CompareCareWV™

Researchers & Medical Professionals

Introduction

As the WV state health data repository, the role of the West Virginia Health Care Authority is to make health care information available to the public. In pursuit of this effort, CompareCareWV™ presents quality and average gross charge information by facility. CompareCareWV™ provides the consumer with the tools to find and compare acute care hospitals' quality of care on select indicators and average aggregate charges associated with the selected procedure or discharge.

What charges are being published?

The average gross technical and average gross professional charges are being displayed for frequent and/or common inpatient and outpatient services.

Technical charges, which include hospital and facility charges, are summarized at the episode of care level. All technical charges that are associated with the episode are rolled up to the episode so that total charges for the event are recorded.

Physician, or professional charges, is rolled up in a similar fashion. All professional services for the episode of care are matched to the episode by patient and service date identifiers. This rollup will include surgical, anesthesia, consultant, and evaluation and management services.

Once all technical and professional charges for the episode are accumulated, arithmetic means are calculated at the episode level. For inpatient claims the calculation is by CMS Diagnosis Related Group (DRG). AHRQ Clinical Classification Software (CCS) level calculations are performed for non inpatient claims.

What quality information is being published?

The Centers for Medicare & Medicaid Services (CMS), the Hospital Quality Alliance (HQA), Joint Commission, and the nation's hospitals have worked together to create and publicly report hospital quality information. This information measures performance on National Quality Improvement Goals and measures how well hospitals care for their patients. The measures, which are endorsed by the National Quality Forum, allow hospitals to report on key quality of care indicators that include heart attack, heart failure, community acquired pneumonia, surgical care improvement for infection prevention, readmissions and mortality.

In addition, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Survey, a national standardized survey instrument and data collection methodology for measuring patients' perspectives on their hospital care, have been provided.

Why publish this information?

Consumers are requesting it. Consumers are increasingly making their health care decisions based on the quality of care provided as more costs for that health care are shifting to the patient. In addition, uninsured consumers need a tool to manage the financial decisions related to their care. This site is intended to assist consumer awareness and decision-making.

Where is the data coming from?

For charges, the average gross charge is calculated from State payor claims data including PEIA, Medicaid and other state payors. We have utilized publicly available claims grouping software tools to aggregate procedures to commonly termed reimbursed items. These groupers include the CMS Diagnosis Related Group (DRG) grouper and the AHRQ Clinical Classification Software (CCS) grouper.

Data are dependent on the accuracy and completeness of the data submitted by the payors. Data collection may not be the same for all payors. There may be some variability in assigning diagnoses and categorizing the amounts for the claims.

The quality data is provided by the US Department of Health and Human Services, Centers for Medicare and Medicaid Services, Hospital Compare, a quality tool provided by Medicare.

What does this mean to our facility?

Average gross patient charges and quality information are now available for public review. Facilities may receive inquiries from consumers or other professionals about the information now being published. These contacts may be an opportunity to expand the patient base or to initiate patient services activity. Providers can view this publication as a tool to assist patients and professionals with their health care decision making.

What are the detailed calculations for average gross price?

The outpatient hospital costs listed on the CompareCareWV™ web site are the total costs for all services associated with the episode of care. Once the episode of care is identified, the primary procedure (most intensive in terms of resource consumption) is identified and grouped using the Clinical Classifications Software for CPT®/HCPCS software from the Healthcare Cost and Utilization Project (HCUP).

An episode of care can be thought of as all of the services (both facility and professional providers) performed for an individual in a facility setting for a specific reason, between specific dates. For example:

    • Patient John Doe had a broken arm treated at Hospital A. Because his physician was concerned about damage to his wrist, an MRI was ordered. For this episode, the services       would include:
        o The hospital charges such as supplies, MRI, and X-Ray.
        o The professional charges associated with the interpretation of the MRI and interpretation of the X-Ray.

    • Patient Jane Doe had a routine mammography performed at Hospital B. Since no other services were required, the services for this episode included:
        o The hospital charges for the mammography itself.
        o The professional charges for the interpretation of the mammography.

The above examples would be represented as two distinct episodes in the CompareCareWV™ database. In the event either of the patients would have received care for different reasons (diagnosis codes) at different facilities, those other services would have been interpreted as separate episodes.

