Most Oregon Hospitals Aren’t Following Federal Transparency Guidelines, Advocacy Group Finds

Joan McGuire
Kaiser Permanente Interstate Medical Office Central in Portland.

A study from found that Oregon hospitals are among the least transparent in the nation

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Nearly four-fifths of Oregon hospitals are not fully compliant with federal pricing transparency guidelines, according to a report released last week by a patients’ rights advocacy group.

The report, published by, found that 79% of Oregon hospitals were not in full compliance with the Hospital Price Transparency Rule, a federal guideline established by the Centers for Medicare and Medicaid Services three years ago. The rule mandates that hospitals provide clear, accessible pricing information about the hospital’s services in a downloadable form in a single online location.

The latest version of the  Semi-Annual Hospital Price Transparency Report covers the period between August 2023 and February 2024. The last version of the same study, published in July 2023 found 68% of Oregon hospitals were out of compliance with the rule.

Oregon hospitals were among the least compliant in the nation, according to the organization’s sixth Semi-Annual Hospital Price Transparency report, which ranked Oregon 34th in compliance with the rule.

The report includes a list of 2,000 hospitals nationwide that were reviewed for the study, and states whether or not each individual hospital was in compliance. Just four Oregon hospitals made the grade: Adventist Health Tillamook, OHSU Hospital Portland, CHI St. Anthony Hospital in Pendleton and Willamette Valley Medical Center in McMinnville were all in compliance with the rule. The 15 other Oregon hospitals assessed in the study were not.

Failure to comply can result in federal fines, but PRA founder and chairman Cynthia Fisher tells Oregon Business lack of enforcement means most hospital systems can obscure prices and add on additional fees.

“Insurance companies and hospitals are making money by adding charges and creating facility fees and adding codes and, if you have upfront certainty, they can’t do that anymore,” Fisher says. “You can interview fine businesses — small, medium large — and you’ll find some of them will have had their coverage rates go up by 18% since last year. That’s far higher than inflation. This has been happening year over year, and businesses and unions are getting fed up. They want access to the pricing data.”

An estimate from Mercer and Willis Towers Watson estimated workplace health plan prices will increase by more than 6% next year.

“Health and Human Services secretary [Xavier] Becerra needs to enforce the law. He has the right to fine every one of them $2 million if they aren’t compliant,” Fisher adds. 

Some Oregon hospitals were found non-compliant because their pricing information varied by location. The organization’s study last year found 98% of Kaiser Permanente hospitals were fully complying, but Kaiser now posts multiple pricing files, instead of a single file as required by the rule, so none of Kaiser’s hospitals were deemed fully compliant, despite the hospital having pricing information available.

Debbie Karman, director of public relations at Kaiser Permanente Northwest
released a company statement to Oregon Business in response to the group’s findings.

“Kaiser Permanente has complied with the required elements for hospital price transparency. We post one machine readable file with prices for all health care services and one shoppable services file with the prices for common services for each Kaiser Permanente Hospital as required by the regulation.

The Patient Rights Advocate group that conducted this survey and issued this report is not a government entity with authority to interpret CMS requirements. They have erroneously categorized Kaiser Permanente as non-compliant.”

Fisher says in lieu of federal oversight, states can pass laws themselves to keep hospital prices transparent.

She pointed to Colorado, where her study found 50% of all hospitals were compliant with Hospital Price Transparency rules. In 2022, the state passed House Bill 22-1285, which prohibits hospitals from taking collection actions against patients or their guarantors if the hospital is not in compliance with federal price transparency laws.

Fisher credited the law with Colorado’s relative success keeping hospital prices clear.

“In Colorado they have penalties for the hospital the state can issue beyond the federal government,” Fisher says. “They put in consumer protection acts so that no consumer can be taken to court or billed for medical debt if the hospital doesn’t have prices shown, or hasn’t been upfront about the prices, and the consumers can actually go after the hospitals when they get these bills. And if they can show proof that their pricing isn’t there, they can have proof to not have that claim be against them.”