Post the Price

We found missing price information at some locations in the Cleveland Clinic system. We contacted Cleveland Clinic to ask whether they offered the surgery. Only one hospital within the system did not (South Pointe). Of the 10 locations that did offer the surgery, six indicated on the price estimator that it was unable to provide a price. At least at the time of our search, the missing prices make these locations out of compliance with the federal rule.

Most of the price estimators provided both the hospital price (fees that cover the facility costs) and the physician price (fees that cover the surgeon performing the procedure). The University Hospitals system was the only system which failed to provide both charges. Although their price estimator states that “additional physician charges may be incurred,” the hospital did not give an indication as to how the patient could find a surgeon’s price (see the screenshots below to view an example of these differences).

Physician charges for total knee replacement ranged from $3,756 to $10,231 in this study of Cleveland area hospitals. These charges are significant and could change the total cost of the procedure in a way that is significant to patients looking for lower prices.

Lastly, some hospital systems were unclear as to which locations their prices applied. For instance, the Summa Health and MetroHealth systems only had one price listed, despite each system having multiple hospital locations. We called to clarify, and were informed that the same price applied to all of their locations.

We found a wide range of prices for total knee replacement for hospitals in the Cleveland area (see the chart below). 

Self-pay price: The lowest self-pay price was $26,324 at MetroHealth and the highest was $242,121 at the two SummaHealth locations. 

Insured price: The insured prices were much lower than the self-pay prices. This is most likely because the selected health plan’s deductible and out-of-pocket maximum cap the charges to the patient. The insured price ranged from $5,900 at SummaHealth and Cleveland Clinic locations to $9,100 at MetroHealth and University Hospital locations.

The price of a total knee replacement varied by thousands of dollars in the Cleveland area, with a more than $200,000 difference between the highest and lowest self-pay price. Even for insured people who have the selected health plan, the prices differed by more than $3,000.

There was also significant price variability within hospital systems for self-paying patients. For example, there is a price difference of over $9,000 for this procedure for self-pay patients between the Cleveland Clinic system locations that posted a price (see the chart below).

Similarly, each location in the University Hospitals system had a different self-pay price (note: none of which included the physician costs). University Hospitals Lake West Medical Center had the lowest self-pay price within the system at $38,867.65. The highest self-pay price within the same system was nearly double: $75,593.53 at UH Portage Medical Center. 

When we compared the insured price within any of the four hospital systems, there was no variation.

When prices are easy to find and information is complete, hospital price transparency can arm patients with information that could save them thousands of dollars. The federal hospital price transparency rules require prices to be posted and available for patients online. This study shows that Cleveland-area hospitals are not fully complying with consumer-friendly requirements for price transparency in a variety of ways:

• We had to call to clarify whether the procedure was offered and whether physician prices were included
• Prices were not available for several Cleveland Clinic hospital locations that offer the procedure
• Price estimates do not match prices available through hospital machine-readable files.

Despite these difficulties, our investigation into total knee replacement prices in the Cleveland area shows that shopping around could help people find lower prices, especially for self-pay patients. The over $200,000 difference between the highest and lowest self-pay price in Cleveland for total knee replacement is significant. Patients might be willing to travel a little farther for the procedure if they can get a lower price, as long as those prices are accurate. Even if you want to be seen by a certain provider or hospital system, price shopping within a hospital system can save money. Indeed, there was a $9,000 difference among four of the Cleveland Clinic locations. Insured patients also have the potential to save money, as seen by the more than $3,000 price difference found for the selected health plan in this study. 

Hospitals frequently disclaim the price information provided as estimates only. However, insurers are required to provide similar pricing information with their own transparency rules. Under the No Surprises Act, self-pay patients have the right to a good faith estimate. If the final bill is more than $400 over the estimate, patients can dispute that charge. 

Although it is not currently in effect, insured patients are also supposed to be able to access estimates through their insurer by way of an “advanced explanation of benefits” (AEOBs). When enforced, insurers will have to send AEOBs to patients giving them a reliable estimate based on their health plan benefits and spending. This is an easier way for patients to know prices of their scheduled care. They would not have to search websites or know billing codes to get the price. 

Public prices from hospitals is a good step toward helping patients search for and find lower prices. To be truly useful, hospitals must come into full compliance and provide real prices for patients. PIRG will continue to investigate price transparency tools across the country and to push for clear, justified health care pricing.