Additional Utilization, Payer and Case Mix Information for Florida Acute Care Hospitals Commission on Healthcare and Hospital Funding May 26, 2015 1
Hospital Pricing vs. Average Payment 10 Most Common Inpatient DRGs @ FL Acute Care Hospitals $90,000.00 $80,000.00 $70,000.00 $60,000.00 $50,000.00 $40,000.00 $30,000.00 $20,000.00 $10,000.00 $0.00 NORMAL NEWBORN PSYCHOSE S VAGINAL DELIVERY W/O COMPLICA TING DIAGNOSE S ESOPHAGI TIS GASTROE NT & MISC DIGEST DISORDER S W/O MCC MAJOR JOINT REPLACEM ENT OR REATTACH MENT OF LOWER EXTREMIT Y W/O MCC CESAREAN SECTION W/O CC/MCC CELLULITIS W/O MCC NEONATE W OTHER SIGNIFICA NT PROBLEM S SEPTICEMI A OR SEVERE SEPSIS W/O MV 96+ HOURS W MCC KIDNEY & URINARY TRACT INFECTION S W/O MCC Average Charge Per Stay $3,024 $17,048 $13,900 $27,989 $71,572 $24,620 $25,607 $6,288 $71,621 $26,997 National Average Payment (Ver 30.0) $891.64 $5,102.18 $3,078.21 $3,944.71 $11,207.26 $4,592.45 $4,488.68 $9,584.86 $10,057.27 $4,177.38 2
Major Joint Replacement by Payer 25% 22% 46% Medicare Commercial Health Insurance Medicare Managed Care Medicaid Managed Care Medicaid TriCare or Other Federal Government VA Other State/Local Government Self pay Workers' Compensation Non-Payment Other Commercial Liability Coverage 3
Septicemia (Severe Sepsis) by Payer Medicare 17% 9% Medicare Managed Care Commercial Health Insurance Medicaid 58% 6% 3% 2% Self pay Medicaid Managed Care TriCare or Other Federal Government Non-Payment Other VA Other State/Local Government 4
Neonate w/ Complications by Payer Medicaid Commercial Health Insurance 31% Self pay 54% 6% 7% 2% Medicaid Managed Care TriCare or Other Federal Government Other Non-Payment Other State/Local Government VA 5
Hospital Payer Mix Proportion of visits by type of payer 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% National Average Florida Inpatient Florida ED Florida ASC (All Services) Other Gov't. 2.8 2.6 2.7 Other 3.8 0.3 0.4 0.6 None 5.8 8.6 22.9 3.1 Medicare 39.1 45 16.8 44 Medicaid 16.1 21.1 33.5 7.4 Commercial 35.2 22.3 23.8 42.2 6
Regional Cost Differences Medicare is statutorily required to adjust payments for physician fee schedule services to account for differences in costs due to geographic location. There are currently 89 different localities which have not been revised since 1997. Miami Ft. Lauderdale Rest of Florida 2.5 2.49 2 1.5 1.715 1 1.033 1.03 0.96 1.315 0.5 0 GPCI PE GPCI MP 7
Case Mix Index Methodology defined by U.S. Centers for Medicare and Medicaid Services (CMS) National average is 1.37 Minimum: 0.58 Maximum: 3.73 Standard Deviation: 0.31 Calculated/Assigned by Diagnostic Related Group (DRG) Indicates amount of resources required to treat patients in that group, compared to other groups 8
Hospital Case Mix Index Reflects diversity, clinical complexity, and resource needs of population served Can be used to adjust for average cost per patient (or per day), relative to other hospitals Hospital CMI >1 = adjusted cost will be lower Hospital CMI <1 = adjusted cost will be higher 9
FACL CNTY NAME 15 Acute Care Hospitals in Florida with Lowest Hospital Case Mix (Highest Adjusted Cost) FACL NAME CASE MIX (Excluding Newborns) TOTAL DISCHARGES (Excluding Newborns) LEVY REGIONAL GENERAL HOSPITAL WILLISTON 0.77 638 MONROE DEPOO HOSPITAL 0.79 671 MADISON MADISON COUNTY MEMORIAL HOSPITAL 0.83 343 FRANKLIN GEORGE E WEEMS MEMORIAL HOSPITAL 0.85 279 WALTON HEALTHMARK REGIONAL MEDICAL CENTER 0.91 953 ORANGE FLORIDA HOSPITAL APOPKA 0.91 2,704 CALHOUN CALHOUN-LIBERTY HOSPITAL 0.91 509 SANTA ROSA JAY HOSPITAL 0.92 499 BAKER ED FRASER MEMORIAL HOSPITAL 0.92 172 UNION LAKE BUTLER HOSPITAL HAND SURGERY CENTER 0.93 62 HOLMES DOCTORS MEMORIAL HOSPITAL 0.94 787 SUWANNEE SHANDS LIVE OAK REGIONAL MEDICAL CENTER 0.94 1,252 JACKSON CAMPBELLTON-GRACEVILLE HOSPITAL 0.95 145 HARDEE FLORIDA HOSPITAL WAUCHULA 0.96 276 BRADFORD SHANDS STARKE REGIONAL MEDICAL CENTER 0.96 1,535 10
FACL CNTY NAME 15 Acute Care Hospitals in Florida with Highest Case Mix (Lowest Adjusted Cost) FACL NAME CASE MIX (Excluding Newborns) TOTAL DISCHARGES (Excluding Newborns) COLLIER PHYSICIANS REGIONAL MEDICAL CENTER - PIN 1.71 6,151 DUVAL UF HEALTH JACKSONVILLE 1.71 23,564 ORANGE FLORIDA HOSPITAL 1.71 57,666 MARION OCALA REGIONAL MEDICAL CENTER 1.72 11,497 PINELLAS ALL CHILDREN'S HOSPITAL 1.72 7,933 DUVAL ST VINCENT'S MEDICAL CENTER RIVERSIDE 1.72 25,503 BROWARD HOLY CROSS HOSPITAL 1.73 16,499 BROWARD CLEVELAND CLINIC HOSPITAL 1.74 10,132 HILLSBOROUGH FLORIDA HOSPITAL CARROLLWOOD 1.79 4,424 ORANGE ORLANDO REGIONAL MEDICAL CENTER 1.88 27,996 HILLSBOROUGH TAMPA GENERAL HOSPITAL 1.93 41,323 HILLSBOROUGH SHRINERS HOSPITALS FOR CHILDREN-TAMPA 1.97 282 ALACHUA UF HEALTH SHANDS HOSPITAL 1.98 39,128 DUVAL MAYO CLINIC 2.20 12,965 HILLSBOROUGH H LEE MOFFITT CANCER CENTER & RESEARCH INSTITUTE 2.35 9,336 11
