CLEVELAND — When you go to the doctor, do you really know what your paying for? The News 5 Investigators have been diving deep into hospital price transparency laws and rules for several years. We’re following through on where Northeast Ohio facilities stand today.
A federal rule for medical price transparency went into effect five years ago. Plus, a recent Ohio law states hospitals have to fully comply with up-front pricing.
What the study says
“Once we can see prices in healthcare, everyone, everyone is going to save money,” said Ilaria Wheeler, with PatientRightsAdvocate.org. It just released a new study that it said shows only 35% of Ohio hospitals are fully compliant with the rules.
“We urge all Ohio hospitals, all hospitals nationwide, stop posting algorithms,” Wheeler said. “Post real dollars-and-cents prices, so American consumers and Ohioans can access this pricing data.”
The report shows MetroHealth and two hospitals it checked from Summa are compliant. However, it reported numerous facilities from Cleveland Clinic, University Hospitals and Mercy are not.
“Over 90% of Americans are delaying the care they need because it’s either too expensive or they don’t know the price upfront,” Wheeler said. “This is a huge problem.”
What the hospitals say
Not one of the three listed non-compliant medical systems would answer our questions on camera.
UH sent a statement saying in part, "health systems are subject to several different federal price transparency policies….”
Mercy said in part that the report is “inaccurate” and that Mercy provides “an innovative price estimator tool….”
Cleveland Clinic told us in part it “meets federal price transparency requirements….”
You can see their full statements below.
What about the Ohio Department of Health?
Ohio law states the Ohio Department of Health is in charge of enforcing price compliance, and it has to publish a list of those not following the rules. However, we found the post for the month of September had no names, just blank lines. ODH sent a reply that stated, in part, it "monitors all state hospitals" and it follows "compliance under Ohio statutes...." But it does beg the question: is a blank list with no information on the non-compliance list real accountability?
“Ohio, please start enforcing it. You can now. You now have that right,” Wheeler said. “Ohio state lawmakers, please start enforcing actual prices up front.”
If you want help figuring out your medical prices, Wheeler suggests you use the Ohio Hospital Price Finder Tool to see prices, compare services and even check on prices after you get a bill to see if you’re being charged correctly.
University Hospitals statement
“Hospitals and health systems are subject to several different federal price transparency policies, often in addition to similar policies at the state level. These include the hospital price transparency rule, good faith estimates and an advanced explanation of benefits.
Healthcare consumers are understandably interested in knowing what a service is going to cost. For those who don’t have insurance coverage, hospitals assist patients to learn about their eligibility for financial assistance for free or discounted care.
For more information on UH’s price transparency and price estimates, please visit: https://www.uhhospitals.org/patients-and-visitors/billing-insurance-and-medical-records/cms-medicare-price-transparency-initiative [uhhospitals.org] “
Bon Secours Mercy Health statement
“The report referenced is inaccurate. Each of our locations has complied with federal requirements, posting standard charges online for consumers. We value transparency and continuously improve our processes to ensure that our patients have access to accurate and comprehensive pricing information.
We are committed to transparency in pricing for each patient and will provide cost estimates prior to care, based on the services scheduled. In addition, we provide an innovative price estimator tool [mercy.com], which is available online. This tool empowers patients to estimate the cost of their health care services based on insurance coverage or cash payments and includes hundreds of services including (but not limited to) cardiology, radiology, lab, surgery, maternity care and therapies.
While estimates are based on the service, several factors including multiple diagnoses or a patient's individual needs can impact these estimates.
We understand that financial challenges can arise, and we are dedicated to assisting our patients in any way we can. Our financial assistance programs are designed to support individuals who may require additional help with their medical bills. Everyone deserves access to quality health care, regardless of their financial situation.”
Cleveland Clinic statement
“The report does not accurately represent the cost-of-care information and resources Cleveland Clinic makes available to patients. Cleveland Clinic complies and meets federal price transparency requirements and posts regularly updated hospital pricing information online. Pricing for each Cleveland Clinic hospital is available here: Comprehensive Hospital Charges Lists [my.clevelandclinic.org]
Most patients do not pay these rates as their specific healthcare plan coverage determines any out-of-pocket charges. Patients can also request service estimates through Cleveland Clinic’s online self-service tools, MyChart and our website. Financial advocates can help explain costs before care, and financial assistance is available for eligible patients.”
Ohio Department of Health statement
“As we have said in response to past questions on this topic, the Ohio Department of Health (ODH) actively monitors all state hospitals, including investigating complaints and performing periodic audits.
The sample size for those audits varies. They have included anywhere from 20% to 100% of the state’s hospitals at a given time. ODH posts non-compliance lists based on state laws.
Keep in mind that what the law requires ODH to look for and what other groups look for may not be the same, so to compare our findings with that of others could be an 'apples to oranges' comparison. Compliance under Ohio statutes would be different than that of a group that is using different criteria.
Please also understand that ODH is not fact-checking prices that hospitals are listing. That is not the letter nor the spirit of the law – rather, the law tasks ODH with determining if hospitals are providing information that consumers have access to and that they can use to evaluate where to seek services.”
