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Mass. Gen. Laws. Ann. ch. 12C, § 8 - Reporting requirements for institutional providers and their parent organization and other affiliates

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The Center for Health Information and Analysis must require the uniform reporting of revenues, charges, costs, prices, and utilization of health care services by institutional providers, their parent organizations, and affiliated entities.  The uniform reporting will allow the Center to identify patient-centered and provider specific trends in cost, price, availability, and utilization of medical, surgical, diagnostic and ancillary services provided by acute hospitals, nursing homes, chronic care and rehabilitation centers, and other specialty hospitals.  The Center must also require providers to report agreements providing a discount, rebate, or other type of remuneration to other providers relating to the provision of health care services. 

The Center must require acute and non-acute hospitals to file the following information with the Center:

  • Charge book
  • Cost data
  • Audited financial statements
  • Merged billing and discharge data

The Center must designate standardized systems for determining, reporting and auditing volume, case-mix, proportion of low-income population, and other necessary information to compare acute and non-acute care hospitals by cost, utilization and outcome.  The information may be required to be submitted electronically.  The Center must prepare an annual report that analyzes the comparative information to assist third party payers and purchasers of health care services to make informed decisions.  The report must also contain comparative price and service information on mental health services.

The Center must also collect and analyze data deemed to be in the public’s interest in monitoring the financial conditions of acute hospitals.   The information must be analyzed on an industry-wide and hospital-wide basis and include:

  • Gross and net patient services revenues
  • Sources of hospital revenue
  • Private sector charges
  • Trends in inpatient and outpatient case-mix, payer mix, hospital volume, and length of stay
  • Total payroll as a percent of operating costs, including salary of 10 highest paid employees
  • Other relevant measures of financial health or distress

The Center must publish an annual report on the financial trends in the acute hospital industry, including an analysis of the inefficiencies leading to financial distress in the industry.  The report must note which hospitals are considered to be in financial distress and in danger of closing. 

The Center must publicly report on and put on its website information on health status adjusted total medical expenses, broken down by major service category and payment methodology, relative prices, and costs.  The affected provider must be given the chance to review the information at least 10 days before it is posted on the website.  The Center must also request the health status adjusted total medical expenses of provider groups that serve Medicare patients from the Centers for Medicare and Medicaid Services.  

When collecting and compiling information the Center must ensure that:

  • Providers that are part of a representative group are actively involved in the collection methodologies and dissemination tactics;
  • The entire methodology for collecting and analyzing data be disclosed to all relevant provider groups;
  • Data collection and analytical methods must be based on reliable and valid standards;
  • The limitations of data sources and analytical methods used to develop provider profiles be clearly identified;
  • Provider profiling initiatives must use standards-based norms;
  • Provider profiles and other compiled information must be shared with the provider before dissemination, allowing the provider to include additions or  corrections to their profiles prior to publication;
  • Comparisons among provider profiles must control for patient case-mix;
  • Effective safeguards against unauthorized use or disclosure of patient profile information are developed;
  • Effective safeguards to protect against the dissemination of invalid, inconsistent, inaccurate, or subjective profile data are implemented;
  • The quality and accuracy of provider profiles and data are evaluated regularly.

Current as of June 2015