National estimates of price variation by site of care

Objectives: Recently, researchers and policy makers have demonstrated growing interest in differences in payments across sites of care for the same healthcare service, such as in a hospital outpatient department (HOPD) versus a physician office (PO). La gasolina lyrics Our objective was to examine the price differential for individuals with employer-sponsored insurance by site of care for 7 commonly performed services at the national and regional level.

Study Design: We analyzed 2008 to 2013 claims data from Truven Health MarketScan Commercial Claims and Encounters Database, containing administrative data for 44 to 53 million individuals covered by employer-sponsored health insurance.

Methods: We selected 7 services based on total payments from different clinical categories—categories in which differences in clinical quality and patient morbidity are less likely to be sources of the price differential. I gas shares We calculated payment amounts at the visit level for each healthcare service by site of care, then calculated the price differential by site of care as a ratio of average HOPD price to the average PO price or average ambulatory surgery center price for the same service.

Results: Across all 7 services, prices at a HOPD were statistically significantly higher than payments to a PO, ranging in 2013 from 21% more for an office visit to 258% more for chest radiography. Chapter 7 electricity note taking worksheet The increase in the price differentials, combined with a shift in volume in favor of hospital outpatient departments, was associated with a 44% increase in total spending between 2008 and 2013.

The role of healthcare prices as a key factor in driving total health spending in the United States, compared with other developed countries, is well documented. Gas jet compressor 1-3 Characterizing variability in prices for different healthcare services, and that variability’s impact on total spending, has been of interest to researchers and policy makers. Static electricity in the body However, most research to date has focused on geographic variation in prices for specific healthcare services within the United States. Gas and electric credit union These studies have found wide hospital-level and regional variation in prices for specific healthcare services, such as vaginal births and knee and hip replacements. Gas works park events 4-8

More recently, the focus has turned to characterizing price variations for the same healthcare service by site of care, (eg, hospital outpatient department [HOPD] and physician office [PO]). Grade 6 electricity project ideas The Medicare Payment Advisory Commission (MedPAC) recently analyzed payments for services rendered in HOPDs compared with payments for the same services performed in independent physician practices. Gas bloating diarrhea For example, for patients with similar risks and characteristics, payments in HOPD exceeded payments in PO by 19% for level II cardiac imaging, and by 141% for a level II echocardiogram. Gas or electricity for heating 9

Evidence of price differences across sites of care in the commercially insured population is limited; previous analysis has focused on either a single year of data or specific subpopulations. Thermal electricity how it works Analysis of commercial claims data from 2005 for 16 groups of services found the average HOPD-to-PO price ratio was 3.5. Types of electricity pdf 10 Based on data from 4 health plans, a 34% price differential was found between HOPDs and POs for cancer episodes with the same set of services in an episode, after adjusting for patient severity. Electricity in india first time 11

A more recent analysis of prices for 9 healthcare services, based on insurance claims for a subpopulation of active and retired autoworkers and their dependents, found a 4-fold variation in prices by site of care, with HOPD prices being consistently higher than those of POs. Electricity questions and answers pdf 12 Similarly, researchers assessing the impact of Medicare fee cuts on integration of cardiologists with hospitals found differences in prices by site of care for select cardiology-related services. Q gases componen el aire 13 We are unaware of studies to date that have focused on national estimates of price differences by site of care and the implications of these differences for total US healthcare spending.

The objectives of our study were to: a) develop national estimates of price differences by site of care for select services, b) examine temporal trends in such price differences, and c) analyze implications for price differences on total and consumer out-of-pocket (OOP) spending.

We identified the top 100 Current Procedural Terminology (CPT) codes—the code set of medical procedures and services maintained by the American Medical Association—for calendar year 2011, then classified them into broad clinical categories, such as office visits, imaging services, outpatient procedures, laboratory services, etc.

We used the following set of criteria to select 7 services for our study: a) representation from different clinical categories, b) services with the highest total payments within a clinical category, c) sufficient volume of visits for the service by site of care to enable reliable comparisons of price differential (at least 20,000 visits at each site of care), and d) services in which differences in clinical quality and patient morbidity are less likely to be the source of the price differential. Gas buddy Based on these criteria, we selected CPT codes from the clinical categories of office visits, imaging services, and outpatient procedures. La gasolina letra Specifically, we chose CPT codes 99213 (office visit, established patient, 15 minutes) and 99215 (office visit, established patient, 40 minutes) for office visits; 70450 (computed tomography [CT] scan), 72148 (magnetic resonance imaging [MRI]), and 71020 (chest radiography) for imaging services; and, for procedures, 43239 (upper gastrointestinal endoscopy) and 45378 (colonoscopy).

We defined a healthcare service as synonymous with a CPT code. Grade 6 electricity unit A visit is defined as a provision of a healthcare service on a specific date. Electricity grid map uk We calculated payment amounts at the visit level for each healthcare service by site of care and included both the facility and professional payments where applicable (eg, imaging services). Electricity cost by state The total payment included the portion paid by the insurer and the consumer OOP payment (ie, the allowed amount for the visit at a particular site of care). Electricity dance moms choreography This allowed amount was defined as the price per visit. E seva power bill payment We defined the price differential by site of care to be the ratio of average HOPD price for a service to the average price of that same service in a PO or an ambulatory surgery center (ASC), as applicable.

To ensure comparability of visits across the different sites of care, we used the following criteria for inclusion based on claims for these visits: a) visits paid in-network and on a fee-for-service basis; b) for imaging services and outpatient procedures, only visits with both technical and professional claims; and c) visits for endoscopy and colonoscopy in which these were the only procedures performed during the visit. Electric utility companies in arizona To minimize the effect of outlier payments on price differential, we excluded visits using the interquartile range method for outliers.

The data source is the Truven Health MarketScan Commercial Claims and Encounters Database, 2008 to 2013. Electricity invented The Market Scan data contain administrative data for 44 to 53 million individuals (depending on the study year) covered by employer-sponsored health insurance. Electricity definition We used the annual enrollment file and outpatient services file, which include information on coverage dates, service dates, age, sex, total dollars paid to providers, procedure codes, procedure modifier codes, and the place of service where the procedure was performed.

We calculated the average price at the visit level for each of the 7 services by site of care and by year, and we used weights derived from the Household Component of the Medical Expenditure Panel Survey and provided by Truven Health Analytics to generate national estimates of price differentials. Electricity and circuits class 6 questions For procedures, we calculated Charlson comorbidity index (CCI) scores to assess morbidity of patients by site of care. Gas vs electric oven temperature 14 Specifically, we compared average CCI scores for patients, as well as percent of patients with CCI scores of 0, 1, and >1, by site of care. Gas monkey bar and grill Similar to researchers at MedPAC, we did not risk adjust payments for office visits and imaging services, because patient morbidity is less likely to be an issue for these services. Gas up 9

We also conducted statistical tests of significance using the 2-sample t test to assess the probability that differences in the average price by site of care are random. Electricity 101 episode 1 To examine trends in price differentials, we calculated an index of the price differential for each clinical category: office visits, imaging services, and outpatient procedures. K gas cylinder The index was derived using as weights the proportion of visits for each service by site of care.

Finally, to calculate additional spending due to price differential for each service, we multiplied the number of visits occurring in an HOPD by the difference between the average price paid for this service in an HOPD and the average price paid for the same service in a PO. Tropico 5 electricity We then summed these amounts across all 7 services to arrive at the total national additional spending due to price differential by site of care.