On May 22, 2025 CMS released new price transparency information for health plans and hospitals, including guidance for the production of the hospital price transparency machine readable file (MRF). The information release was expected in response to the February 25, 2025 Executive Order which we previously discussed. While the release was expected, there are several things that remain confusi...
A Cleverley Response to The Price Transparency Executive Order
Some of our clients inquired as to how the recent transparency executive order might affect the current machine readable file template. While the executive order from February 25, 2025, titled “Empowering Patients Through Radical Price Transparency,” affirms this administration’s commitment to price transparency, it does not ...
A Closer Look At Hospitals Costs with Our Founder, Bill Cleverley
I have been in the hospital industry as both a professor and consultant for 51 years. One thing that has never changed in these 51 years is that healthcare and hospitals in particular have been singled out for rising costs—which, translated, means that healthcare and hospitals are absorbing a greater percent of our nation’...
What Will Die Hard Cost John McClane?
Every year the question is presented— is Die Hard a Christmas movie, and every year two opposing camps form. The first strongly believes that it is, in fact, a Christmas movie, and the second one is wrong. But that’s not what we’re here to discuss today!
We’re here to discuss what the injuries John McClane sustained in Die Hard would cost for him and his lo...
Exploring the Relationship Between Quality and Cost in Hospital Data
CMS has recently released its 5-star hospital compare ratings with the distribution shown in Table 1. The ratings are based upon metrics in five areas: Mortality (22%), Safety (22%), Readmission (22%), Patient Experience (22%), and Timely and Effective Care (12%).
These quality metrics are important because Medicare does pay h...
Patient Rights Advocate Dramatically Overstates Hospital Non-compliance
Last month, PatientRightsAdvocate.org (PRA) released its Sixth Semi-Annual Hospital Price Transparency Compliance Report (https://www.patientrightsadvocate.org/semi-annual-report-feb2024). The report shows that 34.5% of the 2,000 US hospitals it reviewed comply with federal price transparency requirements. Unfortunately, PR...
Cleverley + Associates Looks at the Link Between Value and Hospital Price Transparency
On January 18th of this year Money Magazine released its list of Best US hospitals. They provided 5 overall metrics for each of the top US hospitals: Overall Grade (A+ to B), Top Specialty, Price Transparency (A+ to D-), Top Service, and Federal rating. They explained their methodology for determining the ove...
Are Health Insurance Firms Putting Profits Over Patient Care?
There have been some advertisements on various media platforms suggesting that major health insurance firms are prioritizing profits over the health of patients. The website that contains more information is www.healthcomesfirst.org and is an initiative of Trinity Health. The primary focus of the commercials and the website is that ...
What’s New in Hospital Price Transparency and How Did We Get Here?
The CY24 OPPS Final Rule contains additional information and requirements regarding hospital price transparency. The changes build on transparency requirements previously established in past rules and other regulations.
In 2010 the ACA responded to calls for price transparency.
In 2014 the FY15 IPPS proposed rule c...
Should Healthcare Services be Priced at Identical Cost Markups?
Over the last 25 years our firm has received a large number of proposed pricing strategies from our clients. One of those strategies is to set all prices for their Charge Description Master (CDM) codes at a constant markup from cost. To put this in perspective, the 2021 US median hospital markup for acute care hospitals not ...
Is Contract Labor Impacting Hospital Costs?
The American Hospital Association in March 2023 reported the results of a recent study on contract labor in hospitals.
“Contract labor expenses for hospitals and health systems surged 258% from 2019 to 2022 as nationwide labor shortages forced many to rely on contract staffing firms to meet patient demand, according to an analysis of 2022 data from ov...
A RESPONSE TO THE CY24 OPPS PROPOSED RULE (CMS-1786-P)
Cleverley + Associates has been following the continued evolution of Price Transparency laws and guidelines. We created summary of all the elements contained in the CY24 OPPS Proposed Rule as it relates to hospital pricing transparency. We also put together proposed comments to CMS to assist others as they consider comments for their organi...
Do For Profit Hospitals Have Lower Expenses per Adjusted Patient Day?
In the August 7th issue of Becker’s Hospital Review, values for adjusted expense per inpatient day were shown for all 50 states by ownership/control status. The data seemed to suggest that non-profit hospitals were more costly than either for-profit or government hospitals. While the results were not intended to frame polic...
There Are Other Healthcare Pricing Strategies
Over the last 25 years our firm has entertained a large number of proposed pricing strategies from our clients. One proposed strategy from our clients that is becoming more popular is to set all prices for their Charge Description Master (CDM) codes at a constant markup from cost. To put this in perspective, the 2021 US median hospital markup for ac...
Last month, PatientRightsAdvocate.org (PRA) released its 4th Semi-Annual Hospital Price Transparency Compliance Report. While the report shows an increase in the percentage of compliant hospitals it reviewed (24.5% – up from 16% in its 3rd report), the criteria and conclusions are not consistent with those determined by the CMS in another recent report. In that report, released last month...
