Data

Analyzing information on healthcare costs can be difficult due to all the variables involved in collecting and reporting the data. A savvy patient must understand where the data is coming from, and what it can and cannot tell you.  Here is an explanation of the data on this site, and how you best to use it.

 

Who compiled this data?

The data shared on this site is a compilation of publicly available data published by the Pennsylvania Health Care Cost Containment Council (PHC4).  The Council is an independent state agency formed under Pennsylvania statute (Act 89 of 1986, as amended by Act 3 of 2009) in order to address rapidly growing health care costs. The Council’s strategy to contain costs is to stimulate competition in the health care market by:

  1.  giving comparative information about the most efficient and effective health care providers to individual consumers and group purchasers of health services; and
  2.  giving information to health care providers that they can use to identify opportunities to contain costs and improve the quality of care they deliver.

What kind of data is included?

The data provided in the tables refers to hospital discharges. This data was compiled submitted to PHC4 by Pennsylvania hospitals and was subject to standard validation processes by PHC4 and verified for accuracy by the hospitals at the individual case level.

This report also includes the average hospital charge for conditions and procedures. The average hospital charge represents the entire length of the hospital stay. It does not include professional fees (e.g., physician fees) or other additional post-discharge costs, such as rehabilitation treatment, long-term care and/or home health care. The average charge is adjusted for the mix of cases that are specific to each hospital.  While charges are what the hospital reports on the billing form, they may not accurately represent the amount a hospital receives in payment for the services it delivers. Hospitals usually receive less in actual payments than the listed charge.

The terminology of price and cost in healthcare can also be confusing.  Here is the best way to understand the differences.

 

Defining Costs, Charges, and Reimbursement

Cost

To providers: the expense incurred to deliver health care services to patients.

To payers: the amount they pay to providers for services rendered.

To patients: the amount they pay out-of-pocket for health care services.

Charge or price: the amount asked by a provider for a health care good or service, which appears on a medical bill.

Reimbursement: a payment made by a third party to a provider for services. This may be an amount for every service delivered (fee-for-service), for each day in the hospital (per diem), for each episode of hospitalization (e.g., diagnosis-related groups, or DRGs), or for each patient considered to be under their care (capitation).

http://journalofethics.ama-assn.org/2015/11/stas1-1511.html

The data presented here represents hospital charges, or the amount that the hospitals billed for services.  The amount they paid, and the amount a patient paid, varies based on insurance contracts and individual financial scenarios.

 

What is the timeframe of the data shared?

This report covers adult (18 years and older) inpatient hospital discharges, regardless of payer, during the period January 2014 through December 2014.  2014 is the last year of full data the PHC4 has published.  As full calendar years are shared, this site will be updated.

Medicare fee-for-service payment data was obtained from the Centers for Medicare and Medicaid Services. Medicaid payment data (fee-for-service and managed care) was obtained from the Pennsylvania Department of Human Services. The most recent Medicare and Medicaid payment data available to PHC4 for use in this report was for 2013.

 

What areas are covered by this data?

Regions are fluid, with no set boundaries for healthcare consumption.  For the purpose of this site, we have chosen to focus on loosely defined regions beginning with Central Pennsylvania.  Over the coming year additional regions will be added.

 

Why should I review this data?

Cost is an important aspect in choosing healthcare.  Understanding both cost and quality can help a patient make the best decision for their clinical and financial situations.  This site is not intended to be a single, all-encompassing source of information for making decisions about health care, rather it is meant to help open a dialogue about healthcare costs.  By reviewing this information, patients should be able to see trends in charges and be empowered to ask questions of their local facilities to help them understand the financial responsibilities they can expect as they pursue care.

This data can provide a different perspective for different audiences.  For example:

  • Patients/Consumers can use this report as an aid in understanding the average charges (part of which they are likely responsible for) that can be expected for a particular provider or facility. This, coupled with quality information like what ConnectCare3 can provide, can help them make a balanced decision about their care.
  • Group Benefits Purchasers/Employers can use this report as part of a process in determining where employees, subscribers, members, or participants should be encouraged to investigate for their health care.