Hospital Charges And Average Length of Stay August 2013

Transcription

1 Hospital Charges And Average Length of Stay August 2013 Keeping Colorado Healthy

2 2012 Hospital Charges & Average Length of Stay Report A report on the most common reasons for hospitalization Prepared by the Colorado Hospital Association as a Voluntary Effort of Colorado Hospitals July 2013

3 This report is available for purchase from CHA: Hard copy or searchable, printable CD ROM $ ASCII formatted CD ROM $ A non printable PDF version is available on CHA s website: For data on inpatient hospital quality indicators, visit: Colorado Hospital Association 7335 East Orchard Road, Suite 100 Greenwood Village, Colorado Tel.: (720) Fax: (720)

4 Table of Contents Colorado Hospital Association... 6 Mission Statement Who We Are Data Services Hospital Charges and Average Length of Stay... 7 Why Charges May Vary Talk to Your Doctor and Hospital!... 8 Diagnosis Related Groups (DRGs) and APR DRGs: What Are They?... 9 How to Read This Report Participating General Hospitals Listing: APR DRGs and Major Diagnostic Categories (MDCs) in This Report Hospital Charges, Average Length of Stay by APR DRG Appendix A: Most Common Reasons for Hospitalizing Patients in Appendix B: Major Diagnostic Categories Appendix C: Medicare and Medicaid Patient Days as a Percent of Each Hospital s Total Patient Days Appendix D: Summary of Data Elements/Indicators for Inpatient Admissions and Outpatient Surgeries Appendix E: Standardized Range: Technical Description Appendix F: Colorado Hospital Association Discharge Data Program Database What is the CHA DDP Database? What Questions can be Answered with DDP Data? Who Uses DDP data? How are DDP Data Obtained from CHA Members? What is the Price? What are the Limitations Associated with DDP Data? What is Done to Ensure Accuracy? For More Information 3

5 Table of APR DRGs No. Description... Page 45 Cerebrovascular accident (CVA) and precerebral occlusion with infarct (stroke or blood clot causing blockage of blood vessels) 53 Seizure Pulmonary embolism and respiratory failure Pulmonary embolism Other pneumonia Chronic obstructive pulmonary disease (COPD) (lung diseases that cause blockage, including chronic bronchitis and emphysema) 141 Asthma (lung condition, often allergic in nature, causing labored breathing) Percutaneous cardiovascular procedures with acute myocardial infarction (AMI).. 85 (balloon repair of a heart vessel with diagnosis of a heart attack) 175 Percutaneous cardiovascular procedures without acute myocardial infarction Heart failure Cardiac arrhythmia and conduction disorders (irregular heartbeat) Major small and large bowel procedures (colostomy, ileostomy, operations on the intestines) 225 Appendectomy (surgical removal of the appendix) Intestinal Obstruction Nonbacterial gastroenteritis, nausea and vomiting (severe flu) Other digestive system diagnoses (hernia, irritable colon) Laparoscopic cholecystectomy (gall bladder removal through small incisions in the abdomen) 282 Disorders of pancreas except malignancy Hip joint replacement

6 Table of APR DRGs, continued No. Description... Page 302 Knee joint replacement Dorsal and lumbar fusion procedures, except for curvature of the back (surgical repair of two or more back vertebrae by immobilization) 308 Hip and femur procedures for trauma, except joint replacement (repair of hip and upper leg bone fractures due to injury) 313 Knee and lower leg procedures, except foot (repair of knee and ligaments, repair of ankle fractures) 315 Shoulder, upper arm and forearm procedures Cervical spinal fusion and other back/neck procedures excl. disc excis/decomp Other back and neck disorders, fractures and injuries (non surgical treatment for back pain, sprains, and fractures of spine) 383 Cellulitis and other bacterial skin infections (includes abscesses) Diabetes Renal failure (kidney failure) Kidney and urinary tract infections Other kidney and urinary tract diagnoses, signs, and symptoms Cesarean delivery (surgical delivery of a baby) Vaginal delivery Neonate, birth weight greater than 2,499 grams, normal newborn or newborn with other problems Septicemia and disseminated infections

7 Mission and Vision Mission: Support members collaborative commitment to advance the health of their communities through affordable, accessible, high quality health care. Vision: Members succeeding in achieving optimal health care value in their communities. Who We Are The Colorado Hospital Association (CHA) represents 95 hospitals and health systems throughout Colorado. CHA helps caregivers and health professionals in Colorado hospitals do what they do best meet the health care needs of their communities. By working together, member hospitals and health systems create changes to better serve their communities. Colorado hospitals create a tremendous impact on the state s economic stability, contributing to nearly every community across the state with more than 71,000 jobs. Hospitals support local businesses, create additional employment through their purchases of goods and services, and are essential to successful local and statewide economic development initiatives. Data Services Through the publication of this report on hospital charges and average length of stay, Colorado hospitals continue their commitment to helping the public better understand the health care delivery system. This publication is based on CHA s Discharge Data Program, an administrative database established in In addition to charges and average lengths of stay, inpatient quality indicators are available from the Discharge Data Program at CHA also maintains a financial database called DATABANK, the source of CHA s Reference Guide to Colorado Hospital Financial and Utilization Data. 6

