GRAND FORKS — Several North Dakota hospitals are not compliant with federal price transparency regulations for hospitals, a report by a patient rights advocacy group found.

The compliance report randomly surveyed five North Dakota hospitals as part of its nationwide audit. While all five hospitals do post their prices in some form somewhere on their website as required by federal regulations, all five — Altru Hospital in Grand Forks, CHI St. Alexius Health in Bismarck, Trinity Hospital in Minot, and the Sanford Medical Centers in Bismarck and Fargo — were found to be not fully compliant with various aspects of the rule.

The North Dakota hospitals are far from unique. The Massachusetts-based Patient Rights Advocate semi-annual hospital price transparency compliance report released earlier this month, compiled by auditing a random sample of 500 hospitals nationwide out of the roughly 6,000 that are subject to the rule, found that only about 5.6% are fully compliant.

According to the federal price transparency rule, which went into effect on Jan. 1, hospitals must post all prices online, easily accessible without barriers, such as having to submit personal identifying information. Cost information should be organized in a machine-readable standard charges list for all items, services, payers and plans, as well as all discounted cash prices. Hospitals should also have a standard charges list or a price estimator tool for the 300 most common shoppable services.

Hospitals were found to be noncompliant if they failed to meet any aspect of that criteria. Of the 500 hospitals nationwide in the report, only 28 were found to be fully compliant.

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All five hospitals declined to be interviewed by the Grand Forks Herald. Altru and Sanford each provided emailed statements. Trinity Hospital declined any comment, and CHI St. Alexius did not respond to multiple requests for comment.

The report notes that Altru is missing cash prices in its standard charges file. Teresa Moe, Altru's director of payor contracting and reimbursement, noted that Altru currently includes charges as case rates, but in light of the report will work to break those charges out to achieve full compliance.

"At this time, we use a machine readable format to list our charges, which is not as user friendly as we’d like, but does meet the standard," Moe said in an emailed statement. "We continue to work on improving the interpretation of these charges for our patients."

Altru has also implemented a price estimator tool via MyChart, where patients can input information about upcoming procedures or services to receive an easy-to-understand estimate, Moe said.

Of the five hospitals, Sanford was the most compliant, meeting 10 of the 12 standards outlined in the report. According to the report, Sanford is considered noncompliant because its standard charges file is missing specific plan names for major payers.

In an emailed statement, Sanford Vice President of Corporate Contracting Martha Leclerc reiterated the health system's commitment to cost transparency, and claimed Sanford is going "above and beyond" to ensure patients get the information they need.

"Sanford Health is compliant and meets all the requirements for cost transparency; however, published costs can be extremely misleading due to differences in health insurance and how charges are bundled, among other factors," she said in her statement. "The published prices also don’t reflect what a patient pays out of pocket, which can be confusing for consumers. We’re committed to eliminating confusion and always offer financial counseling to help patients understand potential costs up front."

The report notes that Trinity Hospital is missing payer and specific plan names, and CHI St. Alexius Health only includes CPT codes, or numbers assigned to each service and procedure, and gross prices.