CMS Wrote 3,646 Warnings to Reach 29 Fines

CMS's Hospital Price Transparency Enforcement Activities and Outcomes file refreshed at the start of August. Thirteen thousand three hundred fifty-five rows, seven columns, one row per action, going back to the first warning notice in January 2021.

Nothing in the file is new by itself; every CMP, CAP request, and closure notice showed up on the CMS Hospital Price Transparency page as it landed. What is new is that the file is finally long enough to read as a program instead of a scoreboard.

We read every action, grouped by Case_ID in date order, and asked what actually happens after a warning notice arrives at a hospital. The answer is not the story the trade press has been telling.

The three-hop path

Across the whole file, 3,646 cases contain a Warning Notice. Of those, 1,099 later got a CAP Request. Of those, 14 later got a Civil Monetary Penalty notice.

That is a 30.1 percent step from warning to CAP, and a 0.38 percent step from warning to fine. One CMP for every 260 warnings the program has ever issued (chart above).

Read the other way: 1,788 total CAP cases produced 28 later CMPs, a 1.57 percent conversion. Every one of those 28 escalations went through the CAP door first; there is not a single case in the file where a warning turns directly into a fine.

Median warning-to-CAP is 101.5 days. Median CAP-to-close is 90 days. For the tiny cohort that reaches a CMP, the median CAP-to-CMP gap is 161.5 days, or about half a year from the letter to the check, most of it spent inside a CAP.