8 Hospital Charges and Average Length of Stay Consumers and purchasers of health care such as businesses, insurance, managed care companies and the general public seek information to compare the cost and quality of hospital care. Since 1988, Colorado hospitals have released information on the charges and length of stay for the 35 most common inpatient medical conditions and surgical procedures performed in Colorado hospitals. CHA provides average hospital charges and length of stay for procedures not included in this report. Each hospital can provide estimated charges for a person who anticipates being admitted. Charges cannot be used to judge quality of health care. Hospital specific inpatient quality indicators are available for 11 conditions and procedures at Consumers can use the quality and charge information together to ask better questions and to make more informed decisions about their health care. Why Charges May Vary Charges vary for many reasons. The following are some of the factors that affect charges. Individual responses: Outcomes and length of stay vary, even for the same diagnosis. No two patients, their health status, reactions to treatment or recovery time are identical. Unpaid care: The number of patients whose care is not fully paid affects charges. The gap between the cost of care and payment results in those costs being shifted to other patients. Patients enrolled in Medicare and Medicaid (government funded programs) accounted for more than 50 percent of hospital days statewide in A hospital with a high number of Medicare or Medicaid patients must set charges high enough to recover the shortfall in costs not paid by these programs. Appendix C shows the percentage of Medicare and Medicaid patient days for reporting hospitals. People with inadequate or no health care insurance who cannot afford to pay for their care also contribute to cost shifting. Complexity of care: Hospitals that offer more complex services (such as burn units or trauma care) use more resources to treat patients, so charges are higher. Comparability of billing: What is included in the charges may not be comparable. For example, Medicaid and some health insurers require hospitals to include care for both the mother and the newborn as part of delivery charges (APR DRGs 540 and 560). Other health plans require these charges to be billed separately. Hospitals with a high percentage of patients with combined charges for mother and baby appear to have higher delivery charges. Similarly, charges for hospitals where physician fees are included will appear higher than at hospitals where they are not. 7

9 Individual physician judgment: Charges for some APR DRGs, such as vaginal delivery (560), have little variation within the minor severity level because physicians agree on standard treatment. Other APR DRGs have a significant range of charges even within the minor severity level because the category includes a variety of illnesses for which treatment varies. An example is chronic obstructive pulmonary disease (140), which includes both bronchitis and emphysema. Medicine is an art as well as a science, and individual physician judgment based on education, experience and patient needs influences treatment decisions. Talk to Your Doctor and Hospital! Studies have found that well informed patients who actively participate in their medical care often have better health outcomes than more passive patients. Ask questions about your diagnosis and proposed medical care; written information may be available. If the terms are too technical, ask for their definition. Clear information will help you more successfully follow your doctor's advice. This report is one tool to help you be a more active participant in the health care system; use it as a guide. Ask your physician which APR DRG category (defined in the following section) might be comparable to your condition. (Many physicians will be more familiar with the standard DRG numbering system.) Review the number of patients treated at each hospital, the average length of stay and the average charges for each of the severity categories. Check the inpatient quality indicators ( if they are related to your condition or proposed procedure. Ask your physician and hospital (start with a patient representative or admissions counselor) how your condition and health status might affect costs, procedures and length of stay. Ask your insurance company what is covered under your plan and what you will be expected to pay out of pocket for the proposed medical care. If you are concerned about your ability to pay, talk to a hospital financial counselor prior to admission if possible. Here are some questions to ask when your doctor recommends tests, surgery or other procedures: What operation, treatment or tests are being recommended? Why? What are the benefits, risks and alternatives? What could happen without treatment? How many of these cases have the hospital staff or physician treated? 8

10 Will the outcome of a test affect treatment? How soon does an operation need to be done? What are the qualifications of the surgeon, anesthesiologist or other key health care providers who will be involved? Can you receive the care as an outpatient without staying overnight in a hospital? How long will recovery take? Will there be limits on activity during recovery? What kind of pain will there be after surgery? How will it be managed? What are the charges and fees? (See the section Why Charges May Vary ) What additional charges may be incurred? For example: Will there be a bill from a laboratory or a medical specialist to read an x ray or other test? Will there be other consulting specialists, such as an anesthesiologist? Will Medicare and/or other insurance cover charges? Will the physician accept the insurance payment in full? Do the physicians accept the same insurance as the hospital? (They may NOT in some cases) Is home health care an option? Diagnosis Related Groups (DRGs) and APR DRGs: What Are They? DRGs Diagnosis Related Groups, or DRGs, were developed for Medicare as a means of relating injuries and illnesses a hospital treats to the costs incurred by a hospital. This system groups the thousands of existing treatments and procedures into similar categories of diseases and diagnoses. Payment rates are set for specific DRGs based on what an average patient within a category of disease might be expected to cost a hospital to treat. A hospital is paid that rate regardless of how ill a patient is, how long the patient stays in the hospital or how much it costs the hospital to provide the care. DRGs have several limitations: The system was designed for Medicare, a program primarily for people over age 65. The resources used by other patients are not adequately addressed. DRGs do not exist for some admissions to a hospital, such as pediatric admissions. 9

11 DRGs focus on resource intensity (the volume and type of diagnostic and therapeutic services, along with the unit where care is provided for a particular diagnosis) rather than the severity of illness (extent of the illness or disease) or risk of mortality (likelihood of dying). DRGs do not recognize the impact of secondary diagnoses of the patient. For example, all patients with chronic obstructive lung disease are considered equal. DRGs do not take into account risks due to age or other conditions, such as high blood pressure or diabetes. x

12 APR DRGs Substantial work has been done over the years to develop a system that reflects information about the severity of illness of each hospital s patients. One of these systems is the All Patient Refined Diagnosis Related Groups, or APR DRGs, developed by 3M Health Information Systems. The APR DRG system was designed to: Compare hospitals across a wide range of resource and outcome measures Evaluate differences in mortality rates Identify opportunities for hospitals to improve quality and other internal management issues The basic principle of APR DRGs is that the severity of illness or risk of mortality of a patient is correlated with the patient s underlying health problems. For example, patients with extreme severity of illness or risk of mortality rankings have multiple serious diseases, such as heart failure or insulin dependent diabetes. APR DRGs incorporate four levels of severity of illness (how sick a patient is) and risk of mortality (likelihood of dying), in addition to the resource intensity used by DRGs. The levels are minor, moderate, major and extreme. These are not scores and do not describe a hospital s total patient population. A severity level of major is not equivalent for a patient with a fractured leg and a patient with heart failure. DRGs are combined into 316 APR DRGs that include diagnoses not used for the Medicare population, such as pediatric diagnoses. 11