What is the Price of the Injuries in Die Hard?
Is Die Hard a Christmas movie? Well, it’s a movie that is watched most during the holidays, takes place during Christmas, and features Christmas as a plot point, so technically yes. But that’s the beside the point. We’re here to discuss what Die Hard would cost for John McClane and his local hospital because, let’s face it, he had a bad day.
Clever...
On Monday, CMS announced the availability of a standardized machine-readable file format that hospitals can elect to use in complying with the price transparency final rule. The sample formats, presented in .CSV and .JSON, are accompanied by a data dictionary. CMS notes that the use of these sample formats are voluntary. It’s also important to note that the samples contain fields that are no...
Listen to our President, Jamie Cleverley, join Riley Matthews, Lead Product Manager at Experian Health, to discuss the Hospital Price Transparency Rule and what it means for hospitals around the country. What challenges are providers seeing? How are facilities moving forward despite these issues? How is the disclosed machine readable file information being handled? What comes next?
Listen now! ...
How Do We Measure Hospital Costliness?
Because the majority of a hospital’s revenue is fixed by fee schedule or related to billed charges almost every hospital in the US is vitally concerned with their relative cost position. Quite naturally, hospital executives are interested in a facility wide metric of cost that can be benchmarked with their prior cost position and more importantly against o...
We Examine Myths of Healthcare Pricing
Hospital pricing is on the minds of many in the healthcare industry today, especially since the initiation of hospital transparency reporting. It is our belief, that many hospital pricing decisions often rely on widely believed pricing myths. The body of this article will attempt to define and confront some of these “myths.”
Myth # 1 Pricing makes a smal...
Why is Hospital Pricing Strategy So Important?
In many hospital executive’s minds, there is little need for strategy in the establishment of hospital chargemaster prices. This mentality can often create unfavorable outcomes that can affect the financial and strategic position of the hospital. Let’s review three common simplistic pricing strategies and the possible negative outcomes that might ...
Many healthcare providers have become very concerned about their posted charges for specific services and procedures in the new price transparency world in which they live. To this end, it is very common to see providers either reduce existing charges or refrain from price increases in selected areas. One very common result of price reductions is to increase the number of patient claims where a...
What is the relationship between hospital costs CMS quality rating?
At the time of this writing Medicare has provided incentive payments for improvements in hospital inpatient quality to approximately 3,000 acute care hospitals through its Value Based Purchasing (VBP) program. A number of commercial payers have also introduced VBP programs for payment to their participating hospitals. Th...
Cleverley + Associates Will Attend the HFMA Annual Conference
We’re headed to HFMA’s Annual Conference in Denver, Colorado. Bryan Gordon, our Senior Regional Account Executive will be presenting on Price Transparency, the history of regulation, what hospitals are facing now, and what might be next.
The HFMA’s Annual Conference is a three-day-long, interactive forum where attendees can learn abo...
How Do We Compare Payment Rates Across Health Plans and Hospitals?
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. We’ve already answered “Why do Hospitals Offer Lower rates to Some Payers?” and “What Is The Relationship Between Insurance Contracts and What Members Pay?” so let’s look at “Why do Hospital...
What Is The Relationship Between Insurance Contracts and What Members Pay?
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. Last time we answered “Why do Hospitals Offer Lower rates to Some Payers?” Now we’ll look at “What Is The Relationship Between Insurance Contracts and What Members Pay?” and next we’ll inv...
We Answer Questions About Hospital Payer Rates
Recently we were asked by a hospital client to address three common questions they hear from the public regarding price transparency. So, in our next three blog posts we’ll answer the following questions:
Why do Hospitals Offer Lower rates to Some Payers?
What Is The Relationship Between Insurance Contracts and What Members Pay?
Why Do Hospitals C...
A Response to the CY20 Opps Proposed Rule (CMS-1717-P) For Increased Price & Payment Disclosures
1) BACKGROUND
The CY20 OPPS Proposed Rule contains additional information and requirements regarding hospital price transparency. The proposal, which can be traced to guidelines provided in the Affordable Care Act, primarily follows several recent important government communications regarding th...
Die Hard Cost John McClane
Is Die Hard a Christmas movie? Obviously. Is it the greatest Christmas movie? Well, that’s up for debate. We’ll let your holiday dinner table take up that one.
But we at Cleverley + Associates can weigh in where we’re experts, which is hospital pricing data! Action movies, especially one as hard core as Die Hard, mean injuries and injuries mean hospitals. Sure, John M...
About Price Transparency
CMS did everything they proposed on transparency…including the very large increase in fines!
CMS has remained focused on the importance of Price Transparency, consistently stressing that their goal is to empower patients to make informed decisions regarding their health care. In their recent fact sheet, CMS called out what they called “sub-optimal compliance.”
We’ve cov...