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Medicare News
Medicare Posts Hospital Payment Information for All
Counties Online
Important step toward transparency in health care
costs, quality - see analysis
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Medicare and the taxpayers may wish more senior
citizens lived in states like Texas, Florida and Oklahoma, where
heart valve operations appear to be less expensive. |
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See more
analysis below news story. |
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June 2, 2006 In a move aimed at helping
consumers, and others who pay the healthcare bills, along with care
providers, the Centers for Medicare & Medicaid Services yesterday posted
online data about what Medicare pays for 30 common elective procedures
and other hospital admissions. It is "only a beginning," a CMS
spokesperson said, but the information is among the first to shed light
on what certain healthcare procedures cost in every county in the USA.
To help consumers, providers, and payers make more
informed health care decisions, the Department of Health and Human
Services through its Centers for Medicare & Medicaid Services (CMS)
today posted information on what Medicare pays for 30 common elective
procedures and other hospital admissions. President Bush directed the
data be made publicly available to all Americans as part of the
Administrations commitment to make health care more affordable and
accessible.
Once people gain better information, they become
better consumers of health care and that helps get health care costs
down and quality of care up, Department of Health and Human Services
Secretary Mike Leavitt said.
The federal government is the biggest single
purchaser of health care in America, and by taking steps to post prices
and quality data, we hope to encourage more insurance companies,
hospitals, clinics and doctors to do the same, he added.
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The new information shows the range of payments by
county and the number of cases treated at each hospital for a variety of
treatments provided to senior citizens and people with disabilities in
fiscal year 2005.
These include 30 common elective procedures
including heart operations and implanting cardiac defibrillators, hip
and knee replacements, kidney and urinary tract operations, gallbladder
operations and back and neck operations, and for common non-surgical
admissions.
The new information on how many patients a
hospital treats and on payments for the most common kinds of hospital
care adds to the information that people can use to make better
decisions on their care, said CMS Administrator Mark B. McClellan,
M.D., Ph.D.
In all areas of care -- hospitals, physicians,
nursing homes, health plans, and prescription drugs -- we are supporting
collaborative efforts that are providing unprecedented information to
help people get the best quality care for the best price.
President Bush directed the data be made publicly
available to all Americans as part of the Administrations commitment to
make health care more affordable and accessible.
The department is working closely with a number of
national and local organizations to develop more comprehensive and
personalized information on quality and cost. One major initiative
involves six pilot projects supported by the Ambulatory Care Quality
Alliance, with funding from CMS and the Agency for Healthcare Research
and Quality (AHRQ), to provide information to patients and health care
providers via collaboratives in Massachusetts, Indiana, Minnesota,
Wisconsin, Arizona and California.
Another example is the quality measures on
hospitals across the nation currently being reported to the public (Click
Here) supported by the Hospital Quality Alliance (AQA).
In addition to the 17 clinical quality measures
available now, the hospital information will be expanded to include
information on patient satisfaction and outcomes in the coming year.
These and other quality alliances are taking further steps to increase
the range of useful measures being reported to consumers, including
measures of care efficiency as well as cost information, and to develop
quality measures for continuity of care with the AQA and other partners.
The steps we are taking to provide patients better
information is part of a long-range vision that can transform our health
care system and put value and quality at the center, said AHRQ Director
Carolyn M. Clancy, M.D.
In addition to the information posted today, CMS
will post payment information for common elective procedures for
ambulatory surgery centers later this summer, and common hospital
outpatient and physician services this fall.
People need to know how much their health care
costs. They need to know the quality of the care they receive. And they
need to have a reason to care, Secretary Leavitt said. Right now, none
of these things exist in our health care system, but today we are taking
an important step toward transparency.
As we give consumers better information on how
their health care dollars are spent, they will demand more value for
their money, and the result will be better treatment at lower costs.
ANALYSIS: Looking at the Report
By Tucker Sutherland, editor
This is a good step by Medicare toward providing
senior citizens with more information to make informed medical
decisions. Cost may not always be the major consideration, since
Medicare is paying for it, but it is helpful to know more about the
number of cases, similar to yours, that a hospital handles.
