In just the past 50 years, advancements in medical technology have led to many breakthroughs in new procedures, alternative surgical methods and a broader range of treatment options for patients. While medical advancements and improvements in choice are generally beneficial, patients have been left to digest additional information related to costs, efficacy, outcomes, and comparisons among medical providers.

Few countries demonstrate this better than the US. In the US, the Affordable Care Act of 2008 aimed to provide patients with access to quality data to help them make more informed decisions about their care. In 2021, the Centers for Medicare and Medicaid Services (CMS) mandated that all US hospitals are required to provide information about their prices in a clear and accessible format. Several studies have found that the sheer quantity of publicly released information on healthcare providers in terms of initiatives and indicators can be overwhelming and confusing for users.1 This article aims to highlight the importance of transparency in healthcare, and how Cleveland Clinic has made this a priority.

Several studies have found that the sheer quantity of publicly released information on healthcare providers in terms of initiatives and indicators can be overwhelming and confusing for users

Promoting integrity

Traditionally, a hospital’s charge description master (the list of prices for each individual service and item that can be charged) was difficult to find. The enactment of the Hospital Price Transparency Final Rule in 2021 radically altered this trend, as hospitals are now required to publish their charge masters in a machine-readable format. The intention of the rule was to promote integrity amongst hospitals and streamline healthcare delivery by offering patients and insurers a clearer view of hospitals’ prices.

In turn, this would help patients better understand the amounts for which they would be responsible to pay, while also helping insurers better prepare for upcoming claims expenditures and offering a way to compare average costs and negotiated reimbursements across different providers.

A clear charge master allows insurance companies to compare average charges across hospitals, instead of the discounts that these hospitals may be offering.

Cleveland Clinic supports hospital pricing transparency and has demonstrated this for several years by posting their comprehensive hospital charges list on its website and offering estimates for care. Moreover, 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. Either through their MyChart account or through Cleveland Clinic’s website, patients have the ability to produce their own estimates.

As medical services have become more standardised, patients and insurance companies have tended to focus on cost to guide their decisions. While the price of a service is crucial in determining its value, outcomes should also factor into the decision-making process.

Cleveland Clinic supports hospital pricing transparency and has demonstrated this for several years

Cleveland Clinic recognises that no rating methodology is perfect; therefore, encouraging individuals to use a variety of sources to help identify quality care. Cleveland Clinic is committed to transparency, and our outcomes are readily available on our website, giving patients access to comprehensive data on procedures, volumes, mortality, complications, and innovations.

Quality wins

In fact, several studies performed over the last two decades invariably reveal that quality is one of the main factors in determining a patient’s choice of hospital2. As insurance companies and third-party administrators (TPAs) promote steerage through the use of narrow networks, quality will (and should) continue to play a pivotal role in these developments. Furthermore, Cleveland Clinic understands that reducing readmissions, length of stay, and complications, ultimately results in lower costs.

Cleveland Clinic understands that reducing readmissions, length of stay, and complications ultimately results in lower costs

Recent innovations in medicine and surgery have undoubtedly benefited patients in various ways. At the same time, the amount of data and information related to price and quality is more readily available, which can make choices for patients, insurers, and TPAs more difficult. Cleveland Clinic continues to advance initiatives that promote transparency, including being among the first hospitals in the US to publish outcomes. Even slight modifications to the application of quality data will allow patients and insurance companies to easily compare providers to make the best decision for themselves.

1: National Institutes of Health, Public Reporting as a Quality Strategy

2: S. Saghafian & W. Hopp, Can Public Reporting Cure Healthcare? The Role of Quality Transparency in Improving Patient-Provider Alignment