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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

Or, Hospitals can use a patient estimator tool instead of ‘shoppable’ services.

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 Northeast region of the United States. How Hospitals in the Northeast region comply with CMS Price Transparency Requirements?

We analyzed 688 hospitals in the Northeast Region, found 207(30%) compliant, and 481 (70%) are non-compliant with CMS requirements. As of April 1, 2021, the non-compliant hospitals will face a penalty of $300/day for a total of $13.13 Million and the penalty for each non-compliant hospital is $27,000.

We analyzed 32 hospitals in Connecticut, found 17(53%) hospitals compliant, and 15 (47%) hospitals are non-compliant with CMS price transparency requirements. The 15 non-compliant hospitals will face a total penalty of $409,500.

We analyzed 10 hospitals in Delaware, found 0 (0%) hospitals compliant, and 10 (100%) hospitals are non-compliant with CMS price transparency requirements. The 10 non-compliant hospitals will face a total penalty of $273,000.

We analyzed 35 hospitals in Maine, found 7 (20%) hospitals compliant, and 28 (80%) hospitals are non-compliant with CMS price transparency requirements. The 28 non-compliant hospitals will face a total penalty of $764,400.

We analyzed 51 hospitals in Maryland, found 6 (12%) hospitals compliant, and 45 (88%) hospitals are non-compliant with CMS price transparency requirements. The 45 non-compliant hospitals will face a total penalty of $1,228,500.

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We analyzed 74 hospitals in Massachusetts, found 7 (9%) hospitals compliant, and 67 (91%) hospitals are non-compliant with CMS price transparency requirements. The 67 non-compliant hospitals will face a total penalty of $1,829,100.

We analyzed 27 hospitals in New Hampshire, found 7 (26%) hospitals compliant, and 20 (74%) hospitals are non-compliant with CMS price transparency requirements. The 20 non-compliant hospitals will face a total penalty of $546,000.

We analyzed 77 hospitals in New Jersey, found 7 (9%) hospitals compliant, and 70 (91%) hospitals are non-compliant with CMS price transparency requirements. The 70 non-compliant hospitals will face a total penalty of $1,911,000.

We analyzed 171 hospitals in New York, found 41 (24%) hospitals compliant, and 130 (76%) hospitals are non-compliant with CMS price transparency requirements. The 130 non-compliant hospitals will face a total penalty of $3,549,000.

We analyzed 184 hospitals in Pennsylvania, found 104 (57%) hospitals compliant, and 80 (43%) hospitals are non-compliant with CMS price transparency requirements. The 80 non-compliant hospitals will face a total penalty of $2,184,000.

We analyzed 12 hospitals in Rhode Island, found 4 (33%) hospitals compliant, and 8 (67%) hospitals are non-compliant with CMS price transparency requirements. The 8 non-compliant hospitals will face a total penalty of $218,400.

We analyzed 15 hospitals in Vermont, found 7 (47%) hospitals compliant, and 8 (53%) hospitals are non-compliant with CMS price transparency requirements. The 8 non-compliant hospitals will face a total penalty of $218,400.

The following six hospitals have exceeded the CMS requirements by giving Chargemaster MR file, Shoppable Services MR file, and Estimator tools.

JOHNSON MEMORIAL HOSPITAL

ARNOT OGDEN MEDICAL CENTER

IRA DAVENPORT MEMORIAL HOSPITAL

PHELPS MEMORIAL HOSPITAL CENTER

HOLY REDEEMER HOSPITAL AND MEDICAL CENTER

MONONGAHELA VALLEY HOSPITAL

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