Healthcare Transparency Index Q1 2014

Change Healthcare Corporation • 216 Centerview Drive, Suite 300 • Brentwood, Tennessee 37027 • 888.920.5234 • [email protected] • www.changehealthcare.com

© 2007-2014 Change Healthcare CorporationHCTI 2014 Q108/01/14

Healthcare Transparency Index2014 Q1 ReportAugust 2014

2 Healthcare Transparency Index

© 2007-2014 Change Healthcare Corporation

Table of Contents

Consumers Need Actionable Information on Cost and Quality ..............................3

Facility Costs, Not Professional Fees, Drive Variability in Healthcare Costs ...........4

Identifying Target Opportunities by High Cost and High Variability ........................6

About the Healthcare Transparency Index ..............................................................7

About Change Healthcare .......................................................................................7

Transparency Matrix™ ............................................................................................8

Appendix .................................................................................................................9

Category Guide ......................................................................................................... 10

Matrices ..................................................................................................................... 11

National Data Set ...................................................................................................... 16

Glossary .................................................................................................................... 55




The healthcare cost and quality transparency movement

is contributing to a new age of healthcare consumerism

in which patients will achieve what government and

business have not – better, more affordable healthcare.

Powering this transformation are patients who are

expected to cover a growing share of their healthcare

costs, and, thus, are increasingly motivated to shop

for care.

According to the Kaiser Family Foundation, 38 percent

of covered employees have a deductible of $1,000 or

more for single coverage (up from 18 percent five years

ago), and 15 percent have a deductible of $2,000 or

more (up from 5 percent in 2008)1. These consumers

want to assess and compare the cost and quality – or

the value – of their healthcare services before they buy.

While cost and quality transparency is critical to their

understanding of value, it is not sufficient. To achieve

true consumerism in healthcare, individuals need to

know where the best opportunities are for value-based

information that is timely, personalized and actionable.

Such objective cost and quality information empowers

them to save money for themselves, their employers and

their health plans.

This isn’t just a theory. When working with health plans

and self-insured employers nationwide to proactively

alert consumers of potential cost savings on recurring

medical services and prescription medications, Change

Healthcare has seen more than $500 in yearly cost

savings per purchaser2.

In fact, a recent analysis by West Health Policy Institute

suggests that transparency initiatives could cut $100

billion over 10 years from health spending3. While this is

a small step towards meaningfully impacting the trillions

of dollars we spend on healthcare in this country each

year, it is a step in the right direction.

Consumers Need Actionable Information on Cost and Quality

38%

of employees have a deductible of

$1,000 or more

15% of employees have a

deductible of $2,000 or more

transparency initiatives could cut

$100B over the next 10 years

Change Healthcare has seen more than

$500 in yearly cost savings

per purchaser

1. The Kaiser Family Foundation and Health Research & Educational Trust. Employer Health Benefits 2013 Annual Survey. http://kaiserfamilyfoundation.files.wordpress.com/2013/08/8465-employer-health-benefits-20131.pdf

2. Based on a Change Healthcare case study with Cerner Corporation. Results may vary by client.

3. White C, et al. Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending. West Health Policy Center Policy Analysis, May 2014. http://www.westhealth.org/sites/default/files/Price%20Transparency%20Policy%20Analysis%20FINAL%205-2-14.pdf



In an effort to keep a pulse on cost variability across

various medical and dental services, Change Healthcare

aggregates its in-network claims from credentialed

providers across its client base, which has geographic

coverage that spans nationally and covers 7 million

lives. The prices reported are the actual costs paid

for procedures, as opposed to billed amounts. This

data collection results in the quarterly Healthcare

Transparency Index (HCTI), which identifies the largest

opportunities for savings – both for the consumer and

the plan sponsor.

As part of the release of the HCTI for the first quarter

of 2014, Change Healthcare analyzed the relationship

between professional fees, such as those charged by a

radiologist or physician, and facility fees across

four high-frequency inpatient procedures and four

imaging services.

As one can see from the table below, the analysis

found that the largest variations in cost came from the

facility fees, not the professional fees. This conclusion

is especially interesting given that doctors’ fees often

receive the bulk of the blame for escalating

healthcare costs.

Since the facility fees vary so widely, patients should be

encouraged to ask their doctor at which area hospitals

he or she has privileges to perform a surgery or deliver

a baby. Once the patient is informed about their facility

options, they can comparison shop among facilities and

still use their same doctor.