13 How to Read This Report This report provides information about hospital inpatient charges and length of stay for calendar year Physician charges and outpatient surgery charges are not included. The following descriptions and definitions will help readers understand the data pages. APR DRG NUMBER and NAME: In the top left hand corner of each page is the APR DRG number and name. The data are presented in numerical order using the APR DRG number. A list of the 35 APR DRGs in this report is on pages These 35 APR DRGs accounted for more than 54 percent of the discharges from 74 acute care hospitals in Colorado in A ranking of the number of patients admitted to Colorado hospitals by APR DRG is in Appendix A. Beginning with 2012 data, version 29.0 of 3M s APR DRGs was used for analysis. Version 29.0 superseded version There are 316 APR DRGs in version 29.0 (314 base APR DRGs and 2 ungroupable APR DRGs). For version 29.0 APR DRGs, there are a total of 13,677 ICD 9 CM diagnosis codes. This report uses Version 29 of 3M s APR DRG. MDC: Three hundred and five (305) APR DRGs combine into 25 Major Diagnostic Categories (MDCs). Eleven APR DRGs are not grouped. Appendix B shows data by MDC. The list of the 35 APR DRGs included in this report (pages 15 16) shows the corresponding MDC. PEER GROUP: Hospitals are grouped according to the Medicare payment method that applies to each one. They fall into four categories: Denver Metro, Other Urban, Rural, and Critical Access Hospitals. The list of Participating Hospitals (pages 13 14) includes the peer group for each hospital. HOSPITAL NAME: Colorado s acute care hospitals are in alphabetical order within each peer group by APR DRG. If a hospital did not treat patients in an APR DRG, it is not listed. This report does not include rehabilitation, psychiatric, specialty or children s hospitals. SEVERITY: The APR DRG system assigns levels of severity, or how sick the patient is, by considering: Principal diagnosis, the main reason for admission to the hospital; Secondary diagnoses, underlying or complicating conditions such as diabetes or hypertension; Age; Presence of certain non operating room procedures, such as dialysis. The levels for severity of illness are minor, moderate, major and extreme. 12

14 MINOR severity of illness is relatively without complications or secondary diagnoses that would consume additional resources. MODERATE, MAJOR and EXTREME levels each have additional factors that make the illness worse and require additional resources to provide care. These factors may be different for each illness category. TOT/AVG is the total number of patients treated for all severity levels and the average length of stay and average charges for all patients in that diagnosis category. OUTLIERS will be found for some hospitals under Tot/Avg. This is the number of patients who have an unusually short or long length of stay compared to other patients in the same category. Exceptionally short or long lengths of stay may be due to death or transfer to another facility, a catastrophic condition, or coding or data submission errors. These exceptional values are excluded from the calculations because they distort the averages. Charges per day less than $150 or more than $100,000 also have been excluded. # of PTS: This shows the number of patients in each severity level and the total number of patients treated in this APR DRG for each category and each hospital. Each level of severity and the total must represent at least five patients or the information is suppressed because of the lack of statistical validity. The symbol is used to reflect fewer than five patients. LENGTH OF STAY is shown by three numbers: ALOS is the average length of stay for patients in each severity level and for all patients. LOW and HIGH numbers reflect the statistical standardized range for length of stay. There is 95 percent probability the expected length of stay lies between these numbers. Standardized range is calculated separately for each hospital and each category. This shows what is likely to happen in that hospital. Peer Group Totals can be used for comparisons. TOTAL CHARGES are shown by three numbers: AVG CHG is the average charge for patients in each severity of illness level and for all patients. These are hospital charges and, in most cases, do not include separate physician charges. LOW and HIGH numbers reflect the statistical standardized range. There is 95 percent probability that the expected charges lie between these numbers for this hospital. The standardized range is calculated separately for each hospital and each category. This shows what is likely to happen in that hospital. Peer Group Totals can be used for comparisons. 13

15 PEER GROUP TOTAL: At the end of each grouping of hospitals (Denver Metro, Other Urban, Rural, and Critical Access Hospitals) is the total for number of patients in that group of hospitals and peer group average length of stay and charges. STATEWIDE TOTAL: At the end of each APR DRG category is the total number of patients statewide and the statewide average length of stay and charges. 14

