79% of Hospitals Still Aren't Fully Transparent on Pricing

On January 1st, the latest round of CMS price transparency requirements went into effect. Hospitals are now required to publish machine-readable files with negotiated rates for every item and service they provide, plus a consumer-friendly display of at least 300 shoppable services. The penalties for non-compliance have been increased. The reporting standards are clearer than ever.

And yet, as of the latest data, only about 21% of hospitals in the United States are fully compliant with every element of the federal requirements. That doesn't mean the other 79% are publishing nothing. Many do post machine-readable files, and tools like ours can pull usable pricing data from a much larger share of hospitals than that 21% number suggests. But there's a wide gap between "we uploaded a spreadsheet" and "we published complete, accurate, format-compliant data for every payer and every service."

The distinction matters, and it's worth unpacking.

What Changed on January 1

The 2026 updates aren't minor tweaks. CMS tightened the machine-readable file format requirements, mandating a specific schema that makes it harder to publish technically-compliant-but-practically-useless files. They raised the maximum penalty to $2 million per year for large hospitals. And they added new requirements around payer-specific negotiated rates that close some of the loopholes hospitals had been exploiting.

On paper, this should be the tipping point. The rules are clear, the penalties are real, and the technical standards are specific enough that compliance is measurable. Hospitals can't just throw a PDF on their website and call it transparency anymore.

In practice, though, enforcement still depends on CMS actually following through. And that's where things get complicated.

Publishing Something vs. Full Compliance

When I talk to people about the 21% full-compliance number, the most common reaction is disbelief. How can hospitals just ignore a federal mandate? But the reality is more of a spectrum than a binary.

At Panopticare, we're ingesting machine-readable files from well over a hundred hospitals in the Chicago area alone. Most of them have published something. The issue is that "something" ranges from genuinely useful pricing data all the way down to files that technically exist but are full of gaps, errors, or meaningless entries. One hospital listed every procedure at $0. Another published 40,000 rows where the price column was blank. These files exist on a website somewhere, but they don't meet the standard that CMS set, and they're not particularly useful to patients.

Full compliance means publishing a machine-readable file in the correct schema with negotiated rates for every payer and every service, plus a consumer-friendly display of at least 300 shoppable services. That's a high bar, and most hospitals fall short on at least one element. Some are missing payer-specific rates. Others have the data but in a non-standard format. Some smaller community hospitals genuinely struggle with the technical requirements.

Then there are the hospitals that could comply but have calculated that the cost of full transparency (when your chargemaster shows the same MRI costs $400 down the street and $2,800 at yours) is higher than the cost of partial compliance. The 21% full-compliance rate has barely budged in years. The new enforcement mechanisms might change that math, but only if CMS uses them consistently.

Enforcement Is Getting Serious (Maybe)

There are some encouraging signs. In 2025, CMS fined 10 hospitals for non-compliance, with penalties reaching up to $310,000. That's still a rounding error for most health systems, but it's a signal. The new $2 million cap is more attention-getting, especially for mid-sized hospitals where that actually shows up on the balance sheet.

Several state attorneys general have also started their own enforcement actions, which adds another layer of pressure. Oklahoma's SB 889 created state-level penalties on top of federal ones. A handful of other states are considering similar legislation.

But let's be honest: even $2 million a year is not a meaningful deterrent for a hospital system generating hundreds of millions in revenue. The real pressure is going to come from somewhere else entirely.

Consumer Tools Are the Real Enforcement Mechanism

Here's what I think most people in this space are missing: the regulation was never going to be enough by itself. You can mandate that hospitals publish their prices, but if nobody is reading those files, hospitals have very little incentive to make them accurate or complete.

The actual enforcement mechanism is consumer behavior. When patients start choosing hospitals based on published prices, when a hospital loses a knee replacement to a competitor because the price was $15,000 lower and the patient could see that before making a decision, that's when compliance becomes a competitive necessity rather than a regulatory checkbox.

This is exactly why I built Panopticare. The raw data exists, scattered across thousands of hospital websites in various formats and levels of quality. What's missing is the layer that makes that data useful to actual people making actual healthcare decisions. We pull in machine-readable files, normalize the data, cross-reference it with insurance rates from Transparency in Coverage filings, and present it in a way that lets you compare prices in about 30 seconds.

We're now processing data from over a hundred hospitals in the Chicago area alone, with more than 1.3 million payer-specific rates from insurers like BCBS, Cigna, and Aetna. The data is there. The question is whether patients will start using it.

What Comes Next

I think 2026 is going to be the year where hospital price transparency either becomes real or settles into permanent non-compliance. The regulations are about as strong as they're going to get without Congressional action. The technical standards are clear. The enforcement mechanisms exist.

What's still missing is the feedback loop between published prices and patient behavior. Most people still don't know they can compare hospital prices before a procedure. Most don't know that the same surgery can cost three or four times as much at one hospital versus another, even within the same city.

If tools like ours can start closing that information gap, if we can make price comparison as natural for a hip replacement as it is for a plane ticket, then compliance will take care of itself. Not because of fines, but because publishing incomplete or unusable data will mean losing patients to the hospital that publishes real prices.

That's the bet, anyway. And I think it's a pretty good one.