Facility Costs, Not Professional Fees, Drive Variability in Healthcare Costs

1,132%

Inpatient BundlesThe four inpatient procedures include hip replacement, knee replacement, C-section delivery and vaginal delivery. The orthopaedic procedures showed the

greatest variation in both facility and professional costs, although the variation was far higher in the facility costs than the professional costs.

HipReplacement

KneeReplacement

C-SectionDelivery

VaginalDelivery

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000

$1,669

$2,613

$4,190

$32,1901,132%

151%

$1,669 $4,190127%

$1,803 $32,2251,687%

$5,300 $15,962201%

$2,613 $10,679319%

$2,097 $3,28457%

$2,179 $3,03339%

Professional Facility % Cost Variability



Given that facility fees can greatly impact the overall

cost of the procedure, how can patients find out how

much any given procedure will cost based on their

individual plan, network and location?

Change Healthcare offers a Cost Lookup tool that

provides expected costs for more than 81 percent of

medical services and 75 percent of prescriptions used

by our client population; we also provide pricing on a

number of dental and vision services. For instance, if a

doctor performs a procedure at three different facilities,

the associated costs for that doctor at each of those

facilities would give the consumer a clear idea of the

costs associated with each option.

Users can search for a prescription, medical, dental

or vision service, receiving accurate pricing matched

for their location, plan design and network; a personal

view of total cost, member cost and plan cost; bundled

pricing that reflects the comprehensive instance of care;

and quality ratings for facilities and providers from both

public and private data sources, including patient

satisfaction surveys.

For the patient, facility shopping will have the greatest

economic impact when the services fall within the

individual or family deductible. For example, if the

individual has a deductible of $2,500, and the facility

cost of MRIs range from $596 to $2,529, choosing

a facility that costs less than the average of $1,494

could mean a reduction of out-of-pocket costs for the

consumer of $1,000 or more (assuming the provider

cost is near the median of $144 and there are no other

medical costs to contribute to the deductible).

Given the wide variation even between the average

facility cost for a knee replacement and the highest cost,

a consumer who is informed about facility costs could

save their employer/health plan a significant amount of

money. While the patient may not directly benefit from

the cost savings, since even those with high-deductible

plans will likely already have met their deductibles, they

may eventually benefit since rising healthcare costs for

employers and health plans will affect premium rates

paid by consumers in the long-term.

ImagingThe four imaging services analyzed in this iteration of the HCTI included MRIs, CT scans, ultrasounds, and mammograms. Of the four, the CT scans,

ultrasounds and MRIs showed the greatest variance, especially in facility costs.

Professional Facility % Cost Variability

MRIs

CT Scans

Ultrasounds

Mammograms

0 $500 $1,000 $1,500 $2,000 $2,500 $3,000

324%

230%

202%

469%

350%

163%

$596

$85 $280

$410

$71

$34-$92

$38-$84

$124 $559

$347$132

$213

$2,334

$2,529

121%

175%



This release of the HCTI for the first quarter of 2014

includes a series of charts that plot services into

high/low-cost and high/low-cost variability quadrants to

help identify services that could be targets for

intervention. Change Healthcare has found that

even within a given network, charges for pharmacy,

medical and dental services often vary by more than

300 percent. Both low-cost and high-cost services can

show wide variability.

In an effort to identify high-cost, high-variability services,

Change Healthcare created the Change Healthcare

Transparency Matrix (see page 8). The vertical axis

represents the average cost of the service, while the

horizontal axis is the variability in pricing of that service.

The healthcare services clustered in the top right of the

quadrant, called the Target quadrant – high-cost, high-

variability services – provide the richest opportunities

to reduce costs for plan sponsors and consumers.

Examining data from the first quarter of 2014, eight

services fell into the Change Healthcare Transparency

Matrix’s Target quadrant. The idea is to alert healthcare

consumers – as well as health plans and employers – to

where the greatest healthcare costs and cost variability

is occurring.

The analysis identified hip replacement, knee

replacement, all MRIs and all CT scans as targets in the

Transparency Matrix – not surprising, given that we have

seen them consistently carry high costs and

high variability.

Other services that fall into the Target matrix for their

respective procedure categories include women’s health,

high-level specialists, tooth extraction and cavities.