16 Participating General Hospitals Licensed Available City... Hospital... Peer Group... Beds... Beds Alamosa... San Luis Valley Reg. Medical Center...Rural Aspen... Aspen Valley Hospital...Critical Access Aurora... Children s Hospital Colorado...Denver Metro The Medical Center of Aurora...Denver Metro University of Colorado Hospital...Denver Metro Boulder... Boulder Community Hospital...Other Urban* Brighton... Platte Valley Medical Center...Denver Metro Brush... East Morgan County Hospital...Critical Access Burlington... Kit Carson County Memorial Hospital..Critical Access Cañon City... St. Thomas More Hospital...Rural Cheyenne Wells... Keefe Memorial Hospital...Rural Colorado Springs... Memorial Health System...Other Urban Penrose St. Francis Health Services...Other Urban Cortez... Southwest Memorial Hospital...Critical Access Craig... The Memorial Hospital at Craig...Critical Access Del Norte... Rio Grande Hospital...Critical Access Delta... Delta County Memorial Hospital...Rural Denver... Denver Health...Denver Metro Exempla Saint Joseph Hospital...Denver Metro National Jewish Health...Denver Metro Porter Adventist Hospital...Denver Metro Presbyterian/St. Luke's Med. Center...Denver Metro Rose Medical Center...Denver Metro St. Anthony Hospital...Denver Metro...** **430 Durango... Mercy Regional Medical Center...Rural Eads... Weisbrod Memorial County Hospital...Critical Access Englewood... Swedish Medical Center...Denver Metro Estes Park... Estes Park Medical Center...Critical Access Fort Collins... Poudre Valley Hospital...Other Urban Fort Morgan... Colorado Plains Medical Center...Rural Frisco... St. Anthony Summit Medical Center...Rural Fruita... Family Health West...Critical Access Glenwood Spgs... Valley View Hospital...Rural Grand Junction... Community Hospital...Other Urban St. Mary's Hospital & Reg. Med. Ctr....Other Urban Greeley... North Colorado Medical Center...Other Urban* Gunnison... Gunnison Valley Hospital...Critical Access Haxtun... Haxtun Hospital District...Critical Access Holyoke... Melissa Memorial Hospital...Critical Access Hugo... Lincoln Community Hospital...Critical Access

17 Licensed Available City... Hospital... Peer Group... Beds... Beds Julesburg... Sedgwick County Health Center...Critical Access Kremmling... Middle Park Medical Center...Critical Access La Jara... Conejos County Hospital Corp....Critical Access La Junta... Arkansas Valley Regional Med. Ctr....Rural Lafayette... Exempla Good Samaritan Med. Ctr....Denver Metro Lamar... Prowers Medical Center...Critical Access Leadville... St. Vincent General Hospital District...Critical Access Littleton... Littleton Adventist Hospital...Denver Metro Lone Tree... Sky Ridge Medical Center...Denver Metro Longmont... Longmont United Hospital...Other Urban* Louisville... Avista Adventist Hospital...Other Urban* Loveland... McKee Medical Center...Other Urban Medical Center of the Rockies...Other Urban Meeker... Pioneers Medical Center...Critical Access Montrose... Montrose Memorial Hospital...Rural Pagosa Springs... Pagosa Springs Medical Center...Critical Access Parker... Parker Adventist Hospital...Denver Metro Pueblo... Parkview Medical Center...Other Urban St. Mary Corwin Medical Center...Other Urban Rangely... Rangely District Hospital...Critical Access Rifle... Grand River Hospital District...Critical Access Salida... Heart of the Rockies Reg. Med. Ctr....Critical Access Springfield... Southeast Colorado Hospital District...Critical Access Steamboat Spgs... Yampa Valley Medical Center...Rural Sterling... Sterling Regional MedCenter...Rural Thornton... North Suburban Medical Center...Denver Metro Trinidad... Mount San Rafael Hospital...Critical Access Vail... Vail Valley Medical Center...Rural Walsenburg... Spanish Peaks Reg. Health Center...Critical Access Westminster... St. Anthony North Hospital...Denver Metro...**... ** Wheat Ridge... Exempla Lutheran Medical Center...Denver Metro Woodland Park... Pikes Peak Regional Hospital...Critical Access Wray... Wray Community District Hospital...Critical Access Yuma... Yuma District Hospital...Critical Access * These hospitals have technically been moved into the Denver Metro category for Medicare payment purposes. They are still included in Other Urban in this report. ** The licensed and available beds are combined for St. Anthony Hospital and St. Anthony North Hospital. Data Source: CHA DATABANK Program 16

18 All Payer Refined Diagnosis Related Groups (APR DRGs) with Corresponding Major Diagnostic Categories (MDCs) in This Report APR MDC DRG Description Cerebrovascular accident (CVA) and precerebral occlusion with infarct (stroke or blood clot causing blockage of blood vessels) Seizure Pulmonary embolism and respiratory failure Pulmonary embolism Other pneumonia Chronic obstructive pulmonary disease (COPD) (lung diseases that cause blockage, including chronic bronchitis and emphysema) Asthma (lung condition, often allergic in nature, causing labored breathing) Percutaneous cardiovascular procedures with acute myocardial infarction (balloon repair of a heart vessel with diagnosis of heart attack) Percutaneous cardiovascular procedures without acute myocardial infarction Heart failure Cardiac arrhythmia and conduction disorders (irregular heartbeat) Major small and large bowel procedures (colostomy, ileostomy, operations on the intestines) Appendectomy (surgical removal of the appendix) Intestinal obstruction Nonbacterial gastroenteritis, nausea and vomiting (severe flu) Other digestive system diagnoses (hernia, irritable colon) Laparoscopic cholecystectomy (gall bladder removal via small incisions) 17

19 APR MDC DRG Description Disorders of pancreas except malignancy Hip joint replacement Knee joint replacement Dorsal and lumbar fusion procedures, except for curvature of the back (surgical repair of two or more back vertebrae by immobilization) Hip and femur procedures for trauma, except joint replacement (repair of hip and upper leg bone fractures due to injury) Knee and lower leg procedures, except foot (repair of knee and ligaments, repair of ankle fractures) Shoulder, upper arm & forearm procedures Cervical spinal fusion & other back/neck procedures excluding disc excis/decomp Other back and neck disorders, fractures and injuries (non surgical treatment for back pain, sprains and fractures of spine) Cellulitis and other bacterial skin infections (includes abscesses) Diabetes Renal failure (kidney failure) Kidney and urinary tract infections Other kidney and urinary tract diagnoses, signs, and symptoms Cesarean delivery (surgical delivery of a baby) Vaginal delivery Neonate, birth weight greater than 2,499 grams, normal newborn or newborn with other problems Septicemia and disseminated infections 18

