The Centers for Medicare & Medicaid Services (CMS) issued a Price Transparency Mandate, which requires six thousand hospitals in the US to publish their standard charges in a machine-readable format and a consumer-friendly manner on their websites from January 1, 2021. Starting Jan 1, 2022, the non-compliant hospitals will have to pay $300 per day upto 30 beds, and beds above 30 will pay $10/bed/day not exceeding $5500 per day. This 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.
Beginning January 1, 2021, the CMS started to monitor and enforce these price transparency requirements. For hospitals that do not comply, CMS may issue a warning notice, request a corrective action plan, impose a civil monetary penalty and publicize the penalty on a CMS website.
Recently two hospitals in Georgia, Northside Hospital Atlanta were penalized $883,180 and Northside Hospital Cherokee $214,320 by the CMS for non-compliance.
| Hospital Name | CMP Amount | Effective Date |
| Northside Hospital Cherokee | $214,320.00 | 2021-09-09 |
| Northside Hospital Atlanta | $883,180.00 | 2021-09-02 |
We have analyzed more than 5000 hospital data across the United States to see if they are compliant with CMS requirements and simplified the 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 engine, 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 better understand their healthcare costs before receiving treatment and making healthcare more efficient and affordable. This pricing information is highly beneficial for uninsured, underinsured consumers and self-insured employers to price shop healthcare services.
We started with the Southeastern region, followed by the Southwest, Northeast, Midwest, West, and other areas, including Puerto Rico, Virgin Islands, and Washington DC.
Let us look at how Hospitals in the West region if they comply with CMS Price Transparency Requirements.
We analyzed 883 hospitals in the West Region and found 221(24%) are compliant, and 672 (76%) are non-compliant with CMS requirements. As of July 21, 2022, the non-compliant hospitals will face a cumulative penalty of $204,117,510.
West Region Pic:
Alaska:
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 cumulative penalty of $2,094,420.
California:
We analyzed 361 hospitals in California , found 72(20%) hospitals compliant, and
289(80%) hospitals are non-compliant with CMS price transparency requirements.
The 289 non-compliant hospitals will face a cumulative penalty of $117,916,650.
Colorado:
We analyzed 91 hospitals in Colorado, found 23(25%) hospitals compliant, and
68(75%) hospitals are non-compliant with CMS price transparency requirements.
The 68 non-compliant hospitals will face a cumulative penalty of $16,325,220.
Hawai:
We analyzed 23 hospitals in Hawaii, found 4(17%) hospitals compliant, and
19(83%) hospitals are non-compliant with CMS price transparency requirements.
The 19 non-compliant hospitals will face a cumulative penalty of $4,484,310.
Idaho:
We analyzed 45 hospitals in Idaho, found 17(38%) hospitals compliant, and
28(62%) hospitals are non-compliant with CMS price transparency requirements.
The 28 non-compliant hospitals will face a cumulative penalty of $4,922,490.
Montana:
We analyzed 60 hospitals in Montana, found 15(25%) hospitals compliant, and
45(75%) hospitals are non-compliant with CMS price transparency requirements.
The 45 non-compliant hospitals will face a cumulative penalty of $5,481,270.
Nevada:
We analyzed 43 hospitals in Nevada, found 6(14%) hospitals compliant, and
37(86%) hospitals are non-compliant with CMS price transparency requirements.
The 37 non-compliant hospitals will face a cumulative penalty of $12,902,190.
Oregon:
We analyzed 61 hospitals in Oregon, found 10(16%) hospitals compliant, and
51(84%) hospitals are non-compliant with CMS price transparency requirements.
The 51 non-compliant hospitals will face a cumulative penalty of $12,317,280.
Utan:
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 cumulative penalty of $5,939,550.
Washington:
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 cumulative penalty of $19,360,320.
Wyoming:
We analyzed 28 hospitals in Wyoming, found 6(21%) hospitals compliant, and
22(79%) hospitals are non-compliant with CMS price transparency requirements.
The 22 non-compliant hospitals will face a cumulative penalty of $2,373,810.
Alabama:
We analyzed 117 hospitals in Alabama. 17(15%) hospitals are compliant, and
100(85%) hospitals are non-compliant with CMS price transparency requirements.
The 100 non-compliant hospitals will face a cumulative penalty of $28,863,800.
Arkansas:
We analyzed 85 hospitals in Arkansas. Out of those, 36 (42%) hospitals are compliant, and 49 (58%) hospitals are non-compliant as per CMS price transparency guidelines. The 49 non-compliant hospitals will face a penalty of $1.25M in total.
Florida:
We analyzed 207 hospitals in Florida. Out of those, 52 (25%) hospitals are compliant, and 155 (75%) hospitals are non-compliant as per CMS price transparency guidelines. The 155 non-compliant hospitals will face a penalty of $3.95M in total.
Georgia:
We analyzed 142 hospitals in Georgia. 44 (31%) hospitals are compliant, and 98(69%) hospitals are non-compliant as per CMS price transparency guidelines. The 155 non-compliant hospitals will face a penalty of $2.50M in total.
Kentucky:
We analyzed 102 hospitals in Kentucky. 31 (30%) hospitals are compliant, and 71(70%) hospitals are non-compliant as per CMS price transparency guidelines. The 102 non-compliant hospitals will face a penalty of $1.81M in total.
Louisiana:
We analyzed 144 hospitals in Louisiana. 42 (29%) hospitals are compliant, and 102(71%) hospitals are non-compliant as per CMS price transparency guidelines. The 144 non-compliant hospitals will face a penalty of $2.60M in total.
