprise. Eurasian energy flows have been rewired over the last four years, first by the Russia-Ukraine war and now by the U.S.-Iran conflict. Nord Stream was an early turning point in that structural shift, and the latest Gulf disruptions have only accelerated it.

What had been obvious to energy analysts for weeks finally broke into the mainstream over the weekend, with even Fox News plastering charts showing the U.S. has become the world's emergency gas station.

The next chart, shared by independent research firm SemiAnalysis, shows yet another rewiring of global energy flows, this time in Taiwan's helium sourcing, which was previously dominated by shipments from Qatar; this trend has quickly reversed, with U.S. helium shipments ramping up.

Key points of the SemiAnalysis chart showing the structural shift in Taiwan's helium sourcing:

Qatar dominated - until recently:

• From 2020 through most of 2024, Taiwan's helium imports were heavily dominated by Qatar (orange line)

• Volumes ramped in just a few short years, peaking above $20M/month in 2025

• That reflects Qatar's long-standing role as a low-cost, large-scale helium supplier.

Sudden reversal:

• Qatar volumes are sharply rolling over in 2026

• It's not demand-driven, given AI chip production elevated - it's linked to supply disruption or geopolitical risk and uncertainty in the Mideast, forcing Taiwanese buyers to source from more secure areas

US exporters stepping in:

• U.S. helium (blue line) was volatile and secondary for years

• But by 2026, a clear rebound in U.S. exports to Taiwan

What this all means is that, with Qatar's energy flows disrupted by war-related damage that could take years to fix, the U.S. is stepping in as a swing supplier, given that ExxonMobil's LaBarge facility in Wyoming accounts for about 20% of the world's supply.

Latest note:

• Wyoming's Helium Empire Ascends As Qatar Gas Goes Flat

Helium is critical for Taiwan because it sits at the center of the global semiconductor manufacturing chain. The gas is vital for cooling advanced chipmaking machines that produce chips for iPhones and computers.

The rewiring of global energy flows toward the U.S. comes down to one thing: the Trump administration is trying to reestablish strategic leverage after years of watching that advantage erode under Obama and Biden as China expanded its power. 

https://www.zerohedge.com/energy/taiwan-helium-imports-rapidly-shift-qatar-us-global-energy-flows-are-rewired

OpenAI: Microsoft limited our ability to reach clients

 OpenAI Inc.'s recently appointed Chief Revenue Officer Denise Dresser stated that Microsoft Corporation "limited" the company's ability to reach clients, and hailed OpenAI's partnership with Amazon.com, Inc., CNBC reported on Monday, citing Dresser's memo to employees.

"Our Microsoft partnership has been foundational to our success. But it has also limited our ability to meet enterprises where they are - for many that's Bedrock," Dresser said in the memo. "Since we announced the partnership at the end of February, inbound demand from our customers for this offering has been frankly staggering," she added.

Microsoft reportedly considered legal action against Amazon previously, claiming that the company's $50 billion cloud deal may undermine Microsoft's exclusive hosting rights.

https://breakingthenews.net/Article/OpenAI:-Microsoft-limited-our-ability-to-reach-clients/66056176

Magyar reaffirms support for Israel

 Hungary's incoming prime minister, Peter Magyar, reaffirmed his country's support for Israel on Monday, stating that there is a "special relationship" between the two countries.

"Hungary has always had zero tolerance for anti-semitism and will continue to do so," he told reporters, adding he will not say more. However, Magyar noted Israel is an "important economic partner" for Hungary and that Budapest will seek a "pragmatic relationship" with that country.

Asked about Hungary's withdrawal from the International Criminal Court (ICC) under the still incumbent Prime Minister Viktor Orban, Magyar said the process is impossible to stop, but promised his government would assess mechanisms for cooperation with the court.

https://breakingthenews.net/Article/Magyar-reaffirms-support-for-Israel/66056663

Trump: Iranian ships nearing blockade will be destroyed

 US President Donald Trump took to Truth Social on Monday to confirm his country has begun blocking ships from entering or exiting Iranian ports, while threatening the Islamic Republic that if any of their "fast attack ships" approach the blockade, they will be "immediately ELIMINATED."

"If any of the Iranian ships come anywhere close to our BLOCKADE, they will be immediately ELIMINATED, using the same system of kill that we use against the drug dealers on boats at Sea. It is quick and brutal," he wrote.

US CENTCOM previously said the blockade would be implemented impartially, targeting ships of all nations entering or departing Iranian ports and coastal areas, including those located along the Arabian Gulf and the Gulf of Oman.

https://breakingthenews.net/Article/Trump:-Iranian-ships-nearing-blockade-will-be-destroyed/66057036