Domain

Analytic Methods

Type

Empirical Study

Theme

operations

Start Date

7-6-2014 1:15 PM

End Date

7-6-2014 2:45 PM

Structured Abstract

Introduction:

The Patient Protection and Affordable Care Act (PPACA) is pushing for increased clarity about healthcare charges because of the complexity of medical billing. Consequently, the release in May 2013 of the national summary of Medicare Provider Charge Data for the Top 100 Diagnosis-Related Groups was made public. Similar state-level initiatives to provide information to the public about healthcare charges date back to the 1990s. As a result, hospital claim charge data for Medicare patients treated in Texas is recorded and stored electronically by two different entities, one federal, and one state. These two data repositories can now be compared for consistency. The purpose of this research is to analyze empirical data concerning the consistency of the reported pricing transparency information in these two repositories; and to articulate these methods for future use.

Methods:

This cross-sectional study compares data for the year 2011 from the 131 hospitals that report to both repositories, the Texas Health Collection Information Center – Texas Hospital Discharge Data Public Use Data Files and the Medicare Provider Charge Data, to assess whether reporting requirements for the same variables match between these two datasets. For matching comparison groups from those 131 hospitals, a Bland-Altman analysis is used to compare discharge numbers and a multilevel fixed-effect regression model is used to test for agreement of average total covered charges and to identify any statistically significant differences in the comparison of THCIC to MPCD. These analyses were required to determine agreement, one to examine the completeness of reported discharges, and the other to compare the correctness of average charge amounts for select hospitals and diagnosis related groups (DRGs) in Texas hospitals for 2011.

Findings:

The baseline consistency check reveals a strong level of agreement in the number of reported discharges, and a strong positive correlation between the THCIC and Medicare reported data. The results of this research validate the consistency of Texas reported average total covered charge data to the THCIC and reinforce current oversight efforts.

Discussion:

The need for establishing transparency-reporting baselines for future comparisons of hospital reporting performance coincides with The PPACA push for increased clarity about healthcare charges. Although this study focuses on the Texas state area, it helps to point further research in a meaningful direction nationwide.

Call to Action:

This research offers methods to advance the development of reporting accountability metrics related to pricing transparency efforts. These processes may be modified for use in the over 40 states with claims databases, and be utilized to strengthen the infrastructure of emerging all-payer claims databases.

Acknowledgements

I am on an T-15 CTRIP post doctoral fellowship through the National Library of Medicine, but this work was completed before the fellowship began.

Creative Commons License

Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License
This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 3.0 License.

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Jun 7th, 1:15 PM Jun 7th, 2:45 PM

Accuracy of Charge Transparency: Processes to Validate Electronic Data from State and Federal Repositories for Hospital Charges

Introduction:

The Patient Protection and Affordable Care Act (PPACA) is pushing for increased clarity about healthcare charges because of the complexity of medical billing. Consequently, the release in May 2013 of the national summary of Medicare Provider Charge Data for the Top 100 Diagnosis-Related Groups was made public. Similar state-level initiatives to provide information to the public about healthcare charges date back to the 1990s. As a result, hospital claim charge data for Medicare patients treated in Texas is recorded and stored electronically by two different entities, one federal, and one state. These two data repositories can now be compared for consistency. The purpose of this research is to analyze empirical data concerning the consistency of the reported pricing transparency information in these two repositories; and to articulate these methods for future use.

Methods:

This cross-sectional study compares data for the year 2011 from the 131 hospitals that report to both repositories, the Texas Health Collection Information Center – Texas Hospital Discharge Data Public Use Data Files and the Medicare Provider Charge Data, to assess whether reporting requirements for the same variables match between these two datasets. For matching comparison groups from those 131 hospitals, a Bland-Altman analysis is used to compare discharge numbers and a multilevel fixed-effect regression model is used to test for agreement of average total covered charges and to identify any statistically significant differences in the comparison of THCIC to MPCD. These analyses were required to determine agreement, one to examine the completeness of reported discharges, and the other to compare the correctness of average charge amounts for select hospitals and diagnosis related groups (DRGs) in Texas hospitals for 2011.

Findings:

The baseline consistency check reveals a strong level of agreement in the number of reported discharges, and a strong positive correlation between the THCIC and Medicare reported data. The results of this research validate the consistency of Texas reported average total covered charge data to the THCIC and reinforce current oversight efforts.

Discussion:

The need for establishing transparency-reporting baselines for future comparisons of hospital reporting performance coincides with The PPACA push for increased clarity about healthcare charges. Although this study focuses on the Texas state area, it helps to point further research in a meaningful direction nationwide.

Call to Action:

This research offers methods to advance the development of reporting accountability metrics related to pricing transparency efforts. These processes may be modified for use in the over 40 states with claims databases, and be utilized to strengthen the infrastructure of emerging all-payer claims databases.