Case Mix by Payer Type Florida Acute Care Hospitals, CY2013 1.80 1.60 1.40 1.20 1.00 1.33 1.69 1.05 1.30 1.16 1.44 1.43 1.27 1.56 1.39 1.15 1.31 1.47 1.64 0.80 0.60 0.40 0.20 0.00 12
Case Mix by Region REGION AVG CASE MIX 1 1.32 2 1.25 3 1.34 4 1.45 5 1.44 6 1.40 7 1.31 8 1.38 9 1.30 10 1.32 11 1.33 13
Medical Expenditure Panel Survey (MEPS) MEPS is the only national data source measuring how Americans use and pay for medical care, health insurance, and out-of-pocket spending. Annual surveys of individuals and families, as well as their health care providers, provide data on health status, the use of medical services, charges, insurance coverage, and satisfaction with care annually since 1996. The MEPS Household Component (MEPS-HC) - information from families and individuals that provides timely, comprehensive information on the health status of Americans, health insurance coverage, and access, use, and cost of health services. Includes information on medical expenditures, conditions, and events; demographics; health insurance coverage; access to care; health status; and jobs held. Each surveyed household is interviewed five times over a two-year period. The MEPS Medical Provider Component (MEPS-MPC) - information from providers of medical care that supplements the information collected from persons in the MEPS-HC sample in order to provide the most accurate cost data possible. The MEPS Insurance Component (MEPS-IC) - information from employers in the private sector and state and local governments on the health insurance coverage offered to their employees. Includes information on the number and types of private health insurance plans offered, benefits associated with these plans, annual premiums and contributions to premiums by employers and employees, copayments and coinsurance, by various employer characteristics (for example, State, industry and firm size). 14
Healthcare Cost and Utilization Project (HCUP) HCUP is the Nation s most comprehensive source of hospital data, including information on inpatient care, ambulatory care, and emergency department visits. HCUP enables researchers, insurers, policymakers and others to study health care delivery and patient outcomes over time, and at the national, regional, State, and community levels. National (Nationwide) Inpatient Sample (NIS) The National (Nationwide) Inpatient Sample (NIS) is the largest publicly available all-payer hospital inpatient care database in the United States. Kids' Inpatient Database (KID) The Kids' Inpatient Database (KID) is composed of hospital inpatient stays for children and is specifically designed to allow researchers to study a broad range of conditions and procedures related to children's health. Nationwide Emergency Department Sample (NEDS) The Nationwide Emergency Department Sample (NEDS) captures information on emergency department (ED) visits that do not result in an admission as well as ED visits that result in an admission to the same hospital. State Inpatient Databases (SID) The State Inpatient Databases (SID) are a set of hospital databases containing the universe of the inpatient discharge abstracts from participating States, translated into a uniform format to facilitate multi-state comparisons and analyses. State Ambulatory Surgery and Services Database (SASD) The State Ambulatory Surgery and Services Database (SASD) are a set of databases that capture surgeries performed on the same day in which patients are admitted and released. State Emergency Department Databases (SEDD) The State Emergency Department Databases (SEDD) are a set of databases that capture discharge information on all emergency department visits that do not result in an admission. The SEDD combined with SID discharges that originate in the emergency department are well suited for research and policy questions that require complete enumeration of hospital-based emergency departments within market areas or States. 15
QUESTIONS? Thank You. 16