oregon’s public reporting of hospital cost
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Oregon’s public reporting of hospital cost. Jeanene Smith MD, MPH Office for Oregon Health Policy & Research State Coverage Initiatives Winter Meeting 2008. About OHPR. Responsible for the development and analysis of health policy in Oregon - PowerPoint PPT PresentationTRANSCRIPT
Oregon’s public reporting of hospital cost
Jeanene Smith MD, MPHOffice for Oregon Health Policy & Research
State Coverage Initiatives Winter Meeting 2008
Hospital Cost Transparency Project
About OHPR
Responsible for the development and analysis of health policy in Oregon Reports and conducts analyses relating to health care costs,
utilization, quality, and access Provides analysis, technical, and policy support to the Governor
and the Legislature Serves as the policymaking body for the Oregon Health Plan
(Oregon Medicaid program) Staff to Governor appointed committees and commissions
Health Policy Commission – Strategic health planning Health Resources Commission – Evidence-Based Rx Reviews Health Services Commission – The Prioritized List Medicaid Advisory Committee NEW - Oregon Health Trust Board – Health reform Effort
Hospital Cost Transparency Project
Recent OHPR Reports
Trends in Oregon’s Healthcare Market and the Oregon Health Plan: Report to the 2007 Legislature
Oregon’s Acute Care Hospitals Capacity, Utilization and Financial Trends: Report to the 2007 Legislature
Inpatient Quality Indicators Profile of Oregon’s Uninsured: Findings from the 2006
Oregon Population Survey Oregon Health Policy Commission Roadmap to Health Care
Reform: Creating a High-Value, Affordable Health Care System
Oregon Physicians Workforce Survey, 2007
www.ohpr.oregon.gov
Hospital Cost Transparency Project
What aspect of the health care market is missing?
OHPR provides clear picture of utilization, access and financial state of hospitals Inpatient discharge data Audited financials Databank American Hospital Association survey Physician workforce survey
Reporting had limited use for the general public in health care decision making
OHPR began reporting AHRQ’s Inpatient Quality Indicators in 2004
With quality reporting on going, cost is a missing component to health care decision making
Hospital Cost Transparency Project
How Oregon began hospital cost reporting?
Hospital cost reporting national standard is charge based Hospital association in Oregon currently reporting charges Charge data
Little value for consumers, purchasers, providers and the general public1
Amount typically never paid to hospitals Charges are 2.5 time higher the amount a hospital will actually be paid1
Logical meaningful step is reporting payments to hospitals Payment Data
Reflect actual payments for service provided Provide consumers, purchasers, providers and the general public with
“real” dollar amounts Previous state efforts failed to create political momentum to
report payments Governor Kulongoski made health care cost transparency a
priority Support from insurance carriers, consumers, advocates, government1 Colmers JM. Public reporting and transparency. The Commonwealth Fund Commission on a High Performance Health System, January 2007.
Hospital Cost Transparency Project
Hospital Cost Transparency Project
Goal: To publicly report hospital payment data to improve
cost transparency for consumers, purchasers, providers and the general public
October 16, 2006 Insurance Division, under exam authority, issued a
inpatient claims data call to insurance carriers for calendar year 2005 who had paid claims in excess of $50 million (11 largest carriers)
Collaborated with OHPR
Hospital Cost Transparency Project
Why is this project innovative?
Data obtained from insurance carriers to profile hospitals
Project reports payment dataOregon one of first states to report payment
dataProvide critical piece for use by the general
public for health care decision making
Hospital Cost Transparency Project
Data Methods
Cost transparency workgroup Included members including
Representatives from individual health insurance carriers Oregon Association of Hospitals and Health Systems Oregon Coalition of Health Care Purchasers Individual hospitals representatives Actuaries Other interested stakeholders
Technical workgroup Included analysts from OHPR and insurance carriers
Hospital Cost Transparency Project
Data Methods
Most common conditions or procedures defined as At least 150 observations OR At least $1 million in charges
Used 3M APR-DRG software Risk adjusted Severity level grouping
Assigns severity through Diagnosis, procedure, length of stay, patient age, patient discharge
disposition Categories: Minor/Moderate, Extreme/Severe
Estimation of variance Supplemented claims data with 3-year Oregon hospital
discharge data and Nationwide Inpatient Sample, 2003
Hospital Cost Transparency Project
Results
82 common conditions or procedures reported
Top 5 volume1. Vaginal delivery (APR-DRG 560)2. Normal newborn (APR-DRG 640)3. Cesarean delivery (APR-DRG 540)4. Gynecology procedure for non-malignancy (APR-DRG 513)5. Surgical repair of herniated/ruptured disc (APR-DRG 310)
1. Top 5 total cost1. Vaginal delivery (APR-DRG 560)2. Cesarean delivery (APR-DRG 540)3. Knee joint replacement (APR-DRG 302)4. Extensive procedures on small and large intestines (APR-DRG 221)5. Gynecology procedure, except for cancer or benign tumor (APR-DRG 513)
Hospital Cost Transparency Project
What the data represents?
Oregonians only Oregon hospitals Inpatient claims Discharges from January 1, 2005 to December 31, 2005 Final bills (admit thru discharge) Carriers that earned at least $50 million in OR premiums About 50% of non-HMO commercial inpatient claims (e.g. no
self-insured) Over 70% of the claims submitted by the represented carriers About 11% of all inpatient discharges during 2005 Groupings of diagnoses or procedures (APR-DRG
classifications)
Hospital Cost Transparency Project
Data table example-Researcher
Hospital Cost Transparency Project
Data Table Example-Consumer
Hospital Cost Transparency Project
Cost & Quality
Hospital Cost Transparency Project
Web based, table creator
http://www.ohpr.state.or.us/OHPPR/RSCH/
comparehospitalcosts.shtml
Hospital Cost Transparency Project
Public Reporting
Prior to public release Insurance carriers
Verified data to be displayedHospitals
Provided aggregated hospital level data Was not required to verify data
Encouraged to submit written comments to be posted
Website approved by workgroup
Hospital Cost Transparency Project
Public release
August 3, 2007Press releases
Governor’s officeDepartment of Consumer & Business Affairs
Coverage in major paper press and news affiliate
Hospital Cost Transparency Project
Limitations
Data limitations Not all carriers Medicare or Medicaid claims Capitated health plans Claims for coordination of benefits Claims for patients treated in an outpatient clinic
located at a hospital Synergy with quality data Bridging the gap between hospital payment
and out of pocket cost to consumers
Hospital Cost Transparency Project
Future Directions
Annual reporting requirementLegislationDisplay trending data
Increase the scope of the insurance marketMedicaidMedicare Include all commercial carriers
Refine display with quality
Hospital Cost Transparency Project
Challenges to reporting cost
Political willMust have high level champions
Creating a display useful for consumers and research community
Communicate data more effectively and broadly
ALSO: Health Reform efforts – initial steps for more transparency in Oregon’s healthcare system
Hospital Cost Transparency Project
For more info, questions…
Office for Oregon Health Policy & Researchwww.ohpr.oregon.gov
Jeanene Smith503-373-1625
Sean Kolmer, MPHResearch & Data Manager