Identifying Target Opportunities by High Cost and High Variability

$72 - $241Average: $141

236% Variance

Women’s Health Of�ce Visit

$69 - $226Average: $133

229% Variance

High-Level Specialist Of�ce Visit

$65 - $205Average: $120

215% Variance

$70 - $185Average: $119

164% Variance

Tooth Extraction

Cavity

$7,875 - $30,185Average: $18,033

283% Variance

Hip Replacement

$6,247 - $31,160Average: $17,654

398% Variance

Knee Replacement

$475 - $2,517Average: $1,331

430% Variance

$343 - $2,283Average: $1,131

566% Variance

MRIs

CT Scans



Established in 2007, Change Healthcare is on a mission

to transform the way Americans purchase and utilize

healthcare services by driving sustainable engagement

at the individual level. With a national client base of

health plans and self-insured employers covering lives

in all 50 states and more than 7 million lives on its

platform, Change Healthcare is the premier national

provider of healthcare cost transparency and consumer

engagement solutions that enable consumers to:

• Better understand and utilize their healthcare

benefits

• Make informed healthcare purchasing decisions

based on quality, cost and convenience

• Manage higher out-of-pocket responsibility and

realize savings

This, in turn, helps plan sponsors (both health plans and

self-insured employers):

• Control their healthcare cost growth trend

• Successfully migrate to more cost-effective

plan types

• Optimize existing wellness programs and

on-site clinics

• Improve member/employee satisfaction

and retention

The Change Healthcare Engagement Platform includes:

Healthcare University®, Targeted Engagement Alerts,

Ways to Save® Alerts and Cost Lookup. To learn more,

visit www.changehealthcare.com.

The costs of healthcare services change over time, and

Change Healthcare anticipates there will be changes

in which services qualify as target opportunities for

savings. As a result, Change Healthcare issues updated

HCTI reports quarterly and track changes in the

Transparency Matrix and variation in costs of common

healthcare services over time.

About the HCTIAbout Change Healthcare

The Change Healthcare Cost Lookup tool provides expected costs for more than

OF PRESCRIPTIONS

81%OF MEDICAL SERVICES

75%

used by our client population.

and



Ave

rage

Cos

t ($

)

Lower

Hig

her

HigherVariability (%)

Transparency MatrixPremium Target

Base Emerging

3

10

15

16

911

8

12

14

62

51

4

20

191817

21

23

24

26

25

7

566

385

18,033

1,331

Behavioral Health Office Visit

Chiro/PT/OT Office Visit

Eye Care Office Visit

Pediatric Office Visit

Primary Care Office Visit

Specialist Office Visit

Women’s Health Office Visit

All Colonoscopies and Upper GI Endoscopies

C-Section Delivery

Hip Replacement

Knee Replacement

Vaginal Delivery

All CT Scans

All Mammograms

All MRIs

All Ultrasounds

Adult Preventive Exam

Adult Preventive Exam with Mouth X-Rays (4 Films)

Cavity

Crown

Pediatric Preventive Exam

Pediatric Preventive Exam with Mouth X-Rays (2 Films)

Tooth Extraction

Office Visit with Diabetes Screening

Office Visit with Lipid Screening

Office Visit with Pap Smear

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

22

0

Transparency Matrix™

The healthcare services in the Target quadrant – high-cost, high-variability services – provide the richest opportunities to reduce costs for plan sponsors and consumers.



Appendix



Office Visits• Behavioral Health

- Psychiatrist

- Psychologist

� Therapist

� Counselor

� Licensed Clinical

Social Worker

� Licensed Family Therapist

� Behavioral Health Counselor

• Chiropractic/Physical Therapy/

Occupational Therapy

- Chiropractic

� Chiropractic (DC)

� Chiropractic Facility

- Occupational Therapy

� Occupational Medicine

� Occupational Therapist (OT)

- Physical Therapy

� Physical Medicine and

Rehabilitation

� Physical Therapist (PT)

• Eye Care

- Optician

- Optometrists (OD)

• Pediatrics

- Pediatric Primary Care

- Specialty Pediatrics

� Pediatric Allergy

� Pediatric Cardiology

� Pediatric Critical Care

� Pediatric Endocrinology

� Pediatric ENT - Otolaryngology

� Pediatric Gastroenterology

� Pediatric Hematology/

Oncology

� Pediatric Immunology

� Pediatric Neurology

� Pediatric Ophthalmology

� Pediatric Orthopaedics

� Pediatric Pulmonology

� Pediatric Radiology

� Pediatric Surgery

� Pediatric Urology

• Primary Care

- Family Medicine

- General Practice

- Internal Medicine

- Nurse Practitioner (NP)

