West Region
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:
1.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
2.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
OR
Hospitals can use a patient estimator tool instead of ‘shoppable’ services.
This report provides an analysis of the West region of the United States. How Hospitals in the West region comply with CMS Price Transparency Requirements?
We analyzed 884 hospitals in the West Region, found 247(28%) compliant, and 637(72%) are non-compliant with CMS requirements. As of April 5, 2021, the non-compliant hospitals will face a penalty of $300/day for a total of $18,154,500 and the penalty for each non-compliant hospital is $28,500.
We analyzed 22 hospitals in Alaska, found 8 (36%) hospitals compliant, and 14 (64%) hospitals are non-compliant with CMS price transparency requirements. The 14 non-compliant hospitals will face a total penalty of $399,000.
We analyzed 361 hospitals in California, found 68(19%) hospitals compliant, and 293(81%) hospitals are non-compliant with CMS price transparency requirements. The 293 non-compliant hospitals will face a total penalty of $8,350,500.
We analyzed 91 hospitals in Colorado, found 22(24%) hospitals compliant, and 69(76%) hospitals are non-compliant with CMS price transparency requirements. The 69 non-compliant hospitals will face a total penalty of $1,966,500.
We analyzed 24 hospitals in Hawai, found 10(42%) hospitals compliant, and 14(58%) hospitals are non-compliant with CMS price transparency requirements. The 14 non-compliant hospitals will face a total penalty of $399,000.
We analyzed 45 hospitals in Idaho, found 23(51%) hospitals compliant, and 22(49%) hospitals are non-compliant with CMS price transparency requirements. The 22 non-compliant hospitals will face a total penalty of $627,000.
We analyzed 60 hospitals in Montana, found 23(38%) hospitals compliant, and 37(62%) hospitals are non-compliant with CMS price transparency requirements. The 37 non-compliant hospitals will face a total penalty of $1,054,500.
We analyzed 43 hospitals in Nevada, found 11(26%) hospitals compliant, and 32(74%) hospitals are non-compliant with CMS price transparency requirements. The 32 non-compliant hospitals will face a total penalty of $912,000.
We analyzed 61 hospitals in Oregon, found 22(36%) hospitals compliant, and 39(64%) hospitals are non-compliant with CMS price transparency requirements. The 39 non-compliant hospitals will face a total penalty of $1,111,500.
We analyzed 52 hospitals in Utah, found 26(50%) hospitals compliant, and 26(50%) hospitals are non-compliant with CMS price transparency requirements. The 26 non-compliant hospitals will face a total penalty of $741,000.
We analyzed 97 hospitals in Washington, found 24(25%) hospitals compliant, and 73(75%) hospitals are non-compliant with CMS price transparency requirements. The 73 non-compliant hospitals will face a total penalty of $2,080,500.
We analyzed 28 hospitals in Wyoming, found 10(36%) hospitals compliant, and 18(64%) hospitals are non-compliant with CMS price transparency requirements. The 18 non-compliant hospitals will face a total penalty of $513,000.
The following seventy-one hospitals have exceeded the CMS requirements by giving Chargemaster MR file, Shoppable Services MR file, and Estimator tools.
