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Audit

Audit  Audit of the Center for Health Information and Analysis

Our office conducted a performance audit of the Center for Health Information and Analysis (CHIA) for the period July 1, 2021 through June 30, 2023.

Organization: Office of the State Auditor
Date published: January 3, 2025

Executive Summary

In accordance with Section 12 of Chapter 11 of the Massachusetts General Laws, the Office of the State Auditor has conducted a performance audit of the Center for Health Information and Analysis (CHIA) for the period July 1, 2021 through June 30, 2023.

In this performance audit, we determined whether CHIA maintained information that was updated at least annually on its consumer healthcare information website, CompareCare, as required by Section 20 of Chapter 12C of the General Laws. We also examined how CHIA monitored acute care hospitals as required by Section 8(c) of Chapter 12C of the Generals Laws and whether CHIA took appropriate actions for hospitals that were in noncompliance with Section 9.10 of Title 957 of the Code of Massachusetts Regulations.

Below is a summary of our findings, the effects of those findings, and our recommendations, with links to each page listed.

  
Finding 1
 		CHIA did not appropriately monitor the financial conditions of acute care hospitals and health systems.
EffectBy not receiving, analyzing, and reporting on data related to hospitals and health systems in Massachusetts, CHIA limited its own ability to identify and address concerns regarding hospitals at risk of closing. This may have prevented policymakers from becoming aware of these issues and taking actions to prevent or soften the impacts of these issues. Overall, CHIA appears to have overlooked the risk of hospital closures in the Commonwealth.
Recommendations
  1. CHIA should ensure that it monitors the financial conditions of all acute care hospitals in Massachusetts. To start, it should ensure that acute care hospitals file their financial reporting, in full and on time. When acute care hospitals do not file financial information by CHIA’s deadlines, CHIA should fine acute care hospitals and petition the Superior Court, as appropriate.
  2. CHIA should identify and examine hospitals that are at risk of closure or discontinuing essential services and include this in its annual Massachusetts Acute Hospital and Health System Financial Performance Reports.
Finding 2
 		CHIA did not assess potential fines of $1,613,000 for acute care hospitals and health systems that did not file financial reports by required deadlines.
EffectBy not ensuring that acute care hospitals and health systems meet the Commonwealth’s financial reporting requirements in a timely manner, CHIA risks overlooking hospitals and health systems that are at risk of closing.
Recommendations
 
  1. CHIA should ensure that it communicates to acute care hospitals reporting deadlines that are in accordance with its regulations.
  2. CHIA should ensure that it sends written notice to acute care hospitals that do not comply with its reporting deadlines.
  3. CHIA should issue fines to acute care hospitals that do not comply with reporting deadlines.
Finding 3a
 		CHIA did not publicize the availability of the CompareCare website.
EffectCHIA cannot fulfill its obligation to assist healthcare consumers in Massachusetts with making informed decisions regarding their healthcare if it does not actively publicize the availability of the CompareCare website.
Recommendations
 
  1. CHIA should promote the CompareCare website to the public in order to assist in meeting its legal obligation of assisting healthcare consumers with making informed decisions regarding their healthcare.
  2. CHIA should ensure that information found on the CompareCare website is current, accurate, and accessible for Massachusetts residents.
Finding 3b
 		CHIA did not include certain required information on the CompareCare website.
EffectBy not updating healthcare cost data on an annual basis, CHIA cannot provide accurate healthcare cost estimates to consumers in Massachusetts. This further impedes CHIA’s legal obligation of assisting healthcare consumers in Massachusetts with making informed decisions regarding their healthcare. By not providing any information on infections, as required by law, CHIA failed to provide certain, critical information to the public regarding the quality and safety of care.
Recommendations
 
  1. CHIA should take steps to ensure that commercial healthcare data is available to it when it is required to update cost estimates and other information found on CompareCare.
  2. CHIA should ensure that CompareCare includes data regarding infections that patients may develop while receiving healthcare for another condition.
  3. CHIA should ensure that CompareCare includes data regarding serious reportable events that may occur at healthcare facilities.
  4. CHIA should ensure that CompareCare includes a list of healthcare provider services that are available for people with disabilities.
Finding 4
 		The CompareCare website is not fully accessible under the Americans with Disabilities Act and the Web Content Accessibility Guidelines 2.1.
EffectIf the CompareCare website is not fully viewable in portrait mode, then it may not be fully accessible to users visiting the website on a mounted device with a fixed orientation, such as a smartphone mounted to the user’s wheelchair. If content on the CompareCare website cannot be enlarged without requiring the user to scroll horizontally, then enlarged text is prevented from being easily read in a single column by people with low vision. If webpages on the CompareCare website cannot be fully navigated using only a keyboard, then it may prevent users who cannot use devices that require hand-eye coordination (such as a computer mouse) from accessing all of the website’s features. Finally, if text is not displayed in a contrast ratio of at least 4.5:1, then users with color-vision deficiencies may not be able to fully view content on the CompareCare website.
Recommendations
 
  1. CHIA should ensure that the CompareCare website is readily accessible and usable by individuals of all abilities.
  2. CHIA should review the CompareCare website to ensure that all of its webpages are compliant with the Americans with Disabilities Act and the Web Accessibility Initiative’s Web Content Accessibility Guidelines 2.1.

Table of Contents

Appendix

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Room 230
Boston, MA 02133
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