Cleveland Clinic Shares Strategy and Obstacles to Compliance with CMS Price Transparency Rule
According to a study by Patient Rights Advocate published in July, the Cleveland Clinic is one of 28 hospitals and healthcare systems in the United States that follow CMS’s price transparency rule.
The final rule, which came into effect on January 1, aims to make hospital pricing information readily available to patients so they can compare costs and make more informed healthcare decisions. To facilitate this, hospitals in the United States are required to publish both a machine-readable file with negotiated rates for all items and services and to display the prices of 300 services that can be purchased in a user-friendly format.
Meeting deadlines and maintaining compliance is no easy task for suppliers. CMS estimates that each hospital could spend 150 hours and nearly $ 12,000 to review and ensure that their posted standard rates are accurate and up to date.
To better understand how the Cleveland Clinic worked to comply with the rule and ensure patients understand pricing information, Becker reached out with four key questions.
Here is what the health system had to say about its strategy, the barriers it faced and advice to other health systems:
Editor’s Note: Answers have been edited slightly for style and clarity.
Question: Can you tell us a bit about the Cleveland Clinic’s strategy for complying with the CMS Price Transparency Rule?
Cleveland Clinic: We have been committed to price transparency for many years and have been complying with state level requirements since their implementation almost ten years ago. Regarding federal requirements, we started preparing our response in early 2019. We evaluated several internal and external solutions; however, because the demand was so vast, there was no single source that could provide all the information required to comply with the regulations. Ultimately, we pulled the data from our billing systems and internal analytics.
Q: What obstacles have you faced in releasing price data publicly?
Cleveland Clinic: The large amount of data requested, as well as the effort to compile and verify this data, posed a significant challenge. Additionally, display requirements do not always match the different payment methodologies used by health insurers. This means that the resulting files are not “patient friendly”. As of 2016, the Cleveland Clinic has made care estimates available to patients when planning surgical and diagnostic services and on request for all other services. Although we are committed to transparency and have fully complied with these regulations, it remains difficult and resource intensive.
Q: What advice would you give to another leader in the healthcare system who is working to ensure they have effective and useful price transparency data for patients?
Cleveland Clinic: We believe that for patients, having a clear understanding of their potential out-of-pocket expenses is the most meaningful and usable information.
Q: How do you make sure Cleveland Clinic patients understand the prices?
Cleveland Clinic: As of 2016, the Cleveland Clinic has made care estimates available to patients when planning surgical and diagnostic services and on request for all other services. We recently updated and extended our self-service module for patients where, through their MyChart account or through the Cleveland Clinic website, patients have the option to generate their own estimates. This self-service module for patients is a much better source for patients to understand prices and their financial responsibilities than machine-readable files. We also encourage patients to check with their insurer for detailed information about their personal coverage and any financial liability.