Audit of the Center for Health Information and Analysis (January 3, 2025)
January 3, 2025 · Center for Health Information and Analysis · Read the full official report on mass.gov ↗
Published January 3, 2025 Audit covers July 1, 2021 – June 30, 2023 Under Diana DiZoglio · 2023–present
source
“CHIA did not appropriately monitor the financial conditions of acute care hospitals and health systems.”
Read the plain-English breakdown
This is a Massachusetts State Auditor performance audit of the Center for Health Information and Analysis, covering July 1, 2021 through June 30, 2023.
“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.”
Auditors checked whether CHIA kept required consumer health information updated on CompareCare and whether it properly monitored hospital finances and acted when hospitals missed reporting rules.
“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.”
If CHIA does not collect and analyze hospital financial information, state leaders and the public may miss warning signs that hospitals or key services are in trouble.
“This may have prevented policymakers from becoming aware of these issues and taking actions to prevent or soften the impacts of these issues.”
For an ordinary Massachusetts resident, this matters because CompareCare is supposed to help people compare healthcare costs and quality, and hospital monitoring can affect whether local hospital services stay available.
“The website shall be designed to assist consumers in making informed decisions regarding their medical care and informed choices among health care providers.”
The Auditor concluded that CHIA fell short on both main areas reviewed: hospital financial oversight and the consumer healthcare website.
“Below is a list of our audit objectives, indicating each question we intended our audit to answer; the conclusion we reached regarding each objective; and, if applicable, where each objective is discussed in the audit findings.”
The report recommends that CHIA make hospitals file financial reports on time, use fines when needed, identify hospitals at risk, promote and update CompareCare, add missing required information, and fix website accessibility problems.
“CHIA should ensure that it monitors the financial conditions of all acute care hospitals in Massachusetts.”
The report is significant because it ties weak oversight and missing information to real risks: hospital closures, loss of essential services, inaccurate consumer cost information, and barriers for people with disabilities.
“Overall, CHIA appears to have overlooked the risk of hospital closures in the Commonwealth.”
CompareCare is CHIA’s consumer website meant to let people compare healthcare costs, quality, and other information before choosing care.
“CompareCare offers tools to compare the costs of certain medical procedures at a variety of healthcare facilities in Massachusetts.”
1 figure(s) pending source verification - not shown
What the Auditor checked
- Did not comply Did CHIA maintain information that was updated at least annually on its consumer healthcare information website, CompareCare, as required by Sections 20(a) and (b) of Chapter 12C of the General Laws?
- Did not comply Did CHIA monitor the financial conditions of Massachusetts-based hospitals and health systems and take appropriate actions when hospitals and health systems did not comply with reporting requirements, in accordance with Section 8(c) of Chapter 12C of the General Laws and Section 9.10 of Title 957 of the Code of Massachusetts Regulations?
What the Auditor found
Why it matters: CHIA limited its ability to identify hospitals at risk of closing, which may have delayed policymakers' awareness and response.
Standard: Section 8(c) of Chapter 12C of the Massachusetts General Laws ( Section 8(c) of Chapter 12C of the Massachusetts General Laws )
2 recommendations
- 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.
- 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.
Agency response & Auditor reply
Agency: "Since its inception in 2012, CHIA has consistently collected, analyzed and reported data on the financial performance of hospitals and health systems in a timely and complete manner."
Auditor: "In its response, CHIA states that it has consistently collected, analyzed, and reported on the financial data of acute care hospitals and health systems in a timely manner."
Why it matters: CHIA risked overlooking hospitals and health systems at risk of closing by not enforcing timely reporting requirements.
Standard: Section 8(b) of Chapter 12C of the General Laws and Section 9.10 of Title 957 of the Code of Massachusetts Regulations ( Section 8(b) of Chapter 12C of the General Laws; Section 9.10 of Title 957 of the Code of Massachusetts Regulations )
3 recommendations
- CHIA should ensure that it communicates to acute care hospitals reporting deadlines that are in accordance with its regulations.
- CHIA should ensure that it sends written notice to acute care hospitals that do not comply with its reporting deadlines.
- CHIA should issue fines to acute care hospitals that do not comply with reporting deadlines.
Agency response & Auditor reply
Agency: "The $1,613,000 figure referenced in the report is misguided as it does not account for CHIA’s discretion for reasonable extensions, Heywood’s inability to complete audited financials, nor the agency’s prior fines and active litigation with Steward."
Auditor: "However, we wish to emphasize that CHIA did not fine Steward Health Care for its refusal to file its 2021 and 2022 audited financial statements with CHIA."
Why it matters: Consumers may not know about the website and may be less able to make informed healthcare decisions.
Standard: Section 20(a) of Chapter 12C of the General Laws ( Section 20(a) of Chapter 12C of the General Laws )
2 recommendations
- 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.
- CHIA should ensure that information found on the CompareCare website is current, accurate, and accessible for Massachusetts residents.
Agency response & Auditor reply
Agency: "The limitations of the CompareCare website for consumer shopping purposes have informed our approach to any promotional activities."
Auditor: "While we acknowledge that CHIA is limited by the data that is provided to it from health insurers, this still should not limit its ability to promote the CompareCare website to the public, as required by law."
Why it matters: Consumers may receive outdated cost estimates and miss required information about infections, reportable events, and disability-accessible services.
Standard: Section 20(b) of Chapter 12C of the General Laws ( Section 20(b) of Chapter 12C of the General Laws )
4 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.
Agency response & Auditor reply
Agency: "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."
Auditor: "CHIA is required by law to include this information on the CompareCare website."
Why it matters: Users with disabilities may be unable to view, enlarge, navigate, or distinguish content on the website.
Standard: Section 20(d) of Chapter 12C of the General Laws, Title II of the Americans with Disabilities Act, and Web Content Accessibility Guidelines 2.1 ( Section 20(d) of Chapter 12C of the General Laws; Subpart H of Title II of the Americans with Disabilities Act; Web Content Accessibility Guidelines 2.1 )
2 recommendations
- CHIA should ensure that the CompareCare website is readily accessible and usable by individuals of all abilities.agency: agreed
- 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.agency: agreed
Agency response & Auditor reply
Agency: "CHIA will ensure all relevant accessibility standards are met during the next development phase of CompareCare."
Auditor: "We appreciate that CHIA is taking measures to address our concerns regarding this matter, and we will be following up on this in approximately six months as part of our post-audit review process."
More audits of this entity
Other Office of the State Auditor reports on Center for Health Information and Analysis .
- Center for Health Information and Analysis-Examination of Annual Internal Control QuestionnaireOther · February 18, 2016
- Audit of the Center for Health Information and AnalysisOther · December 31, 2021