1 Do Hospitals React to Penalties? The Impact of Financial Penalties on Hospital Score Reporting Behavior

The Center for Medicare and Medicaid Services (CMS) created the Hospital Compare Program in 2003 to increase transparency between health care providers and consumers. Implemented in 2005, this transparency consists of hospitals ’ collecting and making publicly available a set of hospital quality score measures. The CMS induced participation by financially penalizing hospitals that did not publicly report a specific subset of these measures (called "starter " measures). Three years into the program, the penalty for non-reporting both the starter measures and other ("non-starter") measures was increased. I use a difference-in-differences methodology to analyze the effect of the increased CMS penalty on the likelihood that a hospital publicly reported its starter and non-starter measure scores. I find that the penalty had an economically and statistically insignificant effect on the probability that a hospital publicly reported its starter scores but a statistically significant eight percent effect (p < 0.01) on whether it reported its non-starter scores. These findings are robust to a series of alternative empirical specifications