20 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: DENVER METRO HOSPITALS 95% 95% Denver Health Medical Center Minor $20,584 $16,917 $24,251 Moderate $24,693 $21,173 $28,213 Major $42,848 $35,446 $50,249 Extreme $77,786 $63,517 $92,055 Tot/Avg $37,282 $32,094 $42,471 Outliers Exempla Good Samaritan Medical Center Minor $29,181 $24,817 $33,545 Moderate $35,869 $32,668 $39,070 Major $49,377 $40,584 $58,171 Extreme $78,856 $46,016 $111,695 Tot/Avg $40,474 $36,717 $44,230 Exempla Lutheran Medical Center Minor $34,227 $25,538 $42,915 Moderate $44,397 $39,937 $48,857 Major $45,613 $41,323 $49,903 Extreme $101,616 $66,239 $136,992 Tot/Avg $47,657 $43,651 $51,662 Outliers Exempla Saint Joseph Hospital Minor $31,816 $27,375 $36,256 Moderate $32,108 $28,836 $35,380 Major $39,429 $34,521 $44,337 Extreme Tot/Avg $36,531 $33,081 $39,981 Littleton Adventist Hospital Minor $33,865 $23,170 $44,561 Moderate $44,235 $40,631 $47,840 Major $58,863 $50,120 $67,606 Extreme $99,378 $66,393 $132,363 Tot/Avg $52,921 $47,713 $58,128 Outliers North Suburban Medical Center Minor Moderate $48,022 $40,209 $55,835 Major $55,280 $41,309 $69,251 Extreme $130,934 $47,202 $214,666 Tot/Avg $58,206 $46,717 $69,696 Outliers Parker Adventist Hospital Minor $26,048 $23,686 $28,411 Moderate $34,140 $31,018 $37,263 Major $45,902 $38,460 $53,343 Extreme $85,224 $55,715 $114,733 Tot/Avg $41,390 $36,671 $46,110 Platte Valley Medical Center Minor $33,631 $27,833 $39,429 Moderate $33,823 $29,748 $37,899 Major $47,786 $38,376 $57,195 Extreme Tot/Avg $39,681 $35,282 $44,080 19

21 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: DENVER METRO HOSPITALS 95% 95% Porter Adventist Hospital Minor $25,806 $20,466 $31,146 Moderate $33,995 $30,107 $37,884 Major $46,853 $37,592 $56,114 Extreme $63,656 $46,329 $80,984 Tot/Avg $39,776 $35,159 $44,393 Presbyterian/St. Luke's Medical Center Minor Moderate $44,080 $37,072 $51,088 Major $61,673 $42,144 $81,201 Extreme Tot/Avg $59,594 $43,843 $75,344 Rose Medical Center Minor $44,797 $39,881 $49,713 Moderate $44,723 $39,797 $49,649 Major $52,245 $44,025 $60,465 Extreme Tot/Avg $50,127 $45,057 $55,198 Sky Ridge Medical Center Minor $41,944 $33,872 $50,017 Moderate $55,137 $47,406 $62,867 Major $61,166 $51,767 $70,565 Extreme $227,840 $40,403 $415,276 Tot/Avg $65,151 $51,822 $78,480 St. Anthony Hospital Minor $34,614 $25,601 $43,627 Moderate $44,559 $39,933 $49,184 Major $52,133 $46,106 $58,160 Extreme $112,178 $93,393 $130,964 Tot/Avg $58,861 $53,399 $64,324 Outliers St. Anthony North Hospital Minor $27,285 $20,168 $34,401 Moderate $33,398 $29,254 $37,541 Major $33,769 $29,046 $38,491 Extreme $48,436 $40,336 $56,536 Tot/Avg $34,095 $31,198 $36,991 Outliers St. Luke's Hospital (Closed 4/92) Minor Moderate $29,442 $25,836 $33,048 Major Tot/Avg $40,954 $18,814 $63,094 Swedish Medical Center Minor $34,110 $31,049 $37,171 Moderate $50,586 $47,793 $53,379 Major $68,637 $63,970 $73,304 Extreme $155,975 $133,426 $178,525 Tot/Avg $63,675 $59,877 $67,473 Outliers

22 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: DENVER METRO HOSPITALS 95% 95% The Medical Center of Aurora Minor $39,927 $31,953 $47,901 Moderate $45,677 $41,297 $50,057 Major $57,305 $49,340 $65,269 Extreme $143,760 $74,524 $212,996 Tot/Avg $54,467 $48,028 $60,906 Outliers University of Colorado Hospital Minor $40,074 $35,281 $44,867 Moderate $44,605 $39,938 $49,272 Major $66,873 $53,004 $80,742 Extreme $134,745 $98,486 $171,003 Tot/Avg $54,243 $48,452 $60,035 Outliers PEER GROUP TOTAL Minor $33,639 $31,996 $35,281 Moderate 1, $43,085 $41,884 $44,287 Major $55,095 $52,968 $57,223 Extreme $115,816 $105,095 $126,536 Tot/Avg 2, $51,992 $50,466 $53,518 Outliers

