Additional Utilization,

Payer and Case Mix Information

for Florida Acute Care Hospitals

Commission on Healthcare and Hospital Funding

May 26, 2015

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NORMALNEWBORN

PSYCHOSES

VAGINALDELIVERY

W/OCOMPLICA

TINGDIAGNOSE

S

ESOPHAGITIS

GASTROENT & MISC

DIGESTDISORDER

S W/OMCC

MAJORJOINT

REPLACEMENT OR

REATTACHMENT OFLOWER

EXTREMITY W/OMCC

CESAREANSECTION

W/OCC/MCC

CELLULITISW/O MCC

NEONATEW OTHERSIGNIFICA

NTPROBLEM

S

SEPTICEMIA OR

SEVERESEPSIS

W/O MV96+

HOURS WMCC

KIDNEY &URINARY

TRACTINFECTION

S W/OMCC

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

$0.00

$10,000.00

$20,000.00

$30,000.00

$40,000.00

$50,000.00

$60,000.00

$70,000.00

$80,000.00

$90,000.00

Hospital Pricing vs. Average Payment 10 Most Common Inpatient DRGs @ FL Acute Care Hospitals

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Major Joint Replacement by Payer

3

46%

25% 22%

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

Septicemia (Severe Sepsis) by Payer

4

58%

17%

9%

6%

3%

2%

Medicare

Medicare Managed Care

Commercial Health Insurance

Medicaid

Self pay

Medicaid Managed Care

TriCare or Other Federal Government

Non-Payment

Other

VA

Other State/Local Government

Neonate w/ Complications by Payer

5

54%

31%

7%

6%

2%

Medicaid

Commercial Health Insurance

Self pay

Medicaid Managed Care

TriCare or Other Federal Government

Other

Non-Payment

Other State/Local Government

VA

Hospital Payer Mix

6

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

National Average(All Services)

Florida Inpatient Florida ED Florida ASC

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

Proportion of visits by type of payer

Regional Cost Differences

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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.

1.033

2.49

1.03

1.715

0.96

1.315

0

0.5

1

1.5

2

2.5

GPCI PE GPCI MP

Miami Ft. Lauderdale Rest of Florida

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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

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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

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FACL CNTY NAME 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

15 Acute Care Hospitals in Florida

with Lowest Hospital Case Mix (Highest Adjusted Cost)

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15 Acute Care Hospitals in Florida

with Highest Case Mix (Lowest Adjusted Cost)

FACL CNTY NAME 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

Case Mix by Payer Type Florida Acute Care Hospitals, CY2013

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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

0.00

0.20

0.40

0.60

0.80

1.00

1.20

1.40

1.60

1.80

Case Mix by Region

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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

Medical Expenditure Panel Survey (MEPS)

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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).

Healthcare Cost and Utilization Project (HCUP)

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HCUP is the Nation’s most comprehensive source of hospital data, including information on in-patient 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.

QUESTIONS?

Thank You.

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