Overview
During the audit period, CHIA did not include certain information on the CompareCare website that is required under Section 20(b) of Chapter 12C of the General Laws. Specifically, in 2022, CHIA did not update the healthcare cost data that is used to complete the healthcare cost estimates provided on the CompareCare website. Our review also found that the CompareCare website did not include data regarding infections that patients may develop while receiving healthcare for another condition. Further, our review also found that the CompareCare website did not include a list of healthcare provider services that are accessible for people with disabilities.
By 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.
Authoritative Guidance
Section 20(b) of Chapter 12C of the General Laws states,
The website shall provide updated information on a regular basis, at least annually, and additional comparative quality, price and cost information shall be published as determined by the center. To the extent possible, the website shall include . . . data concerning healthcare-associated infections and serious reportable events reported under section 51H of chapter 11 [of the General Laws] . . . [and] a list of provider services that are physically and programmatically accessible for people with disabilities.
Reasons for Issue
CHIA officials told us that there is a delay when updating the Massachusetts All Payer Claims Database because of the amount of time that commercial health insurance companies take to finalize payment of healthcare claims.
Recommendations
- 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.
- CHIA should ensure that CompareCare includes data regarding infections that patients may develop while receiving healthcare for another condition.
- CHIA should ensure that CompareCare includes data regarding serious reportable events that may occur at healthcare facilities.
- CHIA should ensure that CompareCare includes a list of healthcare provider services that are available for people with disabilities.
Auditee’s Response
CHIA regularly updates CompareCare to include the best data available at the time. Two separate updates were made to CompareCare 18 months apart during the performance audit period: one in December 2021 and another in June 2023.
Quality information provided on CompareCare during the performance audit period included patient safety data on preventing MRSA, preventing C. Difficile, and preventing infections of a surgical site (colon surgery and hysterectomy). Subsequently, several of the quality measures were methodologically restructured by the data steward to no longer align with CompareCare’s display. During the site update in June 2023, this information was removed from CompareCare and replaced with links to the original data sources, where consumers can continue to find the most up-to-date information and compare provider quality. . . .
The requirement to include a list of health care provider services that are available for people with disabilities was too broad to be meaningfully implemented. Disabilities encompass all conditions of the body or mind that makes it more difficult for the person with the condition to do certain activities and interact with the world around them, which could necessitate any number of medical services related to the disability or otherwise. Furthermore, under the [Americans with Disabilities Act], medical care providers must provide individuals with disabilities full and equal access to their services.
Auditor’s Reply
In its response, CHIA states that during the audit period, the CompareCare website included information regarding infections that patients may develop while receiving healthcare for another condition and that this data was subsequently removed in June 2023, due to technical issues with the CompareCare website and the data source. However, CHIA could not provide us with evidence that information regarding infections was present on the CompareCare website during the audit period. To date, the CompareCare website still does not present this required information.
Additionally, in its response, CHIA states that the requirement to include a list of healthcare provider services available for people with disabilities could not be meaningfully implemented because it is too broad. CHIA is required by law to include this information on the CompareCare website. To the extent CHIA believes it is difficult, misleading, or impossible to provide information that it is required to provide by law, it should seek clarification from the Legislature and amendment of the law.
| Date published: | January 3, 2025 |
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