23 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: OTHER URBAN HOSPITALS 95% 95% Avista Adventist Hosptial Minor Moderate $28,817 $23,748 $33,885 Major $51,852 $30,727 $72,978 Tot/Avg $36,573 $25,759 $47,386 Boulder Community Hospital Minor $39,234 $33,039 $45,428 Moderate $43,386 $36,076 $50,695 Major $55,549 $40,792 $70,306 Extreme $111,494 $62,371 $160,618 Tot/Avg $48,260 $41,973 $54,547 Community Hospital Minor Moderate $20,903 $18,007 $23,799 Major Tot/Avg $21,141 $18,033 $24,250 Longmont United Hospital Minor $29,683 $24,700 $34,665 Moderate $29,104 $25,971 $32,236 Major $31,381 $22,641 $40,122 Extreme $62,079 $20,540 $103,618 Tot/Avg $32,034 $27,724 $36,344 McKee Medical Center Minor $15,803 $11,478 $20,128 Moderate $21,394 $18,711 $24,077 Major $32,174 $26,032 $38,317 Tot/Avg $24,202 $21,300 $27,105 Medical Center of the Rockies Minor $21,121 $18,084 $24,158 Moderate $25,162 $21,434 $28,890 Major $36,260 $29,055 $43,466 Extreme $92,762 $72,016 $113,508 Tot/Avg $32,468 $27,501 $37,434 Memorial Health System Minor $26,475 $23,399 $29,550 Moderate $31,366 $29,214 $33,518 Major $38,074 $33,721 $42,427 Extreme $92,742 $64,496 $120,987 Tot/Avg $35,766 $32,946 $38,586 Outliers North Colorado Medical Center Minor $21,841 $16,937 $26,745 Moderate $24,099 $21,381 $26,818 Major $32,206 $26,937 $37,475 Extreme $74,164 $39,680 $108,648 Tot/Avg $28,953 $25,612 $32,293 Outliers Parkview Medical Center Minor $31,450 $28,191 $34,710 Moderate $38,131 $34,624 $41,638 Major $51,811 $44,157 $59,465 Extreme $153,405 $108,887 $197,923 Tot/Avg $46,773 $41,411 $52,134 Outliers

24 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: OTHER URBAN HOSPITALS 95% 95% Penrose St. Francis Healthcare Services Minor $22,712 $19,850 $25,574 Moderate $30,171 $27,582 $32,760 Major $37,646 $32,277 $43,015 Extreme $84,267 $51,469 $117,066 Tot/Avg $33,568 $30,699 $36,437 Poudre Valley Hospital Minor $21,017 $16,984 $25,051 Moderate $24,439 $22,390 $26,487 Major $40,439 $32,050 $48,828 Extreme $63,774 $41,478 $86,071 Tot/Avg $28,967 $26,034 $31,899 St. Mary Corwin Medical Center Minor $32,160 $24,211 $40,110 Moderate $35,886 $31,879 $39,893 Major $49,057 $38,757 $59,358 Extreme $51,603 $24,820 $78,386 Tot/Avg $40,940 $36,299 $45,581 St. Mary's Hospital & Med Cntr Minor $28,060 $17,723 $38,398 Moderate $25,776 $23,533 $28,018 Major $38,498 $32,710 $44,287 Extreme $48,456 $29,484 $67,428 Tot/Avg $30,233 $27,488 $32,978 PEER GROUP TOTAL Minor $27,131 $25,358 $28,905 Moderate $29,983 $28,969 $30,996 Major $40,009 $37,780 $42,238 Extreme $87,203 $74,733 $99,674 Tot/Avg 1, $35,023 $33,800 $36,247 Outliers

25 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: RURAL HOSPITALS 95% 95% Arkansas Valley Reg. Med. Ctr. Moderate $12,424 $9,988 $14,859 Major $16,654 $13,050 $20,257 Tot/Avg $15,081 $12,123 $18,038 Colorado Plains Medical Center Minor Moderate $26,685 $19,089 $34,281 Major Tot/Avg $24,847 $19,488 $30,206 Delta County Memorial Hospital Minor $9,963 $8,334 $11,591 Moderate $13,367 $11,255 $15,480 Major Tot/Avg $12,761 $10,915 $14,608 Mercy Regional Medical Center Minor $12,243 $7,529 $16,957 Moderate $16,711 $12,445 $20,978 Major $22,881 $7,454 $38,307 Tot/Avg $16,760 $13,023 $20,498 Montrose Memorial Hospital Minor $9,487 $8,437 $10,536 Moderate $12,710 $10,671 $14,749 Major $16,043 $5,102 $26,984 Tot/Avg $12,175 $10,506 $13,844 Pioneers Medical Center Minor Moderate Tot/Avg San Luis Valley Regional Medical Cntr Minor Moderate $19,533 $16,772 $22,293 Major Tot/Avg $24,762 $18,665 $30,859 Southwest Memorial Hospital Moderate $19,446 $12,393 $26,500 Major Tot/Avg $18,368 $12,902 $23,834 St. Thomas More Hospital Minor Moderate $14,472 $11,593 $17,350 Major Extreme Tot/Avg $18,754 $13,660 $23,848 Sterling Regional MedCenter Minor Moderate $14,448 $12,072 $16,824 Major $26,507 $18,350 $34,665 Tot/Avg $18,920 $14,326 $23,513 24

26 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: RURAL HOSPITALS 95% 95% Vail Valley Medical Center Minor Moderate Tot/Avg Valley View Hospital Minor Moderate $33,405 $27,239 $39,572 Major $34,884 $24,672 $45,097 Tot/Avg $33,019 $28,468 $37,570 Yampa Valley Medical Center Minor Moderate $14,593 $11,561 $17,625 Tot/Avg $13,657 $10,819 $16,494 PEER GROUP TOTAL Minor $13,070 $10,913 $15,227 Moderate $17,181 $15,640 $18,722 Major $25,866 $21,791 $29,940 Extreme $27,866 $15,578 $40,153 Tot/Avg $18,213 $16,821 $19,604 25