- Nurse Practitioners (ARNPs)

- Physician Assistants (PAs)

• Specialist

- Cardiology

- Dermatology

- Endocrinology/Diabetes/

Metabolism

- Gastroenterology

- Nephrology

- Neurology

- Oncology

� Hematology/Oncology

� Medical Oncology

� Radiation Oncology

- Ophthalmology

- Otolaryngology

- Podiatrists (DPM)

- Pulmonary/Allergy/Immunology

- Rheumatology

- Sports Medicine

- Surgery

� Colorectal Surgery

� General Surgery

� Hand Surgery

� Neurosurgery

� Oral Surgery

� Orthopaedic Surgery

� Plastic Surgery

� Thoracic Surgery

� Vascular Surgery

- Urology

• Women’s Health

- Obstetrics

- Gynecology

Medical Procedures• C-section Delivery

• All Colonoscopies and Upper GI

Endoscopies

- Colonoscopy with Biopsy

- Colonoscopy with Removal of

Lesion(s) or Polyp(s)

- Upper GI Endoscopy

with Biopsy

• Hip Replacement

• Knee Replacement

• Vaginal Delivery

Imaging Services• All CT Scans

- Chest CT Scan

- Face/Jaw CT Scan

- Head/Brain CT Scan

- Pelvis/Abdomen CT Scan

• All Mammograms

- Diagnostic Mammogram

- Screening Mammogram (ACA)

• All MRIs

- Brain MRI

- Lower Extremity MRI

- Spine MRI

- Upper Extremity MRI

• All Ultrasounds

- Abdominal Ultrasound

- Breast Ultrasound

- Transvaginal Ultrasound

Dental Services• Adult Preventive Exam

• Adult Preventive Exam +

Mouth X-Rays (4 films)

• Cavity

• Child Preventive Exam +

Mouth X-Rays (2 films)

• Crown

• Pediatric Preventive Exam

• Tooth Extraction

ACA Services• Office Visit with Diabetes Screening

• Office Visit with Pap Smear

• Office Visit with Lipid Screening

• Screening Colonoscopy

• Screening Mammogram

Category Guide



Cos

t ($

)

Lower

Hig

her

HigherVariability (%)

Office Visits

Primary Care

Behavioral Health

Chiro/PT/OT

Pediatrics

Eye Care

Specialist

Women’s Health

141

116

0 349

227

Office Visits

The following services are included in the Office

Visits category: Behavioral Health, Chiro/PT/OT,

Eye Care, Pediatrics, Primary Care, Specialist and

Women’s Health. Women’s Health and Specialist

visits are Target Opportunities within the Office Visits

category and are in the Emerging category within the

Transparency Matrix.



Medical Procedures

Colonoscopy with Biopsy

C-section Delivery

Hip Replacement

Knee Replacement

Colonoscopy with Removal of Lesion(s) or Polyp(s)

Upper GI Endoscopy with Biopsy

0

17,806

4,827

19,000

329

178

500

Medical Procedures

The Medical Procedures category includes C-section

Delivery, Vaginal Delivery, Colonoscopy with Biopsy,

Colonoscopy with Removal of Lesion(s) or Polyp(s),

Upper GI Endoscopy with Biopsy, Hip Replacement

and Knee Replacement. Hip and Knee Replacements

were the costliest procedures analyzed and also had

a high variability rate, placing them firmly in the Target

quadrant. Patients should work with their doctors to

find high-quality options at a reasonable cost.



1,589

799

642

3820

Imaging

Multiple Imaging services fell into the Target

quadrant. As noted in the summary, MRI and CT

Scans are impacted by their facility costs and have

the most variance because of this.



0

358

86

800

194

153

250

Adult Preventive Exam with X-Rays (4 Films)

Pediatric Preventive Exam with X-Rays (2 Films)

Dental

Cavity and Tooth Extraction were, once again,

identified as Target opportunities in the Dental

category; Pediatric Preventative Exam fell just

outside of this quadrant. Targeted interventions

around any/all of these services could drive

significant cost savings.



