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Since 2000, Cleverley + Associates has become an industry leader in strategic pricing services for
US hospitals. As one of the first firms in the United States to specialize in defensible and transparent
pricing strategies, Cleverley + Associates is a recognized thought-leader on the subject. From basic
market data to comprehensive pricing strategies, we offer it all!
Our approach to pricing is truly distinctive and continually updated. We work with each client to create
a strategy unique to their market conditions, executive mandates, and payer provisions. In the past two
years alone, we have created over 250 unique pricing strategies for our clients. This experience allows
us to offer insight & value that we believe is unmatched.
“Cleverley + Associates is an extraordinary company. Bill Cleverley is extremely bright, provides quality
work, hires excellent people that know what they are doing, and Bill is hands on with his clients. I
could not recommend him highly enough. As far as I'm concerned, he is the only vendor in the US that
should be helping hospitals with pricing.” – comment from a market research project conducted by
Saperstein Associates, April 2008
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| Upcoming Events |
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| 3/25/2010 | | | HFMA Hudson Valley | |
| 5/11/2010 | | | HFMA Region 1 | |
| 6/21/2010 | | | HFMA-ANI | |
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| Contact Us |
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Would you like to find out more about Cleverley & Associates and our custom projects and data solutions?
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Consulting Services
Procedure Pricing Study
Pricing Defensibility Assessment
Post-acute Transfer Payment Audit
Medicare Disproportionate Share
(DSH) Services
Facility-level Reports
Department-level Reports
Encounter-level Reports
Competitive Pricing
APC Charge Performance
DRG Profile
MS-DRG Profile
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Please click on a solution link to learn more. If you have any questions about our solutions or would like more information about them, please click here and a Cleverley + Associates representative will contact you.
| Procedure Pricing Study |
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About the Study
The Procedure Pricing Study reviews a hospital’s prices at the procedure-code level and presents an analysis of suggested rate changes designed to enhance the defensibility and transparency of proposed pricing and to increase the amount of revenue collected per dollar of rate increase. This analysis is designed to allow management to impose a variety of restrictions on rate increases.
Additionally, Cleverley + Associates uses line-item detail from recent claims. This enables a more accurate review of projected recovery rates than simply using revenue-usage files.
Even if you have completed pricing analyses in the past, Cleverley + Associates can work with you to sharpen your adjustments. Changes in payer mix and/or contract terms can introduce new issues that Cleverley + Associates’ staff of analysts can help you resolve.
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| Click on the Next arrow to learn more! |
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Methodology
(click image for larger view)
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Model Assumptions
During the final stage in the Procedure Pricing Study, Dr. William O. Cleverley will assist you in creating a strategy for price adjustments, taking into consideration:
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Pricing transparency |
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Cost-based pricing |
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Across-the-board price adjustments |
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Market-based pricing constraints |
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Self-pay recovery |
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Payer distribution |
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Other unique situations |
Flexibility of Modeling
By working directly with Dr. Cleverley and our staff of consultants, you have the ability to fine-tune your constraints to meet your hospital’s unique needs. Even if you are looking to remain revenue-neutral or strategically lower prices to align with market needs, we can show you the most effective way to do so.
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The Deliverables
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Price Defensibility Assessment |
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APC Charge Analysis |
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DRG Profile Report |
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Major Payer Contract Analysis |
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Exit conference call |
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CDM Review |
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Competitive Pricing Report |
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Mark-up Comparisons |
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Payer Impact |
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Percentage Change in Charges by DRG |
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Pricing Breakdown |
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Pricing Breakdown with Formulas |
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Procedure Pricing Recommendations |
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Recovery Breakdown |
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BETOS Groups |
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Optimum Chargemaster |
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Appendices A. B, C, and D – Charges by Payer, Charges and Profit by Revenue Code, Charges and Profit by Department, Potential CDM Issues |
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Proven Results
Data on Cleverley + Associates’ prior pricing studies revealed:
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Average profit from an across-the-board (ATB) rate increase was $10.8 million, or a recovery rate of 15.6%. |
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Average profit from modeling with price constraints to better align hospital prices was $13.5 million, or a recovery rate of 19.6%. |
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On average, each study generated $3.1 million of additional profit over and above an ATB increase while keeping prices better aligned with competitors and other market factors. |
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Commitment to Quality
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One of the reasons Cleverley + Associates is a leader in the industry is our commitment to quality. We are with you every step of the way, helping you build financial strength.
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Would you like to learn more about our Procedure Pricing Study? Use the links provided below or click here to have a Cleverley + Associates representative contact you.
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| Price Defensibility Assessment |
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To help hospital executives present an independent, third-party review of their facility’s pricing structure, Cleverley + Associates developed the Price Defensibility Assessment. Via this study we analyze a hospital’s prices compared to peer facilities by examining the factors affecting prices and utilizing our methods for evaluating price reasonableness. In addition to our standard analysis, Cleverley + Associates can provide trending information for the metrics reviewed in the summary presentation for the past 3-5 years.
