Becker's Hospital Review

16 CFO / FINANCE Cleveland Clinic shares strategy, roadblocks to complying with CMS price transparency rule By Alia Paavola A ccording to a Patient Rights Advo- cate study published in July, Cleve- land Clinic is among 28 hospitals and health systems in the U.S. complying with CMS' price transparency rule. e final rule, which took effect Jan. 1, aims to make hospital pricing information readi- ly 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 ma- chine-readable file with the negotiated rates for all items and services and display the prices of 300 shoppable services in a con- sumer-friendly format. Meeting the deadline and maintaining com- pliance is no small feat for providers. CMS estimates that each hospital could spend 150 hours and nearly $12,000 to review and en- sure their posted standard charges are accu- rate and up to date. In an effort to better understand how Cleveland Clinic worked to comply with the rule and en- sure 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 meet- ing compliance with CMS' price transparency rule? Cleveland Clinic: We have been commit- ted 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 re- sponse 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 in- formation 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: e large amount of data requested, along with the effort to compile and audit that data, was a significant chal- lenge. Additionally, the requirements of the posting do not always align with the differ- ent payment methodologies used by health insurers. is 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 an- other health system leader working to ensure they have effective and useful price transparency data avail- able to patients? Cleveland Clinic: We believe that for pa- tients, 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: We recently updated and expanded our patient self-service module where, either through their MyChart account or through Cleveland Clinic's website, pa- tients have the ability to produce their own estimates. is patient self-service module is a much better source for patients to under- stand pricing and their financial responsi- bilities than the machine-readable files. We also encourage patients to check with their insurance provider for detailed information about their personal coverage and any finan- cial responsibility. n Sparrow Health System unveils $800M expansion plan By Alia Paavola S parrow Health System will invest $800 million into various capital im- provement projects across its network, the Lansing, Mich.-based organi- zation said Sept. 19. One of the largest planned projects is building a five-story, $350 million pa- tient tower at its Lansing hospital. The project will create 112 private patient rooms and reduce wait times in its emergency department. The health system also said it plans to invest in an ambulatory surgical center near its downtown Lansing hospital, a new medical office with a freestanding emergency department and improvement projects at its community hospitals. "The plan is indicative of the important commitment that guides Sparrow as the region's only community-owned, community-based, community-governed health system," Sparrow said in a news release. "It includes hundreds of millions of dollars in new investment by Sparrow into the Lansing-area economy and shows the importance we place, as the area's largest private employer, on keep- ing jobs in the region and promoting potential employment growth." n

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