0

1,756

612

318

179



Office Visit with Diabetes Screening

ACA Services

ACA Services is a category that includes services

available at no out-of-pocket cost to patients – a

result of the Affordable Care Act. Office Visits with

Lipid Screening has a 185 percent variability and

is now in the Target quadrant. Screening

Colonoscopies should be watched, as the service is

high-cost and – in this iteration of the HCTI – showed

increasing variability in pricing. Office Visit with

Diabetes Screening – with its high variability –

should also be monitored and may benefit from

targeted intervention.



90th Percentile 10th Percentile Median %Variability

Chiro/PT/OT

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$160

$140

$120

$100

$80

$60

$40

$20

$0

$127

$32

304%$134

$32

326%

$131

$32

315%$129

$32

302% $144

$32

349%

$138

$32

331%

Behavioral Health

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$200

$180

$160

$140

$120

$100

$80

$60

$40

$20

$0

$151

$68

123%

$129

$59

118% $141

$47

197%$150

$63

137%$158

$65

142%

$126

$56

124%

National Data SetHigh-Level Office Visits




Eye Care$160

$140

$120

$100

$80

$60

$40

$20

$0

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$132

$45

194%$133

$47

182% $149

$45

228%

$134

$45

198%$143

$46

213%

$145

$46

215%

Pediatrics

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$164

$68

141%$170

$69

144%$175

$70

149%$207

$72

186%

$175

$71

$182

$72

152% 146%

High-Level Office Visits




Primary Care

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$182

$68

169%$188

$68

175%$198

$67

196%

$193

$71

174%$228

$72

217%

$203

$69

196%

Specialist

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$191

$66

190%$198

$66

200%$200

$66

203%$207

$67

211% $226

$69

229%

$208

$67

208%





Women’s Health

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$188

$72

161%$193

$70

176%$203

$70

189%$200

$69

189%$241

$72

236%

$211

$72

193%

Low-Level Office Visits Cardiology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$214