This Assessment includes:
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Conference call/web meeting to review the findings with your staff |
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A PowerPoint presentation summarizing the study findings |
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Competitive Pricing Report comparing your hospital’s charges at the procedure-code level with those of the peers listed above |
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APC Charge Performance Report comparing charges of outpatient procedures by APC with those of the peers listed above |
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DRG Profile Report comparing charge, cost, and profitability by DRG with those of the peers listed above |
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Market Ring BETOS Report comparing your hospital’s aggregate charges at the departmental level to the peers listed above |
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| Hospital Dashboard Report |
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| The Hospital Dashboard Report offers healthcare executives and consultants a means of monitoring key hospital performance drivers by answering two questions: |
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What is the overall financial position of my or any general acute care hospital? |
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What are the individual strengths and weaknesses of the hospital? |
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| Key Features |
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68 critical financial performance ratios |
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Benchmark to a peer of your choice as well as the US median values |
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Cleverley + Associates’ proprietary indices: Hospital Cost Index®, Hospital Charge Index®, Financial Strength Index® |
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| Who Can Use The Report |
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CEOs |
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CFOs |
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Directors of Finance |
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| Hospital Cost/Charge Index Report |
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Hospital senior executives and board members routinely review measures of facility cost to assess the relative cost efficiency of their firms. The most commonly used measures are cost per adjusted discharge or cost per adjusted patient day. These measures have serious flaws, which limit their comparability to other hospitals which is why we developed the Hospital Cost Index®, as a better measure of relative hospital efficiency. Our measure adjusts for case mix complexity in both inpatient and outpatient operations and can be computed from present publicly available databases. This permits comparison of specific hospitals, including direct competitors, and provides easily available benchmarks for cost efficiency that are highly reliable.
We used the same methodology to create the Hospital Charge Index® which is composed of the Medicare charge per discharge (MCPD) and the Medicare charge per outpatient claim (MCPC). This metric is the best possible charge comparison that can be developed from public-use file data. The index can be determined for every US hospital. The three measures further enable price breakouts for inpatient and outpatient business sectors. This is critical when managed-care contracts have split payment methods between inpatient and outpatient areas.
The Hospital Cost/Charge Index Report combines both proprietary measures in one easy-to-read report that compares your hospital to peers and peer groups that you select.
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Data on your hospital & peers/peer group that you choose |
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PDF report & Excel spreadsheet provided |
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Most currently available public data |
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Same day delivery |
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| Who Can Use This Service |
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CEOs |
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CFOs |
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Other Hospital Executive Management |
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Financial Management staff |
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Planners |
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| Market Pricing Summary Report (BETOS Groupings) |
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The Market Pricing Summary Report is a point-in-time analysis of your hospitals charges compared to those of 3 peers and 1 group that you select. Charges are grouped by department for comparison purposes. The departments were created by using Berenson-Eggers Type of Service (BETOS) codes which are assigned for each Health Care Financing Administration Common Procedure Coding System (HCPCS) procedure code. The BETOS Coding system was developed primarily for analyzing the growth in
Medicare expenditures. The coding system covers all HCPCS codes; assigns a HCPCS code to only one BETOS code; consists of readily understood clinical categories (as opposed to statistical or financial categories); consists of categories that permit objective assignment; is stable overtime; and is relatively immune to minor changes in technology or practice patterns.
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| Key Features |
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Data on your hospital & peers/peer group that you choose |
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PDF report & Excel spreadsheet provided |
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Most currently available public data |
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Same day delivery |
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| Who Can Use The Report |
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CEOs |
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CFOs |
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Other Hospital Executive Management |
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Financial Management staff |
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Planners |
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| Competitive Pricing Report |
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The Competitive Pricing Report (CPR) compares your hospital at the procedure-code level with those of client-selected peers or groups. You are able to clearly identify specific procedures for which rate increases or decreases make the most sense. Your rates are also compared with Medicare APC and fee schedule prices to assess potential areas where current prices are below Medicare payment rates.