27 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: CRITICAL ACCESS HOSPITALS 95% 95% Aspen Valley Hospital Minor Moderate Tot/Avg Conejos County Hospital Moderate Tot/Avg East Morgan County Hospital Minor Moderate Major Tot/Avg $9,038 $4,474 $13,602 Estes Park Medical Center Moderate Tot/Avg Family Health West Moderate Tot/Avg Grand River Hospital District Moderate Tot/Avg Gunnison Valley Hospital Minor Moderate Tot/Avg Haxtun Hospital District Minor Tot/Avg Heart Of The Rockies Regional Med Cntr Minor $7,392 $4,819 $9,965 Moderate $15,126 $11,177 $19,076 Tot/Avg $10,764 $7,569 $13,958 Lincoln Community Hospital Moderate Tot/Avg Melissa Memorial Hospital Tot/Avg Mount San Rafael Hospital Minor Moderate Tot/Avg Pagosa Springs Medical Center Moderate Tot/Avg Pikes Peak Regional Hospital Moderate Tot/Avg Prowers Medical Center Minor Moderate $8,067 $5,028 $11,106 Tot/Avg $6,973 $4,534 $9,411 26

28 APR DRG 45: CVA & PRECEREBRAL OCCLUSION W INFARCT PEER GROUP: CRITICAL ACCESS HOSPITALS 95% 95% Rio Grande Hospital Moderate Tot/Avg Sedgwick County Memorial Hospital Minor Moderate Tot/Avg Southeast Colorado Hospital District Minor Tot/Avg Spanish Peaks Regional Health Center Tot/Avg St. Vincent General Hospital District Outliers The Memorial Hospital at Craig Minor Moderate Major Tot/Avg $19,828 $12,375 $27,282 Wray Community District Hospital Minor Moderate Tot/Avg $10,225 $6,499 $13,950 Yuma District Hospital Minor Moderate Tot/Avg PEER GROUP TOTAL Minor $9,545 $7,201 $11,890 Moderate $11,872 $9,968 $13,776 Major $13,764 $6,820 $20,708 Tot/Avg $11,375 $9,811 $12,939 Outliers STATEWIDE TOTAL Minor $28,359 $27,139 $29,579 Moderate 2, $35,569 $34,736 $36,402 Major 1, $48,819 $47,206 $50,432 Extreme $106,367 $97,809 $114,925 Tot/Avg 4, $43,162 $42,136 $44,187 Outliers

29 APR DRG 53: SEIZURE PEER GROUP: DENVER METRO HOSPITALS 95% 95% Denver Health Medical Center Minor $13,260 $11,684 $14,836 Moderate $15,980 $13,444 $18,517 Major $21,666 $18,136 $25,197 Extreme $60,346 $39,655 $81,038 Tot/Avg $20,851 $17,887 $23,814 Outliers Exempla Good Samaritan Medical Center Minor Moderate $28,272 $22,514 $34,030 Major $33,126 $25,813 $40,440 Extreme $90,263 $23,088 $157,438 Tot/Avg $35,198 $26,178 $44,219 Exempla Lutheran Medical Center Minor $27,277 $24,225 $30,329 Moderate $27,061 $24,404 $29,719 Major $44,187 $34,745 $53,630 Extreme $77,497 $46,647 $108,347 Tot/Avg $33,481 $29,755 $37,206 Outliers Exempla Saint Joseph Hospital Minor $22,311 $14,013 $30,609 Moderate $21,313 $18,099 $24,528 Major $31,032 $23,162 $38,902 Extreme Tot/Avg $35,744 $23,166 $48,321 Littleton Adventist Hospital Minor $21,191 $9,974 $32,407 Moderate $35,887 $28,653 $43,120 Major $46,983 $38,546 $55,421 Tot/Avg $39,590 $34,055 $45,125 North Suburban Medical Center Minor $36,636 $26,691 $46,581 Moderate $34,861 $27,635 $42,087 Major $40,204 $29,469 $50,938 Extreme $123,387 $25,578 $221,195 Tot/Avg $46,931 $33,476 $60,386 Outliers Parker Adventist Hospital Minor Moderate $30,488 $21,282 $39,694 Major $44,000 $29,162 $58,838 Tot/Avg $39,638 $29,761 $49,515 Platte Valley Medical Center Minor Moderate $22,229 $16,030 $28,428 Major $23,298 $16,350 $30,245 Tot/Avg $23,720 $19,335 $28,105 28

30 APR DRG 53: SEIZURE PEER GROUP: DENVER METRO HOSPITALS 95% 95% Porter Adventist Hospital Minor $25,634 $18,526 $32,741 Moderate $24,083 $19,989 $28,178 Major $36,708 $28,989 $44,428 Extreme $58,852 $35,099 $82,604 Tot/Avg $32,408 $27,497 $37,319 Presbyterian/St. Luke's Medical Center Minor $13,977 $9,700 $18,253 Moderate $27,288 $19,354 $35,222 Major $27,767 $18,494 $37,039 Extreme Tot/Avg $24,378 $19,417 $29,340 Rose Medical Center Minor $28,868 $22,420 $35,315 Moderate $37,123 $31,749 $42,496 Major $58,536 $44,638 $72,435 Extreme $97,986 $50,046 $145,925 Tot/Avg $48,771 $40,327 $57,214 Sky Ridge Medical Center Minor $33,412 $22,995 $43,829 Moderate $34,221 $29,443 $38,999 Major $50,947 $41,423 $60,471 Extreme Tot/Avg $41,447 $35,794 $47,101 St. Anthony Hospital Minor $23,264 $10,988 $35,540 Moderate $28,433 $22,990 $33,877 Major $35,898 $30,463 $41,333 Extreme $69,575 $36,347 $102,804 Tot/Avg $34,768 $29,822 $39,713 St. Anthony North Hospital Minor Moderate $21,369 $15,734 $27,004 Major $37,479 $26,725 $48,233 Extreme Tot/Avg $28,441 $22,702 $34,180 Swedish Medical Center Minor $36,532 $31,950 $41,113 Moderate $34,072 $30,477 $37,667 Major $47,054 $40,466 $53,641 Extreme $155,863 $71,824 $239,903 Tot/Avg $43,745 $38,217 $49,273 Outliers The Medical Center of Aurora Minor $22,771 $19,358 $26,183 Moderate $31,932 $28,065 $35,798 Major $47,248 $39,076 $55,420 Extreme $71,919 $48,647 $95,191 Tot/Avg $40,205 $35,185 $45,225 29

