A 4-D Hospital Price Scan: Preview of a National Employer-led - - PowerPoint PPT Presentation
A 4-D Hospital Price Scan: Preview of a National Employer-led Transparency Study N A T I O N A L H O S P I T A L P R I C E T R A N S P A R E N C Y C O N F E R E N C E : P A T H T O A F F O R D A B I L I T Y M A R C H 5 , 2 0 1 9 C H A
N A T I O N A L H O S P I T A L P R I C E T R A N S P A R E N C Y C O N F E R E N C E : P A T H T O A F F O R D A B I L I T Y M A R C H 5 , 2 0 1 9 C H A P I N W H I T E C H R I S W H A L E Y
This briefing represents the views of the author, and not RAND or RAND’s funders.
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 U.S. OECD median
Health Spending per Person, 2016 ($U.S., PPP)
Source: Anderson, G. F., Hussey, P., & Petrosyan, V. (2019). It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt. Health Affairs, 38(1), 87-95. doi:10.1377/hlthaff.2018.05144.
$0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 U.S. OECD median
Health Spending per Person, 2016 ($U.S., PPP)
Source: Anderson, G. F., Hussey, P., & Petrosyan, V. (2019). It’s Still The Prices, Stupid: Why The US Spends So Much On Health Care, And A Tribute To Uwe Reinhardt. Health Affairs, 38(1), 87-95. doi:10.1377/hlthaff.2018.05144.
Source: Selden, T. M., Karaca, Z., Keenan, P., White, C., & Kronick, R. (2015). The Growing Difference Between Public And Private Payment Rates For Inpatient Hospital Care. Health Affairs, 34(12), 2147-2150. doi:10.1377/hlthaff.2015.0706.
Health Care Cost Institute. (2018). 2016 Health Care Cost and Utilization Report. Retrieved from http://www.healthcostinstitute.org/report/2016-health-care-cost- utilization-report/. Prices are from Appendix Table A3,, utilization and intensity is estimated by dividing spending (from Appendix Table A1) by prices.
0.90 0.95 1.00 1.05 1.10 1.15 1.20 2012 2013 2014 2015 2016 Inpatient Price Utilization and Intensity 0.90 0.95 1.00 1.05 1.10 1.15 1.20 2012 2013 2014 2015 2016 Outpatient Price Utilization and Intensity
Source: White, C., Bond, A. M., & Reschovsky, J. D. (2013). High and Varying Prices for Privately Insured Patients Underscore Hospital Market Power (No. 27). Retrieved from http://nihcr.org/wp-content/uploads/2015/03/HSC_Research_Brief_No._27.pdf.
Source: White, C., Reschovsky, J. D., & Bond, A. M. (2014). Understanding Differences Between High- And Low-Price Hospitals: Implications For Efforts To Rein In Costs. Health Affairs, 33(2), 324-331. doi:10.1377/hlthaff.2013.0747 .
Source: White, C. (2017). Hospital Prices in Indiana: Findings from an Employer-Led Transparency Initiative (RR-2106-RWJ). Retrieved from https://www.rand.org/pubs/research_reports/RR2106.html .
Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Inpatient_Data_2016_CSV.zip
Source: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Downloads/Inpatient_Data_2016_CSV.zip
$0 $4,000 $8,000 $12,000 $16,000 $20,000
PHYSICIANS' MEDICAL CENTER LLC BAPTIST HEALTH FLOYD MEMORIAL HOSPITAL AND HEALTH CARE CENTER LA PORTE HOSPITAL COMMUNITY HOSPITAL SOUTH FRANCISCAN HEALTH HAMMOND THE ORTHOPAEDIC HOSPITAL OF LUTHERAN HEALTH NETWOR CLARK MEMORIAL HOSPITAL FRANCISCAN HEALTH CARMEL LUTHERAN HOSPITAL OF INDIANA FRANCISCAN HEALTH MUNSTER TERRE HAUTE REGIONAL HOSPITAL DEARBORN COUNTY HOSPITAL GOOD SAMARITAN HOSPITAL ST VINCENT KOKOMO ORTHOINDY HOSPITAL KOSCIUSKO COMMUNITY HOSPITAL INDIANA UNIVERSITY HEALTH ARNETT HOSPITAL BLUFFTON REGIONAL MEDICAL CENTER PINNACLE HOSPITAL GOSHEN GENERAL HOSPITAL FRANCISCAN HEALTH MOORESVILLE PORTER REGIONAL HOSPITAL IU HEALTH WEST HOSPITAL RIVERVIEW HEALTH HENDRICKS REGIONAL HEALTH ORTHOPAEDIC HOSPITAL AT PARKVIEW NORTH LLC DEKALB HEALTH ST MARY'S MEDICAL CENTER FRANCISCAN HEALTH MICHIGAN CITY COMMUNITY HOWARD REGIONAL HEALTH INC MARION GENERAL HOSPITAL ST MARY MEDICAL CENTER INC FRANCISCAN HEALTH CROWN POINT DEACONESS HOSPITAL INC FRANCISCAN HEALTH INDIANAPOLIS ST VINCENT CARMEL HOSPITAL INC