The Facilities for Medicare & Medicaid Companies (CMS) has fined two hospitals in September for alleged violations of its value transparency rule. This marks the third month in a row that the company has issued fines in opposition to hospitals for value transparency noncompliance, following a yearslong interval of sunshine enforcement.
The 2 fines issued on September 5 have been the thirteenth and fourteenth penalties CMS has imposed on hospitals for value transparency violations. Saint Elizabeths Hospital in Washington, D.C. was fined $677,440, and Holy Cross Hospital in Silver Spring, Maryland was fined $325,710.
CMS’ rule goals to make hospitals’ pricing knowledge extra accessible to sufferers to allow them to evaluate prices and make extra knowledgeable choices concerning the healthcare providers they select. The legislation requires all hospitals to publish their gross prices, payer-specific negotiated prices, de-identified minimal negotiated prices, de-identified most negotiated prices and money costs on their web sites in a machine-readable file. It additionally mandates that hospitals should publish pricing for the 300 mostly used providers to their web site in a consumer-friendly method.
The rule went into impact on January 1, 2021. CMS didn’t begin penalizing hospitals for his or her noncompliance with the rule till June 2022, when the company fined two Georgia hospitals. The subsequent fines didn’t come till April of this yr.
However enforcement of the rule appears to have picked up in latest months, as CMS issued three fines in July and 5 in August.
CMS’ growing enforcement of its value transparency rule may stem from the truth that hospitals are starting to have a better time complying with the rule — this was not at all times the case.
In June of final yr — a yr and a half after CMS started imposing the rule — a JAMA examine revealed that fewer than 6% of hospitals have been totally compliant. However a Turquoise Well being report from this yr confirmed that hospitals’ compliance charges are steadily growing. Within the first quarter of 2023, 84% of hospitals had posted some kind of pricing knowledge on-line, in response to the report.
CMS up to date its enforcement course of for the rule in April. The company requires hospitals deemed out of compliance with the rule to submit a corrective motion plan inside 45 days from when CMS points its request for one — and hospitals are required to be in full compliance with the rule inside 90 days from when the company issued its corrective motion plan request. CMS additionally robotically imposes civil financial penalties on hospitals that fail to submit a corrective motion plan throughout the 45-day timeframe.
After CMS points a noncompliance advantageous, the hospital has 30 days to attraction. Three of the 14 hospitals which have been fined for noncompliance have appealed their penalties, and CMS mentioned these instances stay below overview.
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