A fresh analysis from the nonprofit Patient Rights Advocate (PRA) shows that while compliance with federal hospital price transparency rules has reached its highest level yet, only about half of U.S. hospitals are fully meeting the requirements. The report, released Thursday, marks the eighth time PRA has tracked these metrics since the rules took effect in 2021.
PRA reviewed 2,000 hospitals and found that 988—or 49.4 percent—were in full compliance. That's a 28-point jump from the group's previous report in 2024, and the best showing since PRA began monitoring in July 2021. Still, the findings underscore that a majority of hospitals are not giving patients the clear, upfront pricing the federal government intended.
The core issue, according to PRA, is that many hospitals are posting machine-readable files (MRFs) that are technically present but fail to provide usable data. "Overall compliance with formatting requirements improved, but a substantial number of hospitals posted algorithms that failed to satisfy the 'all necessary information' requirement," the report states. "Many of the algorithms were complex and opaque, preventing MRF users from calculating any price at all."
Only 18 percent of all hospitals reviewed posted dollar-and-cents prices for at least half of their items and services. That's a key metric for patients trying to compare costs before undergoing procedures.
PRA founder and chair Cynthia Fisher said in a statement that the Centers for Medicare and Medicaid Services (CMS) "has made progress enforcing its hospital transparency rules, but this report shows that most hospitals still owe patients clear, usable dollars-and-cents prices they can look up before receiving care."
The Trump administration has been stepping up enforcement. In June, it sent warnings to more than 500 hospitals that had not complied with pricing transparency requirements, demanding corrective action. Hospitals that fail to address the issues face penalties of up to $2 million per year.
This report arrives amid broader political battles over healthcare pricing. Lawmakers in the House and Senate have been clashing over how to strengthen price transparency laws, with some pushing for stricter penalties and others focusing on making data more consumer-friendly. Meanwhile, the Department of Justice is probing price-fixing in other sectors, highlighting the broader scrutiny of pricing practices across industries.
For patients, the takeaway is mixed: compliance is improving, but the majority of hospitals still aren't providing the transparency that could help them make informed decisions about their care. As the administration continues its enforcement push, the pressure on hospitals to comply is likely to intensify.
