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Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas.

ABSTRACT: To measure the contribution of market-level prices, utilization, and health risk to medical spending variation among the Blue Cross Blue Shield of Texas (BCBSTX) privately insured population and the Texas Medicare population.Claims data for all BCBSTX members and publicly available CMS data for Texas in 2011.We used observational data and decomposed overall and service-specific spending into health status and health status adjusted utilization and input prices and input prices adjusted for the BCBSTX and Medicare populations.Variation in overall BCBSTX spending across HRRs appeared driven by price variation, whereas utilization variation factored more prominently in Medicare. The contribution of price to spending variation differed by service category. Price drove inpatient spending variation, while utilization drove outpatient and professional spending variation in BCBSTX. The context in which negotiations occur may help explain the patterns across services.The conventional wisdom that Medicare does a better job of controlling prices and private plans do a better job of controlling volume is an oversimplification. BCBSTX does a good job of controlling outpatient and professional prices, but not at controlling inpatient prices. Strategies to manage the variation in spending may need to differ substantially depending on the service and payer.

SUBMITTER: Franzini L

PROVIDER: S-EPMC4254133 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas.

Franzini Luisa L White Chapin C Taychakhoonavudh Suthira S Parikh Rohan R Zezza Mark M Mikhail Osama O

Health services research 20140612 6

<h4>Objective</h4>To measure the contribution of market-level prices, utilization, and health risk to medical spending variation among the Blue Cross Blue Shield of Texas (BCBSTX) privately insured population and the Texas Medicare population.<h4>Data sources</h4>Claims data for all BCBSTX members and publicly available CMS data for Texas in 2011.<h4>Study design</h4>We used observational data and decomposed overall and service-specific spending into health status and health status adjusted util ...[more]

PMID: 24919408

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Project description:ImportanceThe Improving Medicare Post-Acute Care Transformation (IMPACT) Act of 2014 mandated a quality measure of successful community discharge for postacute care services. Examining variation in performance nationally can help identify opportunities for improving patient-centered quality of care.ObjectiveTo examine US facility-level and geographic variation in rates of successful community discharges after inpatient rehabilitation.Design, setting, and participantsThis retrospective cohort study of Medicare claims data from December 31, 2013, through October 1, 2015, included 1154 inpatient rehabilitation facilities submitting claims to the Centers for Medicare & Medicaid Services and a total of 487 862 Medicare fee-for-service beneficiaries discharged from inpatient rehabilitation facilities. Analyses were performed from December 8, 2017, through September 11, 2018.Main outcomes and measuresSuccessful community discharge as defined for the Discharge to Community-Post-Acute Care Inpatient Rehabilitation Facility Quality Reporting Program measure. To be considered a successful community discharge, patients had to discharge from the inpatient rehabilitation facility to the community (ie, home or self-care) and remain there without experiencing an unplanned rehospitalization or dying within the following 31 days. Centers for Medicare & Medicaid Services specifications were followed to identify the cohort, define the outcome, and calculate risk-standardized facility and state rates.ResultsAmong the 487 862 patients included in the cohort, mean (SD) age was 76.4 (10.8) years, and 56.9% were female. The overall rate of successful community discharge after inpatient rehabilitation was 63.7% (95% CI, 63.6%-63.8%). Risk-standardized rates ranged from 42.9% to 83.6% across inpatient rehabilitation facilities. Two hundred sixteen facilities (18.7%) performed significantly better than the mean national rate and 203 (17.6%) performed significantly worse (P < .05). Risk-standardized state rates ranged from 55.9% to 73.3%. Rates were lowest in the Northeast (Massachusetts, 55.9%; New Hampshire, 57.0%) and highest in the West (Oregon, 70.3%; Hawaii, 73.3%).Conclusions and relevanceThe observed variation suggests opportunities exist for improving this important, patient-centered national quality measure. Future research is needed to identify the aspects of care delivery and the community services and supports that facilitate successful community discharge. These findings can be used to guide care improvement efforts and further improve the consistency and quality of postacute care.

Dataset Information

Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas.

Publications

Variation in inpatient hospital prices and outpatient service quantities drive geographic differences in private spending in Texas.

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