Pricing Gap Reports
Build a Pricing Gap Report for a hospital from your assistant - its published prices against similar nearby hospitals, every section of the report as its own answer, and the PDF.
A Pricing Gap Report compares one hospital's own published prices with those of up to 19 similar nearby hospitals. The prices are gross chargemaster prices on facility CPT and HCPCS lines. The comparison hospitals are the same kind of hospital, of similar size, in the same metro area first, with the search widening from 25 to 150 miles. The codes are the ones that make up 80% of the hospital's CMS-estimated revenue, and prices far out of line with the rest of the panel are trimmed.
For each code the yearly gap is (nearby median − the hospital's price) × CMS units. The report shows it as a range, from 50% to 100% capture. It is the same report the app shows on its Pricing Gap Reports page, so a colleague can open it there.
Say something like:
Build a pricing gap report for Piedmont Atlanta Hospital, prepared for Jane Smith, CFO. Then show me the ten codes we price furthest below the nearby median.
The server knows the steps. Your assistant calls pgr_next_step() first, and every result carries next_step with what to call next.
Steps
- Find the hospital.
find_hospitalsgives itshospital_id. - Start the report.
pgr_create_reportwith that id.prepared_for("Jane Smith, CFO") goes on the PDF cover. - Wait. Poll
pgr_get_reportabout every 20 seconds. A build takes about a minute.failedandno_datasay why, andpgr_rebuildretries. - Read it.
pgr_sectionslists every component of the report, one tool each. Read the ones you ask about. - Get the PDF.
pgr_export_pdfreturns a link to the branded PDF.
What each part returns
| Component (where shown) | Tool | What it returns |
|---|---|---|
| The finding (page) / What this report found, How it was built (PDF) | pgr_summary | Codes compared, how many sit below and above the nearby median, the median % gap, the yearly gap range, the split by setting, the method |
| Market card / Market | pgr_market | CMS facts for the hospital's area and the spread of the comparison panel |
| Comparison hospitals, See all / The comparison hospitals, Appendix B | pgr_hospitals | The nearby hospitals, why each was picked, and each one head to head with this hospital, or one code by code |
| Priced vs market, Position tab / Price position | pgr_price_position | The codes by CMS-unit impact: price, nearby median, min and max, % gap, units, impact |
| Priced vs market, Lowest and Highest tabs / Priced below and above the nearby hospitals | pgr_vs_market | The codes priced furthest below or above the nearby median |
| Payer by payer card / the payer note | pgr_payer_teaser | The insurer most of the panel publishes rates for, and the others |
| Payer by payer, per-insurer view | pgr_payer_rates | Each insurer's rate here against the same insurer's median nearby, per code |
| Service lines card / Service lines | pgr_service_lines | Per service line: codes, how many are below, the median gap, the yearly gap, the above-market premium |
| Service lines card, Inpatient tab | pgr_inpatient | Insurers' DRG per-stay prices here against nearby, and the contract terms they publish |
| Published prices, 80/20 / Published chargemaster prices: the 80/20 | pgr_published | The codes that make up 80% of estimated revenue, with revenue and cumulative share |
| Browse every price | pgr_codes | Every compared code with its target price and raise-to-target %, filtered by direction, service line, setting or codes |
| What if | pgr_what_if | What a uniform raise or a capture share of the gap would bring in a year |
| Sources card and disclaimer / Sources, Important | pgr_sources | Every hospital's price file and the CMS datasets used, and the disclaimer |
| Open report / the PDF | pgr_export_pdf | The branded PDF as a short download link |
"What more detail would show" is static copy in the PDF about what your own volumes and contracts would add. It has no tool.
Free and paid
The report and every component above are free, exactly as in the app. Every call still counts toward the daily limit. The setup and polling calls (pgr_next_step, pgr_create_report, pgr_get_report, pgr_list_reports, pgr_panel_suggestions, pgr_sections) count against a separate setup allowance instead.
Two things need an upgrade:
- Choosing your own comparison hospitals.
hospital_idsonpgr_create_reportorpgr_rebuildneeds the Custom comparison panel. The default panel is free. - The insurers' own rates.
pgr_payer_ratesneeds the insurer payer-rates add-on. Without it you get the list of insurers that have rates.
To upgrade, go to the in-app /upgrade page or book a call. See Plans & access.
The PDF
pgr_export_pdf returns a short link (mcp.cognitolabs.ai/d/...) that works for an hour. Give it to the user as it is. The same report is on the app's Pricing Gap Reports page.
What the figures are
The prices are what hospitals publish, not what any payer pays. The yearly figures are estimates from CMS volumes. Confirm them against the hospital's own contracts and volumes before acting on them.
Tools
The reference of each tool and its parameters is on the Pricing Gap Reports tool page.
Run a Black Box study
Compare a provider group's proposed rates with a network's current rates, code by code and payer by payer, from your assistant - upload links, the build, every table and graph of the results as data, and the client PDF.
Run an Out-of-Network Analysis
What happens to revenue if a practice drops a payer and bills its full charge instead - set up the study from your assistant, read every table, chart and PDF section as data, and get the client PDF.