$70

205%

$70

$214

204%$216

$70

208%

$72

$219

205%

$72

$241

232%

$70

$229

228%


*Cardiology Actual Range: $72.45 to $240.51 with a 232% variability

*Women's Health Actual Range: $71.77 to $241.00 with a 236% variability

*

*




Chiropractic

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$120

$100

$80

$60

$40

$20

$0

260%$105

$29

286%

$27

$105

255%$103

$29

252%

$30

$105

286%

$27

$104

259%

$30

$107

Colorectal Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

210%$211

$68

202%

$63

$191

203%$200

$66

215%

$64

$203

247%$69

$240203%

$66

$198

Low-Level Office Visits




Dermatology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$160

$140

$120

$100

$80

$60

$40

$20

$0

173%$134

$49

170%$137

$51

182%

$139

$49

184%$138

$49188%

$157

$54

194%

$146

$50

Endocrinology/Diabetes/Metabolism

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

204%$214

$70

192%$223

$73

205%$239

$73

287%

$283

$73

227%$225

$73

280%

$297

$78





Family Medicine

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$178

$68

160%$183

$70

164%$196

$70

182%

$192

$71

172%$229

$72

218%

$201

$71

184%

Gastroenterology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

184%$194

$68

203%$207

$68

200%$208

$69

223%$219

$68

235%$241

$72

205%$212

$69





General Practice

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

186%$191

$67

187%$189

$66

193%$195

$67

170%$179

$66

196%$201

$68

187%$192

$67

General Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

213%$202

$64

224%$210

$65

231%$209

$63

243%

$227

$66

243%

$226

$66

231%$214

$64





Hand Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

162%$182

$70

175%$188

$68

176%$179

$65

142%$160

$66198%

$213

$72

190%$187

$64

Hematology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

237%$228

$68

254%$253

$72

256%$258

$73243%

$262

$77

261%

$285

$79

256%$258

$72





Internal Medicine

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$187

$69

170%$194

$70

180%$203

$70

189%

$199

$72

174% $236

$72

225%

$209

$72

188%

Nephrology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$228

$72

217%

$217

$73

196%$225

$70

220%$233

$73

218% $263

$78

237%

$240

$71

237%





Neurology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$234

$73

220%$249

$73

240%

$239

$73

228% $257

$75

243%$263

$78

236%

$255

$73

250%

Nurse Practitioner

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$181

$64

183%

$62

$181

191%$199

$61

227%

$62

$197

218%

$66

$245

271%

$62

$203

230%





Ob/Gyn

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$188

$72

167%

$70

$193

176%$203

$70

189%

$69

$200

189%

$72

$241

236%

$72

$211

193%

Occupational Therapy

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$153

$53

189%

$79

$178

127%$175

$37

371%

$50

$135

170%

$49

$96

97%

$83

$232

180%





Oncology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$235

$69

239%

$68

$248

263%$245

$69

254%

$73

$250

242%

$72

$261

264%

$70

$252

259%

Ophthalmology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$184

$67

177%

$66

$194

194%

$183

$63

188%

$69

$202

193%

$69

$201

189%

$67

$189

184%





Optometry

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$200

$150

$100

$50

$0

$143

$46

213%

$46

$145

215%

$132

$45

194%

$47

$133

182%

$45

$149

228%

$45

$134

198%

Oral Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$185

$60

208%

$61

$200

227%

$189

$60

216%

$59

$225

280%$55

$188

244%

$70

$219

212%





Orthopaedic Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$178

$65

172%

$67

$185

176%$183

$65

182%

$66

$186

180%

$68

$187

177%

$68

$187

177%

Otolaryngology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$182

$66

174%

$66

$185

181%$186

$66

182%

$68

$201

194%

$70

$217

208%

$68

$195

185%





Pediatric Specialist

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$350

$300

$250

$200

$150

$100

$50

$0

$242

$77

215%

$80

$300

275%$313

$80

289%

$73

$264

261%

$75

$305

307%

$77

$275

258%

Pediatric Primary Care

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$163

$68

139%

$69

$168

142%$175

$70

149%

$71

$174

146%

$72

$206

185%

$72

$182

151%





Physician Assistant

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$179

$64

179%

$63

$184

191%$196

$61

223%

$64

$199

212%

$69

$237

242%$63

$204

226%

Physical Therapy

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$212

$58

266%

$60

$214

256%

$65

$226

249%

$215

$60

256%

$62

$228

268%

$60

$225

275%Low-Level Office Visits




Plastic Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$185

$67

178%

$68

$190

182% $213

$63

236%

$70

$206

192%

$65

$204

212% $231

$65

255%

Podiatrist

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$200

$150

$100

$50

$0

$133

$49

173%

$49

$133

175% $149

$49

203%

$47

$146

208%

$51

$181

257%$49

$154

214%





Psychiatrist

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$191

$60

218%

$162

$50

224% $190

$55

246%

$176

$55

219% $190

$56

239%$203

$55

268%

Psychologist

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$200

$180

$160

$140

$120

$100

$80

$60

$40

$20

$0

$173

$73

137%

$144

$60

140%$145

$53

174% $155

$73

112% $169

$73

131%

$126

$56

124%





Pulmonary/Allergy/Immunology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$216

$69

212%$219

$70

212%

$246

$72

240%

$230

$70

229%

$198

$68

190%$209

$68

206%

Rheumatology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$223

$71

215%

$214

$70

204%$224

$72

209% $252

$75

236%

$239

$72

234%

$299

$81

268%





Sports Medicine

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$201

$63

218%

$166

$66

152% $180

$72

149%

$135

$55

148% $156

$70

122%

$204

$69

196%

Surgery - Mid-Level

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$250

$200

$150

$100

$50

$0

$188

$66

187%$195

$67

193%$196

$64

204%$204

$66

209%$211

$68

211%

$203

$66

207%





Therapy

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$180

$160

$140

$120

$100

$80

$60

$40

$20

$0

$130

$65

100%

$122

$59

107%$129

$42

206%$127

$63

102%$135

$64

110%

$113

$56

100%

Thoracic Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$400

$350

$300

$250

$200

$150

$100

$50

$0

$244

$70

246% $280

$73

284%

225%$234

$72

426%$355

$68

$312

$63

398%

$283

$73

287%





Urology

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$197

$67

194%$202

$68

196%$203

$68

199%$217

$70

208% $234

$70

235%

$210

$69

204%

Vascular Surgery

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$208

$66

216%

$191

$62

208%$202

$63

219%

$256

$62

310%

$208

$63

232% $231

$69

236%





Medical Procedures

Colonoscopy with Biopsy

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$6,000

$5,000

$4,000

$3,000

$2,000

$1,000

$0

190%

$4,413

$1,523

188%

$4,697

$1,630

164%

$4,483

$1,699

202%

$4,392

$1,453216%

$5,104

$1,613

199%

$4,352

$1,455

C-section Delivery$24,000

$20,000

$16,000

$12,000

$8,000

$4,000

$0

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

174%$20,139

$7,348

211%

$23,741

$7,623

128%$19,822

$8,685

164%

$17,619

$6,680

134%

$18,296

$7,804

284%

$23,526

$6,128




Colonoscopy with Removal of Lesion(s) or Polyp(s)

