The Centers for Medicare & Medicaid Services (CMS) issued a Price Transparency Mandate, which requires six thousand hospitals in the US to publish their chargemaster prices in a machine-readable format and 300 shoppable services in a consumer-friendly manner on their websites by January 1, 2021. The requirement is the first step to taking complex healthcare pricing information and making it transparent.
According to CMS, the machine-readable file should include the following:
Comprehensive file with all items, services, and service packages which include:
• Gross charges
• Discounted cash prices
• Payer-specific negotiated charges
• De-identified minimum negotiated charges
• De-identified maximum negotiated charges
A consumer-friendly display that includes the following standard charges for at least 300 ‘shoppable’ services:
• Discounted cash prices (use gross charges if cash prices are not available)
• Payer-specific negotiated charges
• De-identified minimum negotiated charges
• De-identified maximum negotiated charges
We checked more than 5000 hospital websites to find machine-readable files and patient estimator tools. We analyzed the data to see if the hospitals are compliant with the CMS requirements and simplified the pricing data into a user-friendly format so that anyone can easily understand.
We want to help hospitals that are non-compliant to become compliant using our price transparency innovative Zeatool. Our goal is to help hospitals take this big pricing data, navigate new ways to cut waste, increase revenue, and bring the antiquated healthcare system into the E-commerce age.
Once healthcare data is shoppable, consumers can know the cost of their healthcare services before receiving care. This pricing information is highly beneficial for uninsured, underinsured consumers and self-insured employers to price shop healthcare services.
This report provides an analysis of the Midwest region of the United States. How Hospitals in the Midwest region comply with CMS Price Transparency Requirements?
We analyzed 1482 hospitals in the Midwest Region, found 535(36%) compliant, and 947(64%) are non-compliant with CMS requirements. As of April 6, 2021, the non-compliant hospitals will face a penalty of $300/day for a total of $27,273,600 and the penalty for each non-compliant hospital is $28,500.
We analyzed 194 hospitals in Illinois, found 94 (48%) hospitals compliant, and 100 (52%) hospitals are non-compliant with CMS price transparency requirements. The 100 non-compliant hospitals will face a total penalty of $2,880,000.
We analyzed 141 hospitals in Indiana, found 67(48%) hospitals compliant, and 74(52%) hospitals are non-compliant with CMS price transparency requirements. The 74 non-compliant hospitals will face a total penalty of $2,131,200.
We analyzed 115 hospitals in Iowa, found 54(47%) hospitals compliant, and 61(53%) hospitals are non-compliant with CMS price transparency requirements. The 61 non-compliant hospitals will face a total penalty of 1,756,800.
We analyzed 138 hospitals in Kansas, found 62(45%) hospitals compliant, and 76(55%) hospitals are non-compliant with CMS price transparency requirements. The 76 non-compliant hospitals will face a total penalty of $2,188,800.
We analyzed 141 hospitals in Michigan, found 68(48%) hospitals compliant, and 73(52%) hospitals are non-compliant with CMS price transparency requirements. The 73 non-compliant hospitals will face a total penalty of $2,102,400.
We analyzed 132 hospitals in Minnesota, found 49(37%) hospitals compliant, and 83(63%) hospitals are non-compliant with CMS price transparency requirements. The 83 non-compliant hospitals will face a total penalty of $2,390,400.
We analyzed 115 hospitals in Missouri, found 21(18%) hospitals compliant, and 94(82%) hospitals are non-compliant with CMS price transparency requirements. The 94 non-compliant hospitals will face a total penalty of $2,707,200.
We analyzed 89 hospitals in Nebraska, found 25(28%) hospitals compliant, and 64(72%) hospitals are non-compliant with CMS price transparency requirements. The 295 non-compliant hospitals will face a total penalty of $1,843,200.
We analyzed 44 hospitals in North Dakota, fund 10(23%) hospitals compliant, and 34(77%) hospitals that are non-compliant with CMS price transparency requirements. The 34 non-compliant hospitals will face a total penalty of $979,200.
We analyzed 188 hospitals in Ohio, found 30(16%) hospitals compliant, and 158(84%) hospitals are non-compliant with CMS price transparency requirements. The 158 non-compliant hospitals will face a total penalty of $4,550,400.
We analyzed 55 hospitals in South Dakota, found 8(15%) hospitals compliant, and 47(85%) hospitals are non-compliant with CMS price transparency requirements. The 47 non-compliant hospitals will face a total penalty of $1,353,600.
We analyzed 130 hospitals in Wisconsin, found 47(36%) hospitals compliant, and 83(64%) hospitals are non-compliant with CMS price transparency requirements. The 295 non-compliant hospitals will face a total penalty of $2,390,400.
The following 124 hospitals have exceeded the CMS requirements by giving Chargemaster MR file, Shoppable Services MR file, and Estimator tools.