JOHNSON MEMORIAL HOSPITAL SCHNECK MEDICAL CENTER HANCOCK REGIONAL HOSPITAL ST VINCENT FISHERS HOSPITAL INC KING'S DAUGHTERS' HEALTH COMMUNITY HOSPITAL FRANCISCAN HEALTH CRAWFORDSVILLE PARKVIEW NOBLE HOSPITAL PARKVIEW REGIONAL MEDICAL CENTER UNION HOSPITAL INC DAVIESS COMMUNITY HOSPITAL ST VINCENT ANDERSON REGIONAL HOSPITAL INC DUPONT HOSPITAL LLC MAJOR HOSPITAL INDIANA UNIVERSITY HEALTH NORTH HOSPITAL METHODIST HOSPITALS INC MEMORIAL HOSPITAL OF SOUTH BEND INDIANA UNIVERSITY HEALTH BLOOMINGTON HOSPITAL FRANCISCAN HEALTH DYER COMMUNITY HOSPITAL OF ANDERSON AND MADISON COUNTY FRANCISCAN HEALTH LAFAYETTE INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL ST CATHERINE HOSPITAL INC COLUMBUS REGIONAL HOSPITAL SAINT JOSEPH REGIONAL MEDICAL CENTER WITHAM HEALTH SERVICES COMMUNITY HOSPITAL NORTH REID HEALTH ST VINCENT HOSPITAL & HEALTH SERVICES ELKHART GENERAL HOSPITAL SAINT JOSEPH REGIONAL MEDICAL CENTER - PLYMOUTH COMMUNITY HOSPITAL EAST HENRY COUNTY MEMORIAL HOSPITAL PARKVIEW HUNTINGTON HOSPITAL MEMORIAL HOSPITAL INDIANA UNIVERSITY HEALTH MONROE HOSPITAL UNITY MEDICAL AND SURGICAL HOSPITAL ESKENAZI HEALTH
Medicare Allowed Amount, DRG 470, 2016
= 𝐵𝑚𝑚𝑝𝑥𝑓𝑒 𝐵𝑛𝑝𝑣𝑜𝑢 𝑇𝑗𝑛𝑣𝑚𝑏𝑢𝑓𝑒 𝑁𝑓𝑒𝑗𝑑𝑏𝑠𝑓 𝐵𝑚𝑚𝑝𝑥𝑓𝑒 𝐵𝑛𝑝𝑣𝑜𝑢 = 𝐵𝑚𝑚𝑝𝑥𝑓𝑒 𝐵𝑛𝑝𝑣𝑜𝑢 𝐷𝑏𝑡𝑓𝑛𝑗𝑦 𝑥𝑓𝑗ℎ𝑢𝑡 adjusted for
care comparable across service lines adjusted for
not comparable across service lines
“ P R E V I E W ” I N C L U D E S C L A I M S D A T A A V A I L A B L E C U R R E N T L Y F I N A L R E P O R T W I L L I N C L U D E A D D I T I O N A L C L A I M S D A T A , H O S P I T A L S , A N D S T A T E S
Services Hospital inpatient, hospital outpatient States CO, GA, IL, IN, KS, KY, LA, MA, ME, MI, MO, MT*, NH, NM, NY, OH, PA, TN, TX, VT, WI, WY* Years 2015-7** Hospitals 1222 short-stay general medical/surgical Allowed amount (2015-7) $12.3B, $6.0B inpatient and $6.3B outpatient Claims (2015-7) 310k inpatient stays, 13.5M outpatient lines Data sources 2 all payer claims databases, many health plans, ~40 self-funded employers*** Funders RWJF, NIHCR, self-funded employers (not health plans, or hospitals)
*: not included in this preview; **: NH,CO: 2012-7, IN: 2013-2017, MI,LA: 2015-2018; *** ~20 are included in this preview.
223.3% 225.7% 229.0%
100% 120% 140% 160% 180% 200% 220% 240% 2014 2015 2016 2017 2018 Commercial Medicare
100% 125% 150% 175% 200% 225% 250% 275% 300% 325% 350% 375% 400% 425% PA MI LA NY KY TN VT NM IL KS MA MO All NH OH GA CO ME TX WI IN Inpatient + Outpatient Inpatient Outpatient
277% 286% 295% 161% 151% 149%
100% 150% 200% 250% 300% 350% 2015 2016 2017 IN CO OH NH MI
50% 100% 150% 200% 250% 300% 350% 400% 450% 500% 550%
1 6 11 16 21 26 31 36 41 46 51
Inpatient + Outpatient Inpatient Outpatient
50% 100% 150% 200% 250% 300% 350% 400% 450% 500% 550%
1 6 11 16 21 26 31 36 41 46 51
Inpatient + Outpatient Inpatient Outpatient
0% 20% 40% 60% 80% 100% Low (<1.5) Medium (1.5-2.5) High (>=2.5)
Hospital Compare Star Ratings, 2018 (Share of Hospitals Within Price Group) Hospital Price Group (Relative to Medicare, 2015-7) 5 stars (highest) 4 stars 3 stars 2 stars 1 star (lowest)
E M P L O Y E R S ’ F O R U M O F I N D I A N A R O B E R T W O O D J O H N S O N F O U N D A T I O N N A T I O N A L I N S T I T U T E F O R H E A L T H C A R E R E F O R M I B M W A T S O N H E A L T H C E N T E R F O R I M P R O V I N G V A L U E I N H E A L T H C A R E ( C I V H C ) N E W H A M P S H I R E C O M P R E H E N S I V E H E A L T H C A R E I N F O R M A T I O N S Y S T E M C O L O R A D O B U S I N E S S G R O U P O N H E A L T H T H E H E A L T H F O U N D A T I O N O F G R E A T E R I N D I A N A P O L I S , I N C . H O U S T O N B U S I N E S S C O A L I T I O N O N H E A L T H N E W M E X I C O C O A L I T I O N F O R H E A L T H C A R E V A L U E E C O N O M I C A L L I A N C E F O R M I C H I G A N
C O N T A C T : C H A P I N W H I T E C W H I T E @ R A N D . O R G 2 0 2 - 2 0 3 - 0 2 6 0 @ C H A P I N W H I T E