Mississippi:
We analyzed 96 hospitals in Mississippi. 47 (49%) hospitals are compliant, and 49(51%) hospitals are non-compliant as per CMS price transparency guidelines. The 96 non-compliant hospitals will face a penalty of 1.25M in total.
North Carolina:
We analyzed 112 hospitals in North Carolina. 29 (26%) hospitals are compliant, and 83(74%) hospitals are non-compliant as per CMS price transparency guidelines. The 112 non-compliant hospitals will face a penalty of $2.12M in total.
South Carolina:
We analyzed 67 hospitals in South Carolina. 18 (27%) hospitals are compliant, and 49(73%) hospitals are non-compliant as per CMS price transparency guidelines. The 67 non-compliant hospitals will face a penalty of $1.25M in total.
Tennessee:
We analyzed 113 hospitals in Tennessee. 59 (52%) hospitals are compliant, and 54(48%) hospitals are non-compliant as per CMS price transparency guidelines. The 113 non-compliant hospitals will face a penalty of $1.38M in total.
Virginia:
We analyzed 87 hospitals in Virginia. 17 (20%) hospitals are compliant, and 70(80%) hospitals are non-compliant as per CMS price transparency guidelines. The 87 non-compliant hospitals will face a penalty of $1.78M in total.
West Virginia:
We analyzed 53 hospitals in West Virginia. 21 (40%) hospitals are compliant, and 32 (60%) hospitals are non-compliant as per CMS price transparency guidelines. The 53 non-compliant hospitals will face a penalty of $$816.00K in total.
Disclaimer and Methods:
ZeaMed Healthcare Services, LLC or its affiliate parties have collected the machine-readable files and data from hospital websites to see if the hospitals are compliant with CMS Price Transparency Requirements. The data is extracted from standard charges for items, services, service packages, and shoppable services. As per CMS, the mandatory data fields to be present in the file are tests/procedure codes, tests/procedure description, Gross prices, Cash Prices, negotiated insurance prices, de-identified minimum and de-identified maximum prices with IP, OP differentiation.
There could be some errors while extracting, analyzing, and updating the data. Providers are defining their own column/field names. MR files were available in the following formats CSV, EXCEL, JSON, XML, PDF, DOCX, HTML,Text. MR files had only billing IDs, and when they gave the identifiers, they did not make code type mapping like CPT, MS-DRG, APR-DRG, APC, HCPCS, NDC, Internal Codes. Most of the providers have not mentioned if the price includes all services.
Whatever the hospital websites have reported, that data is displayed here. ZeaTool helps the consumers, hospitals, and healthcare stakeholders understand what is in the machine-readable files. The data could also be from old files because some hospitals have not removed the old files from their websites. The data may not be available because some hospitals’ websites are not friendly and could not find the machine-readable files. In the case of a few providers, the file name was given under the health system name, making it complicated to identify the actual provider to which it belongs. Most providers use their internal names to identify the services, and it is different across the providers. Since some of the providers have not given unique codes, it is challenging to identify the services.
The patient estimator tools or costs provided via these tools are only estimates as per many hospital websites.
The information provided is from the hospital websites only; the users can decide if hospitals are compliant or not.
If any hospital has questions about their data and compliance, they can reach out to us and suggest any corrections to the data. We will make corrections to the data after verifying their data.
We are not responsible for the correctness of data, and it is for the user to check with the hospitals for the latest information. Also, the hospitals may have updated their data which may not reflect on this website. We are not responsible for any suits filed by anyone against the hospitals, and also, we do not take any responsibility for the information provided by the hospital. We are not responsible for any data discrepancies in visiting the website and checking the data’s compliance. The user of the information is responsible for verifying with the concerned hospitals.
We considered hospital to be compliant when the hospital gave the Machine-readable file that contains all items, services, service bundles that include gross, cash price, de-identified minimum price, de-identified maximum price, and insurance negotiated prices plus the 300 shoppable services that have discounted cash price (can give gross prices if cash payment is not available), de-identified minimum price, de-identified maximum price, and insurance negotiated price in a machine-readable format or a patient estimator tool on the hospital website. Since many providers have not given separate outpatient and inpatient prices, we have considered them applicable to both inpatient and outpatient patients except for MS-DRGs and APR-DRGs. The data can still show errors about the inpatient and outpatient services which we are not responsible for. We believe human errors and technological errors could also play a role in data discrepancies.
ZeaMed Healthcare Services, LLC and Affiliate members, websites, apps, and other technologies and people are not responsible for data errors”.
References:
CMS
https://www.cms.gov/hospital-price-transparency/enforcement-actions
Alabama (AL) Total Possible Penalty: $1.86M
Arkansas (AR) Total Possible Penalty: $1.25M
Florida (FL) Total Possible Penalty: $3.95M
Georgia (GA)Total Possible Penalty: $2.50M
Kentucky (KY)Total Possible Penalty: $1.81M
Louisiana (LA)Total Possible Penalty: $2.60M
Mississippi (MS)Total Possible Penalty: $1.25M
North Carolina (NC) Total Possible Penalty: $2.12M
South Carolina (SC) Total Possible Penalty: $1.25M
Tennessee (TN)Total Possible Penalty: $1.38M
Virginia (VA)Total Possible Penalty: $1.78M
West Virginia (WV)Total Possible Penalty: $816.00K