31 APR DRG 53: SEIZURE PEER GROUP: DENVER METRO HOSPITALS 95% 95% University of Colorado Hospital Minor $38,217 $35,036 $41,397 Moderate $37,096 $33,133 $41,058 Major $47,987 $43,342 $52,633 Extreme $118,057 $83,466 $152,648 Tot/Avg $43,824 $40,970 $46,679 Outliers PEER GROUP TOTAL Minor $29,386 $27,625 $31,146 Moderate $29,874 $28,558 $31,189 Major $41,286 $39,175 $43,397 Extreme $89,510 $75,772 $103,249 Tot/Avg 1, $37,383 $35,882 $38,884 Outliers

32 APR DRG 53: SEIZURE PEER GROUP: OTHER URBAN HOSPITALS 95% 95% Avista Adventist Hosptial Minor Moderate Tot/Avg $19,479 $13,723 $25,234 Boulder Community Hospital Minor $21,124 $14,745 $27,503 Moderate $34,520 $21,887 $47,152 Major $38,296 $23,891 $52,701 Tot/Avg $30,803 $24,183 $37,424 Community Hospital Minor Moderate Tot/Avg Longmont United Hospital Minor $18,410 $13,502 $23,319 Moderate $22,437 $17,112 $27,762 Major $36,520 $27,243 $45,797 Extreme Tot/Avg $31,668 $22,500 $40,836 McKee Medical Center Minor Moderate $13,851 $11,156 $16,546 Major $18,851 $11,706 $25,995 Tot/Avg $15,245 $12,298 $18,191 Medical Center of the Rockies Minor $15,821 $11,285 $20,356 Moderate $13,961 $11,396 $16,526 Major $28,385 $14,675 $42,096 Extreme Tot/Avg $22,289 $16,729 $27,850 Memorial Health System Minor $15,135 $13,236 $17,034 Moderate $21,396 $19,030 $23,761 Major $32,074 $25,690 $38,458 Extreme $84,552 $62,106 $106,998 Tot/Avg $25,933 $22,742 $29,123 North Colorado Medical Center Minor $12,575 $9,896 $15,253 Moderate $16,911 $14,360 $19,462 Major $26,008 $19,084 $32,932 Extreme $52,830 $26,506 $79,154 Tot/Avg $19,580 $16,567 $22,592 Parkview Medical Center Minor $21,177 $17,073 $25,282 Moderate $30,632 $27,726 $33,539 Major $39,268 $33,818 $44,719 Extreme Tot/Avg $35,045 $30,390 $39,700 31

33 APR DRG 53: SEIZURE PEER GROUP: OTHER URBAN HOSPITALS 95% 95% Penrose St. Francis Healthcare Services Minor $18,531 $15,511 $21,551 Moderate $22,819 $19,651 $25,988 Major $25,010 $21,324 $28,696 Extreme Tot/Avg $23,348 $20,730 $25,966 Poudre Valley Hospital Minor $12,151 $9,637 $14,666 Moderate $15,539 $13,291 $17,786 Major $23,836 $16,852 $30,820 Tot/Avg $16,896 $14,653 $19,138 St. Mary Corwin Medical Center Minor $19,552 $14,797 $24,307 Moderate $19,489 $16,545 $22,433 Major $31,464 $21,407 $41,520 Extreme Tot/Avg $27,913 $20,690 $35,135 St. Mary's Hospital & Med Cntr Minor $13,827 $9,179 $18,474 Moderate $17,424 $13,869 $20,979 Major $28,102 $17,324 $38,880 Extreme Tot/Avg $20,171 $16,181 $24,160 PEER GROUP TOTAL Minor $16,069 $14,924 $17,214 Moderate $20,456 $19,318 $21,594 Major $30,536 $27,913 $33,159 Extreme $75,610 $61,290 $89,931 Tot/Avg $24,319 $22,980 $25,658 Outliers

34 APR DRG 53: SEIZURE PEER GROUP: RURAL HOSPITALS 95% 95% Arkansas Valley Reg. Med. Ctr. Minor Moderate $11,457 $8,428 $14,487 Tot/Avg $11,553 $8,329 $14,777 Colorado Plains Medical Center Minor Moderate Tot/Avg $13,039 $10,479 $15,600 Delta County Memorial Hospital Minor Moderate $8,147 $5,761 $10,533 Major Tot/Avg $8,874 $5,803 $11,945 Mercy Regional Medical Center Minor Moderate Major Tot/Avg $17,265 $7,735 $26,795 Montrose Memorial Hospital Minor $8,279 $2,061 $14,497 Moderate $13,095 $9,605 $16,585 Major Tot/Avg $12,570 $7,991 $17,149 Pioneers Medical Center Minor Moderate Tot/Avg San Luis Valley Regional Medical Cntr Minor $12,226 $4,738 $19,713 Moderate $8,983 $7,332 $10,635 Major Tot/Avg $10,230 $8,123 $12,337 Southwest Memorial Hospital Minor Moderate Tot/Avg $14,760 $10,492 $19,027 St. Anthony Summit Medical Center Minor Moderate Tot/Avg St. Thomas More Hospital Minor Moderate $14,081 $8,518 $19,644 Tot/Avg $23,374 $4,106 $42,642 Sterling Regional MedCenter Moderate Tot/Avg