Another feature of the episode approach is the determination of the primary procedure. The procedure with the highest professional charge during the episode is selected as such for the episode. Using the "John Doe" example, assume the following service line items:

    • MRI interpretation:     300.00 charge
    • X-Ray interpretation:  50.00 charge

Based upon the above professional charge data, the MRI interpretation would be selected as the primary procedure. The summary record in the database for this episode would include (but not limited to):

    • Patient ID (John Doe)
    • Hospital ID (Hospital A)
    • Diagnostic Category (Muscles, Bones, Joints)
    • Primary Procedure (MRI Interpretation)
    • Facility Charge (2,000 - the sum of all institutional charges)
    • Professional Charge (350.00 - the sum of all professional charges)

In summary, the episode is an inclusive summary of all expenses related to treatment. While the facility portion of the episode is related to one event in a facility, there may be one or more professional services associated with the encounter.

Adjudicated hospital and professional State payor claims are used to calculate the averages. At the claim detail level, the site of service selected is "Hospital". HCA segregated technical and professional charges by the bill type, modifier or revenue code. These selected claims were grouped using standard grouping software utilized for payment or public health purposes. The total average charge is the addition of professional and facility charges. The current version average is over a twelve month historical period ending December 2011. Outlier cases are included in the average. If a facility did not have greater than 5 occurrences, it is not displayed in certain selected CompareCareWV™ procedure choices.

What is included in the WV Hospital Services & Departments section?

The American Hospital Association's annual survey reports numerous patient services provided by hospitals completing the questionnaire. CompareCareWV™ displays a subset of these categories in both a map and a grid format, allowing consumers to choose a facility based on services offered.

Using the map display, consumers can select a category and drill down to the street level to find an exact location. Both pages show street address, web address and phone number for each facility.

Definitions

ADJUDICATED CLAIMS: Paid hospital and provider claims.

CCS: CCS-Services and Procedures provides a method for classifying Current Procedural Terminology (CPT®) codes and Healthcare Common Procedure Coding System (HCPCS) codes into clinically meaningful procedure categories. CPT is a proprietary coding system developed by the American Medical Association (AMA) for coding services provided by health care professionals. CPT is also referred to as HCPCS Level I. HCPCS (also referred to as HCPCS Level II) is a supplementary coding system developed by the Centers for Medicare and Medicaid Services (CMS) to account for supplies and services not accounted for in CPT (HCPCS Level I). The procedure categories are identical to the CCS with the addition of specific categories unique to the professional service and supply codes in CPT/HCPCS. CCS-Services and Procedures is current as of 2010 and can be used with any data that include CPT or HCPCS procedure information.

More than 9,000 CPT/HCPCS codes and 6,000 HCPCS codes are collapsed into 244 clinically meaningful categories that may be more useful for presenting descriptive statistics than are individual CPT or HCPCS codes.

CPT: A proprietary coding system developed by the American Medical Association for coding services provided by health care professionals. CPT is also referred to as HCPCS Level I. CPT stands for Current Procedural Terminology.

DRG: DRG stands for Diagnosis Related Group. It is a system that organizes medical diagnoses and procedures into groups based on estimated hospital resources and severity.

HCPCS: Health Care Common Procedure Coding System is a supplementary coding system developed by the Centers for Medicare and Medicaid Services (CMS) to account for supplies and services not included in CPT. The procedure categories are identical to the CCS with the addition of specific categories unique to the professional services and supply codes in CPT/HCPCS.

HOSPITAL PROCESS of CARE MEASURES: A process of care measure shows how often hospitals give recommended treatments known to get the best results for patients with certain medical conditions or surgical procedures. The hospital process of care measures include heart attack care, heart failure care, pneumonia care and surgical care improvement. The measures, which are constantly being evaluated by health care experts and researchers, are based on scientific evidence about treatments that are known to get the best results.

OUTLIER: Unusually high or low charges

PROCEDURE CODE: Classification system of physician services that is the universe of CPT and HCPCS codes.

REVENUE CODE: Uniform Billing revenue code, used to report a code that defines a specific accommodation, ancillary services, or billing calculation related to the services being billed.