In the chart below, we have taken the data for four
Texas counties and made our own chart. You will see, for example that in
Hidalgo County there were only 45 Heart Valve Operations and one may
want to consider having such an operation down in one of the larger
metro area hospitals, where they have more experience. And, it is
interesting to note, that the mean cost in Hidalgo was higher than in
the metro areas.
But, volume does not necessarily mean less cost. In
looking at several selected states, California had more operations
(2,332) but the cost was
$6,790 above the national mean. We determined the mean as the average
between the bottom 25th percentile and the top 75th percentile.
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2005 Heart Valve Operations - Range of Total Payments, By County
(25th Percentile - 75th Percentile) |
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Locations |
Cases
2005 |
Payment Range |
+/-
Nat.
Avg. |
+/-
Nat.
Mean |
|
25th
Prcntl |
75th
Prcntl |
Mean |
|
Bexar
(San Antonio) |
126 |
$24,750 |
$33,571 |
$29,161 |
-$9,368 |
-$6,512 |
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Dallas (Dallas) |
336 |
$31,710 |
$35,069 |
$33,390 |
-$5,139 |
-$2,283 |
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Harris (Houston) |
394 |
$32,874 |
$43,176 |
$38,025 |
-$503 |
$2,353 |
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Hidalgo (McAllen) |
45 |
$35,886 |
$40,668 |
$38,277 |
-$251 |
$2,605 |
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Massachusetts |
753 |
$44,398 |
$47,939 |
$46,169 |
$7,641 |
$10,497 |
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New
York |
2091 |
$36,313 |
$55,165 |
$45,739 |
$7,211 |
$10,067 |
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California |
2332 |
$36,396 |
$48,527 |
$42,462 |
$3,934 |
$6,790 |
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Texas |
1689 |
$30,393 |
$35,569 |
$32,981 |
-$5,547 |
-$2,691 |
|
Florida |
2330 |
$28,331 |
$34,119 |
$31,225 |
-$7,303 |
-$4,447 |
|
Oklahoma |
419 |
$27,035 |
$31,017 |
$29,026 |
-$9,502 |
-$6,646 |
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TOTAL USA |
32493 |
$30,151 |
$41,193 |
$35,672 |
-$2,856 |
$0 |
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National Average All Payments: |
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$38,528 |
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National Average Charges: |
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$115,221 |
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Editor's Note: % of Bill Medicare Paid |
33.4% |
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See definitions used in the
report at bottom of this page.
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San Antonio |
126 |
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Baptist Health System |
18 |
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Methodist Hospital |
32 |
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TexSan Heart Hospital |
56 |
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University Health System |
12 |
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Houston |
394 |
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Methodist Hospital |
125 |
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St. Luke's Episcopal |
185 |
We live in Bexar County, Texas, (San Antonio) and found the
information about the individual hospitals information, although the report does
not include the cost by hospital, only by county.
The 125 heart valve operations in San Antonio were fairy
evenly spread between four hospitals, and most hospitals had none. TexSan Heart
Hospital did the most and it is an institution I am not familiar with.
In Houston, however, the 394 operations there were pretty
well concentrated in just two hospitals - Methodist and St. Luke's Episcopal. It
is certainly information to consider if getting your heart valve operation done
in Harris County.
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Heart Valve
Operations |
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Procedures Included:
> Replace heart (aortic) valve
> Replace heart (aortic) valve with prosthetic
> Repair heart (mitral) valve, open chest
> Replace heart (mitral) valve with prosthetic |
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Another interesting statistic in the report that caught my
eye was the difference between the "National Average of All Payments" and
"National Average Charges." You will see these in the large chart above and not
that Medicare paid only 33.4 percent of what they were billed.
A spokesman for CMS explained it to me that the charges
were sort of the retail rate the hospitals charge, but Medicare uses their own
formula to pay much less.
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More Opinions |
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KaiserNet.org
reported these additional comments and opinions from the media and other
interested parties:
"Medicare typically
pays the same rate to hospitals within geographic regions, the Wall
Street Journal reports. It is "unclear how the new information will help
individuals navigate the complex hospital payment systems," according to
the Journal (Wall Street Journal, 6/2).
"Tom Nickels, senior
vice president of government relations at the
American Hospital Association, said the information is "worth
looking at, but it doesn't supplant the need to know what your
co-insurance obligation is." He said the federal government should focus
on helping the uninsured obtain coverage rather than negotiating
procedure costs (AP/Albany Times Union, 6/2).
