Cleveland Clinic shares strategy, roadblocks to complying with CMS price transparency rule

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According to a Patient Rights Advocate study published in July, Cleveland Clinic is among 28 hospitals and health systems in the U.S. complying with CMS' price transparency rule.

The final rule, which took effect Jan. 1, aims to make hospital pricing information readily available to patients so they can compare costs and make more informed healthcare decisions. To aid with this, hospitals in the U.S. are required to post both a machine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a consumer-friendly format. 

Meeting the deadline and maintaining compliance is no small feat for providers. CMS estimates that each hospital could spend 150 hours and nearly $12,000 to review and ensure their posted standard charges are accurate and up to date.

In an effort to better understand how Cleveland Clinic worked to comply with the rule and ensure patients understand pricing information, Becker's reached out with four key questions. 

Here's what the health system had to say about its strategy, the roadblocks it faced and advice to other health systems:

Editor's note: Responses were edited lightly for style and clarity.

Question: Can you share a bit about Cleveland Clinic's strategy for meeting compliance with CMS' price transparency rule?

Cleveland Clinic: We have been committed to price transparency for many years and have been compliant with state level requirements since they were implemented nearly a decade ago. With regard to federal requirements, we began preparing our response in early 2019. We evaluated multiple internal and external solutions; however, as the request was so expansive, there was no single source that could provide all of the information required to meet the regulations. Ultimately, we pulled data from our billing systems and internal analysis.

Q: What roadblocks did you face while getting pricing data posted publicly?

Cleveland Clinic: The large amount of data requested, along with the effort to compile and audit that data, was a significant challenge. Additionally, the requirements of the posting do not always align with the different payment methodologies used by health insurers. This means the resulting files are not "patient friendly." Since 2016, Cleveland Clinic has made estimates for care available to patients when scheduling surgical and diagnostic services and upon request for all other services. Although we are committed to transparency and have fully complied with these regulations, it remains challenging and resource intensive.

Q: What advice would you offer another health system leader working to ensure they have effective and useful price transparency data available to patients?

Cleveland Clinic: We believe that for patients, having a clear understanding of their potential out-of-pocket costs is the most meaningful and usable information.

Q: How are you ensuring Cleveland Clinic patients understand pricing?

Cleveland Clinic: Since 2016, Cleveland Clinic has made estimates for care available to patients when scheduling surgical and diagnostic services and upon request for all other services. We recently updated and expanded our patient self-service module where, either through their MyChart account or through Cleveland Clinic's website, patients have the ability to produce their own estimates. This patient self-service module is a much better source for patients to understand pricing and their financial responsibilities than the machine-readable files. We also encourage patients to check with their insurance provider for detailed information about their personal coverage and any financial responsibility.

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