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$5,000

$4,000

$3,000

$2,000

$1,000

$0

149%

$4,461

$1,792

183%

$4,425

$1,565

171%

$4,525

$1,668

206%

$4,742

$1,549

192%

$4,193

$1,435

230%

$4,722

$1,433

Hip Replacement

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$40,000

$35,000

$30,000

$25,000

$20,000

$15,000

$10,000

$5,000

$0

$37,921

$7,268

422%

$31,403

$7,129

340%$33,180

$7,744

328%

$30,185

$7,875

283%

$29,751

$6,907

$26,699

$6,443

314%331%

Medical Procedures

*Extrapolated based on a midpoint between the 10th and 90th percentile

*




Upper GI Endoscopy with Biopsy

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$5,000

$4,000

$3,000

$2,000

$1,000

$0

197%

$4,286

$1,443

222%

$4,451

$1,383

155%$3,610

$1,415188%

$4,355

$1,513

209%

$4,026

$1,304

226%

$4,502

$1,381

Knee Replacement

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$40,000

$35,000

$30,000

$25,000

$20,000

$15,000

$10,000

$5,000

$0

$28,469

$9,011

216% $33,207

$8,792

278%

$30,605

$6,064

405%$31,160

$6,247

399%

$29,326

$6,226

$32,627

$6,105

434%371%

Medical Procedures




Vaginal Delivery$20,000

$16,000

$12,000

$8,000

$4,000

$0

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

250%

$18,570

$5,299

201%$15,985

$5,319

178%$14,913

$5,356

189%$12,613

$4,359

142%$13,570

$5,609

168%$14,363

$5,369

Imaging Services Abdominal Ultrasound

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$1,200

$1,000

$800

$600

$400

$200

$0

$997

$131

659%

$133

$878

559%

$847

$127

568%

$123

$807

558%

$147

$698

375%

$111

$905

714%

Medical Procedures




Brain MRI

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$4,500

$4,000

$3,500

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

496%$3,378

$567

434%

$600

$3,204400%$3,023

$604

478%

$619

$3,579

349%

$635

$2,850

609%

$515

$3,652

Breast Ultrasound

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$600

$500

$400

$300

$200

$100

$0

442%$468

$86

412%

$87

$447

440%$447

$83

420%

$86

$500434%

$87

$466 326%

$100

$427

Imaging Services




Chest CT Scan

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$2,500

$2,000

$1,500

$1,000

$500

$0

$1,911

$317

504%

$332

$1,940

484%

$1,904

$375

408%

$363

$2,031

460%

$338

$1,814

437%

$325

$1,913

489%

Diagnostic Mammogram

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$700

$600

$500

$400

$300

$200

$100

$0

215%$396

$126

238%

$114

$385227%$372

$114

200%

$128

$384

168%

$154

$413229%

$114

$374

Imaging Services




Face/Jaw CT Scan

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$1,800

$1,600

$1,400

$1,200

$1,000

$800

$600

$400

$200

$0

335%$1,087

$250

469%

$267

$1,517

345%$1,200

$270

319%

$258

$1,079

378%

$270

$1,291

464%

$255

$1,437

Head/Brain CT Scan

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$2,000

$1,600

$1,200

$800

$400

$0

384%$1,475

$305

395%

$322

$1,595

426%$1,693

$322

449%

$297

$1,628 411%

$303

$1,549

476%

$320

$1,844

Imaging Services




Lower Extremity MRI

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

395%$2,342

$473

371%

$497

$2,338355%$2,227

$489

398%

$470

$2,338 465%

$357

$2,017

359%

$488

$2,237

Pelvis/Abdomen CT Scan

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$4,500

$4,000

$3,500

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

1,124%

$283

$3,463962%$3,187

$300

984%$3,252

$300

750%

$400

$3,399642%

$429

$3,180

988%

$300

$3,265

Imaging Services




Screening Mammogram

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$500

$400

$300

$200

$100

$0

219%$402

$126

242%

$118

$402

242%$402

$118

193%

$135

$397147%

$156

$386

242%

$118

$402

Spine MRI

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

$451