"Peter Lee, CEO of
the
Pacific Business Group on Health, said, "The days of medical costs
and the difference in health care quality being invisible to consumers
are over" (USA Today, 6/2).
"Craig Keyes -- CEO
of
UnitedHealthcare of Colorado, which is providing pricing and patient
outcome information to doctors in the state as part of a pilot program
-- said, "There have always been a lot of secrets in health care, and
this is part of bringing that out of the black box" (Denver Post, 6/2).
"The
Business Roundtable said, "Unfortunately, today's consumer is
completely unaware of the cost of their health care until they receive a
bill in the mail. By making cost information available, consumers will
be better informed on pricing and better able to make educated health
care decisions" (AP/Albany Times Union, 6/2).
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Julie Appleby, reporting in
USA TODAY did not see a great deal of value in the report. She said:
"
the cost data posted by Medicare won't be useful to most
consumers, because:
The data show the range of what Medicare pays for
procedures in each county, not what those with private insurance or the
uninsured might pay.
They do not show hospital-specific price data.
They do not show what an individual Medicare member pays,
although savvy beneficiaries could estimate based on the program's typical
co-payments and deductibles.
"The newly released data, however, do give consumers
hospital-specific information on how many of each of the 30 procedures or
treatments each hospital did in 2005. That's important because studies have
shown that, in general, the more experience a facility has with a procedure, the
better the outcome for the patient."
Certainly, she has a point. But, this is a start, and if
the information is combined with the information in the hospital quality report,
it will be helpful to many.
Below you will find links to four zipped Microsoft Excel
files. The files are large so printing them is not recommended.
"Top 30 Elective Inpatient Hospital DRGs" contains the
volume and ranges of Medicare payments between the 25th and 75th percentiles for
a limited set of conditions treated in U.S. states and counties. Included are
the 30 conditions that had the highest utilization rates among all Diagnosis
Related Groups (DRGs). Data are aggregated at the county, state and national
level.
"Other Inpatient Hospital DRGs of High Utilization"
contains ranges of Medicare payments between the 25th and 75th percentiles for a
limited set of conditions treated in U.S. states and counties. These conditions
are not among the top 30 utilized Diagnosis Related Groups (DRGs), but were
deemed of interest to the Medicare community. Data are aggregated at the county,
state and national level.
Downloads (The files open in Excel)
●
Top 30 Elective Inpatient Hospital DRGs [Excel Zipped, 1.3MB]
●
Sample State - Florida Top 30 Elective Inpatient Hospital DRGs [Excel Zipped,
60KB]
●
Other Inpatient Hospital DRGs of High Utilization [Excel Zipped, 640KB]
●
Sample State - Florida Other Inpatient Hospital DRGs of High Utilization [Excel
Zipped, 40KB]
If you have trouble with these links, go the the CMS
site -
Click Here
Definitions Used in Report
Data from the December
2005 update of Fiscal Year 2005
Medicare Provider Analysis and Review File (MedPAR).
Field Descriptions
Total Payment:The
sum of Medicare payments for the DRG including DRG, Teaching, Disproportionate
Share, Capital, and Outlier payments for all cases. Also included in Medicare
Payments are co-payments and deductibles paid by patients.
Covered Charges:The sum of the charges for services covered by
Medicare for all cases in the DRG. These will vary from hospital to hospital
because of differences in hospital charge structures.
Number of Cases: The number of discharges assigned to the DRG.
See "Privacy" under Special Notes.
National Average Payments:The sum of the total payments of all
hospitals in the nation divided by the number of cases in the nation for the DRG.
National Average Charges:The sum of the covered charges of all
hospitals in the nation divided by the number of cases in the nation for the DRG.
Range of Total Payments, By County:The range of
payments between the 25th percentile and the 75th percentile. This range
excludes the lowest 25 percent of payments and the highest 25 percent of
payments. It is the range of payments for the most typical cases treated in the
geographic area for the DRG. It excludes unusually low payments for cases such
as those where a patient is transferred to another facility before receiving a
full course of treatment. It also excludes unusually high payments for cases
that are more complex and costly to treat than is typical for most cases in the
DRG. Only one number appears in this field when the 25th and 75th percentiles
are equal. See "Privacy" under Special Notes.
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