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Oregons public reporting of hospital cost


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Title: Oregons public reporting of hospital cost

Oregons public reporting of hospital cost
  • Sean Kolmer, MPH
  • Research Data Manager
  • Office for Oregon Health Policy Research
  • Sean.Kolmer_at_state.or.us
  • Website http//www.oregon.gov/OHPPR/RSCH/compareh

  • About the Office for Oregon Health Policy
  • Current health care reporting for Oregon
  • Hospital Cost Transparency Project
  • Question Answer

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
  • Health Policy Commission
  • Health Resources Commission
  • Health Services Commission
  • Medicaid Advisory Committee
  • Oregon Health Fund Board

Recent OHPR Reports
  • Trends in Oregons Healthcare Market and the
    Oregon Health Plan Report to the 2007
  • Oregons Acute Care Hospitals Capacity,
    Utilization and Financial Trends Report to the
    2007 Legislature
  • Profile of Oregons 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 Physician Workforce Survey, 2007
  • Inpatient Quality Indicators
  • www.ohpr.oregon.gov

What aspect of the health care market is missing?
  • OHPR provides 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 AHRQs Inpatient Quality
    Indicators in 2004
  • With quality reporting on going, cost was a
    missing component to health care decision making

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
  • 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, government

1 Colmers JM. Public reporting and transparency.
The Commonwealth Fund Commission on a High
Performance Health System, January 2007.
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
  • Paid claims in excess of 50 million (11 largest
  • Collaborated with OHPR

Why is this project innovative?
  • Data obtained from insurance carriers to profile
  • Project reports payment data
  • Oregon one of first states to report payment data
  • Provide critical piece for use by the general
    public for health care decision making

Data Methods
  • Cost transparency workgroup
  • Included members including
  • Representatives from individual health insurance
  • Oregon Association of Hospitals and Health
  • Oregon Coalition of Health Care Purchasers
  • Individual hospitals representatives
  • Actuaries
  • Other interested stakeholders
  • Technical workgroup
  • Included analysts from OHPR and insurance carriers

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

  • 82 common conditions or procedures reported
  • Top 5 volume
  • Vaginal delivery (APR-DRG 560)
  • Normal newborn (APR-DRG 640)
  • Cesarean delivery (APR-DRG 540)
  • Gynecology procedure for non-malignancy (APR-DRG
  • Surgical repair of herniated/ruptured disc
    (APR-DRG 310)
  • Top 5 total cost
  • Vaginal delivery (APR-DRG 560)
  • Cesarean delivery (APR-DRG 540)
  • Knee joint replacement (APR-DRG 302)
  • Extensive procedures on small and large
    intestines (APR-DRG 221)
  • Gynecology procedure, except for cancer or benign
    tumor (APR-DRG 513)

What the data represents?
  • Oregonians only
  • Oregon hospitals
  • Inpatient claims
  • Discharges from January 1, 2005 to December 31,
  • Final bills (admit thru discharge)
  • Carriers that earned at least 50 million in OR
  • 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

Compare Hospital Cost website
Cost Quality
Public Reporting
  • Prior to public release
  • Insurance carriers
  • Verified data to be displayed
  • Hospitals
  • Provided aggregated hospital level data
  • Was not required to verify data
  • Encouraged to submit written comments to be
  • Website approved by workgroup

Public release
  • August 3, 2007
  • Press releases
  • Governors office
  • Department of Consumer Business Affairs
  • Coverage in major print press and news affiliates

  • Press coverage highlighted large system
  • Created internal dialogue about difference in
    payments between hospitals with identical charge
  • Many states contacted OHPR with interest in
    creating similar reporting
  • Carrier community
  • Commonly using site for market comparison
  • Continue support and collaboration

  • 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

Future Directions
  • Annual reporting requirement
  • Legislation
  • Display trending data
  • Increase the scope of the insurance market
  • Medicaid
  • Medicare
  • Include all domestic commercial carriers
  • Refine display with quality
  • Moving timetable to release more current data
  • 2 updates in 2008 (2006 data (spring) 2007 data

Challenges to reporting cost
  • Political will
  • Must have high level champions
  • Creating a display useful for consumers,
    purchasers, providers and research community
  • Communicate data more effectively
  • Dissemination strategies

Questions Answers
  • Sean Kolmer, MPH
  • Research Data Manager
  • Office for Oregon Health Policy Research
  • 503-373-1824
  • Sean.Kolmer_at_state.or.us
  • www.ohpr.oregon.gov
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