$2,479

449%$2,513

$467

438%

$468

$2,515

437%

$464

$2,345

406%

$465

$2,374

410%$2,479

$443

460%

Imaging Services




Transvaginal Ultrasound

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$600

$500

$400

$300

$200

$100

$0

$468

$105

346%

$107

$462

331%

$442

$103

329%

$102

$336

229%

$93

$431

365%

$103

$481

369%

Upper Extremity MRI

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$3,500

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

467%$2,576

$454 $485

422%$2,530

442%$2,651

$489

346%

$523

$2,333495%

$368

$2,191

416%

$468

$2,415

Imaging Services




Dental Services Adult Preventive Exams

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$100

$80

$60

$40

$20

$0

74%

$94

$54

114%

$90

$4272%

$93

$54

79%

$95

$53

79%

$95

$53

79%

$95

$53

Adult Preventive Exams and Mouth X-Rays (4 Films)$350

$300

$250

$200

$150

$100

$50

$0

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$306

$95

222%

$285

$94

203%

$220

$96

129%

$149

$80

85%$190

$99

92%

$290

$89

226%




Cavity$250

$200

$150

$100

$50

$0

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$205

$85

141%

$180

$85

112%$185

$70

164%$191

$85

125%122%$189

$85

139%$204

$85

Crown

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$1,200

$1,000

$800

$600

$400

$200

$0

$1,150

$680

69%

$1,013

$679

49%

$971

$515

89%$1,125

$685

64%$1,100

$695

58%$1,135

$680

67%

Dental Services




Pediatric Preventive Exam

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$80

$70

$60

$50

$40

$30

$20

$10

$0

74%

$69

$40

88%

$69

$37

89%

$72

$3875%

$70

$40

180%

$70

$25

70%

$68

$40

Pediatric Preventive Exam and Mouth X-Rays (2 Films)

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$200

$180

$160

$140

$120

$100

$80

$60

$40

$20

$0

144%$161

$66

168%138%$157

$66

153%

$170

$67

101%$139

$69

132%$146

$63

180%$109

$39

Dental Services




Tooth Extraction

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$300

$250

$200

$150

$100

$50

$0

$85

188%$245

$79

147%$195

$65

215%$205

$85

142%$206

$85

148%$211

$85

194%$250

ACA Services Office Visit with Diabetes Screening

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$550

$500

$450

$400

$350

$300

$250

$200

$150

$100

$50

$0

$462

$111

315%

$104

$468

350%$478

$108

342%

$121

$485

300%

$111

$463

318%

$118

$470

298%

Dental Services





2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$550

$500

$450

$400

$350

$300

$250

$200

$150

$100

$50

$0

$445

$165

170%

$163

$515

215%

$517

$168

207%

$185

$523

183%

$178

$506

185%

$179

$506

182%


2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$700

$600

$500

$400

$300

$200

$100

$0

118%$501

$229

105%$598

$292

78%

$317

$563

93%

$608

$314

86%

$594

$319

87%$590

$315

ACA Services




2012 2013

Screening Colonoscopy

Q4 Q1 Q2 Q3 Q4 Q1

2014

$4,500

$4,000

$3,500

$3,000

$2,500

$2,000

$1,500

$1,000

$500

$0

185%

$3,966

$1,391

180%$3,465

$1,238

189%$3,599

$1,246

159%$2,783

$1,073

153%$2,955

$1,166

168%

$1,233

$3,306

Screening Mammogram

2012 2013 2014

Q4 Q1 Q2 Q3 Q4 Q1

$500

$400

$300

$200

$100

$0

219%$402

$126

242%

$118

$402

242%$402

$118

193%

$135

$397147%

$156

$386

242%

$118

$402

ACA Services



Cost: The average cost per instance of a service.

Cost Variability: The percent change between low-cost and high-cost providers for a service.

High cost: This cost is ranked in the 90th percentile. 90 percent of instances had a cost that was less than this amount.

Low cost: This cost is ranked in the 10th percentile. 90 percent of instances had a cost that exceeded this amount.

Glossary

Healthcare Transparency Index Q1 2014

Healthcare

Transcript of Healthcare Transparency Index Q1 2014