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| Key Features |
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Selection of up to 9 peer hospitals |
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Use the CPR in managed-care negotiations |
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Use it to develop pricing strategies for new procedures |
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Executive Summary projects your gross charges at your peers’ prices |
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Printable PDF & Excel spreadsheet |
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VPs of Finance |
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Directors of Finance |
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Directors of Reimbursement |
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Chargemaster Director |
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CFOs |
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CEOs |
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| APC Charge Performance Report |
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| The APC Charge Performance Report permits a comparison of charges for key outpatient procedures. It allows the user to identify specific reasons why charges for selected procedures are different from peer hospitals. Isolation of key drivers such as bundling, mix, pricing, and efficiency can be used to enhance overall competitive position. |
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Overall Facility Summary |
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Overall APC Summary |
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Individual APC Data: Payment and Profitability Summary, Detailed Listing of Procedures |
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Printable PDF & Excel spreadsheet |
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| Who Can Use The Report |
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CEOs |
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COOs |
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CFOs |
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VPs of Finance |
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Directors of Finance |
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APC Coordinator |
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| DRG Profile Report |
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| The DRG Profile Report (DPR) reports your 50 top-volume DRGs and compares them to 3 peers and a group average that you select. The DRG Detail section contains Cost, Charge, and Patient Demographic detailed information. The Cost and Charge information are further broken down into Nursing and Ancillary detail. |
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Excel spreadsheet contains data on ALL reportable DRGs |
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Savings Summary provides a quick, easy-to-read examination of potential cost savings opportunities |
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Provider Overview gives a detailed review of a hospital’s Utilization Profile, Medicare Case Profile, & Financial Profile |
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Printable PDF & Excel spreadsheet |
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| Who Can Use The Report |
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VPs of Finance |
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Directors of Finance |
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Directors of Reimbursement |
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DRG Coordinator |
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CFOs |
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CEOs |
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| MS-DRG Profile Report |
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| The MS-DRG Profile Report (MS-DPR) reports your 50 top-volume MS-DRGs and compares them to 3 peers and a group average that you select. The MS-DRG Detail section contains Cost, Charge, and Patient Demographic detailed information. The Cost and Charge information are further broken down into Nursing and Ancillary detail. |
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Excel spreadsheet contains data on ALL reportable MS-DRGs |
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Savings Summary provides a quick, easy-to-read examination of potential cost savings opportunities |
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Provider Overview gives a detailed review of a hospital’s Utilization Profile, Medicare Case Profile, & Financial Profile |
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Printable PDF & Excel spreadsheet |
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VPs of Finance |
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Directors of Finance |
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Directors of Reimbursement |
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MS-DRG Coordinator |
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CFOs |
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CEOs |
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| Post-acute Transfer Payment Audit |
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If your hospital does not have a system in place to audit Medicare payment for post-acute transfers, you may be leaving a substantial amount of money on the table!
When the CMS modified its transfer payment policy, the goal was to eliminate “double payments" for patients that were admitted to acute care hospitals but transferred to post-acute care facilities. Transfer DRGs were created and hospital payments were reduced; unfortunately, the resulting system of checks and balances put in place by CMS does not fully protect the interests of both CMS and hospitals.
If a transfer DRG was assigned but the care was not provided (or not provided in the proper time period) hospitals may recoup the underpayment. It is up to you and your facility to audit these payments and that is where Cleverley + Associates can help!
Cleverley + Associates will review your post-acute transfer claims and validate the actual delivery of post-acute services where indicated on the claim. We will identify any Medicare claims where original payment was reduced because of a transfer discharge status and there is no Medicare payment for the delivery of post-acute transfer services. By resubmitting these claims, your hospital can recoup significant payments. Cleverly + Associates only gets paid when your receive payment from the CMS.
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| Medicare Disproportionate Share (DSH) Services |
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Medicaid Eligible Days Analysis
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Is your hospital including all of the Medicaid eligible days in its DSH calculation that are allowable under the current regulations? |
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Could you be including days that are not compliant? |
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Are you including Medicaid eligible days in your LIP calculation for your distinct part Rehabilitation unit? |
In the current economy your hospital needs to be achieving optimal DSH and LIP payments while at the same time mitigating your risk of filing days that are noncompliant. When determining your DSH payments on the Medicare cost report, you need to be taking into account the impact of labor and delivery days, observation days, and Medicare dual eligible days. Cleverley + Associates can help you manage your DSH payments!
Cleverley + Associates will review your inpatient discharges for both the acute and rehab populations to include allowable Medicaid eligible days in the cost report. Our scope of work will also include analyzing the impact of observation days and labor and delivery days on the DSH payments, if such information is available. Additionally, we will provide you with a protested items inventory to include in the cost report for items that are not currently allowable in the DSH calculation, but may be in the future.
We then provide a report of allowable Medicaid eligible days that will support the Medicare DSH calculation in the hospital’s filed Medicare cost report. We will also provide the eligibility verification statements as requested by the Medicare Administrative Contractor/Fiscal Intermediary.
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Supplemental Security Income (SSI) Analysis
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Is your hospital’s SSI percentage all over the board? |
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Up one year and down the next? |
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Did you know that you might be able to increase your DSH payments by shifting from the Federal fiscal year to your hospital’s fiscal year? |
Cleverley + Associates can help!
Cleverley + Associates will review your opportunity to shift your SSI percentage from the Federal fiscal year to your hospital fiscal year. Our scope of work will include working with the Centers for Medicare & Medicaid Services (CMS) as your agent to obtain the detail data necessary to recalculate the SSI percentage on your hospital fiscal year and validating that the resulting shift is indeed beneficial. We will then assist you in requesting a reopening of the cost report through your Medicare Administrative Contractor (MAC)/Fiscal Intermediary (FI).
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