Oregon

1
Oregons public reporting of hospital cost

• Jeanene Smith MD, MPH
• Office for Oregon Health Policy Research
• State Coverage Initiatives Winter Meeting 2008

2
About OHPR

• Responsible for the development and analysis of
  health policy in Oregon
• Reports and conducts analyses relating to health
  care costs, utilization, quality, and access
• Provides analysis, technical, and policy support
  to the Governor and the Legislature
• Serves as the policymaking body for the Oregon
  Health Plan (Oregon Medicaid program)
• Staff to Governor appointed committees and
  commissions
• Health Policy Commission Strategic health
  planning
• Health Resources Commission Evidence-Based Rx
  Reviews
• Health Services Commission The Prioritized List
• Medicaid Advisory Committee
• NEW - Oregon Health Trust Board Health reform
  Effort

3
Recent OHPR Reports

• Trends in Oregons Healthcare Market and the
  Oregon Health Plan Report to the 2007
  Legislature
• Oregons Acute Care Hospitals Capacity,
  Utilization and Financial Trends Report to the
  2007 Legislature
• Inpatient Quality Indicators
• Profile of Oregons Uninsured Findings from the
  2006 Oregon Population Survey
• Oregon Health Policy Commission Roadmap to Health
  Care Reform Creating a High-Value, Affordable
  Health Care System
• Oregon Physicians Workforce Survey, 2007
• www.ohpr.oregon.gov

4
What aspect of the health care market is missing?

• OHPR provides clear picture of utilization,
  access and financial state of hospitals
• Inpatient discharge data
• Audited financials
• Databank
• American Hospital Association survey
• Physician workforce survey
• Reporting had limited use for the general public
  in health care decision making
• OHPR began reporting AHRQs Inpatient Quality
  Indicators in 2004
• With quality reporting on going, cost is a
  missing component to health care decision making

5
How Oregon began hospital cost reporting?

• Hospital cost reporting national standard is
  charge based
• Hospital association in Oregon currently
  reporting charges
• Charge data
• Little value for consumers, purchasers, providers
  and the general public1
• Amount typically never paid to hospitals
• Charges are 2.5 time higher the amount a hospital
  will actually be paid1
• Logical meaningful step is reporting payments to
  hospitals
• Payment Data
• Reflect actual payments for service provided
• Provide consumers, purchasers, providers and the
  general public with real dollar amounts
• Previous state efforts failed to create political
  momentum to report payments
• Governor Kulongoski made health care cost
  transparency a priority
• Support from insurance carriers, consumers,
  advocates, government

1 Colmers JM. Public reporting and transparency.
The Commonwealth Fund Commission on a High
Performance Health System, January 2007.
6
Hospital Cost Transparency Project

• Goal
• To publicly report hospital payment data to
  improve cost transparency for consumers,
  purchasers, providers and the general public
• October 16, 2006
• Insurance Division, under exam authority, issued
  a inpatient claims data call to insurance
  carriers for calendar year 2005 who had paid
  claims in excess of 50 million (11 largest
  carriers)
• Collaborated with OHPR

7
Why is this project innovative?

• Data obtained from insurance carriers to profile
  hospitals
• Project reports payment data
• Oregon one of first states to report payment data
• Provide critical piece for use by the general
  public for health care decision making

8
Data Methods

• Cost transparency workgroup
• Included members including
• Representatives from individual health insurance
  carriers
• Oregon Association of Hospitals and Health
  Systems
• Oregon Coalition of Health Care Purchasers
• Individual hospitals representatives
• Actuaries
• Other interested stakeholders
• Technical workgroup
• Included analysts from OHPR and insurance carriers

9
Data Methods

• Most common conditions or procedures defined as
• At least 150 observations OR
• At least 1 million in charges
• Used 3M APR-DRG software
• Risk adjusted
• Severity level grouping
• Assigns severity through
• Diagnosis, procedure, length of stay, patient
  age, patient discharge disposition
• Categories Minor/Moderate, Extreme/Severe
• Estimation of variance
• Supplemented claims data with 3-year Oregon
  hospital discharge data and Nationwide Inpatient
  Sample, 2003

10
Results

• 82 common conditions or procedures reported
• Top 5 volume
• Vaginal delivery (APR-DRG 560)
• Normal newborn (APR-DRG 640)
• Cesarean delivery (APR-DRG 540)
• Gynecology procedure for non-malignancy (APR-DRG
  513)
• Surgical repair of herniated/ruptured disc
  (APR-DRG 310)
• Top 5 total cost
• Vaginal delivery (APR-DRG 560)
• Cesarean delivery (APR-DRG 540)
• Knee joint replacement (APR-DRG 302)
• Extensive procedures on small and large
  intestines (APR-DRG 221)
• Gynecology procedure, except for cancer or benign
  tumor (APR-DRG 513)

11
What the data represents?

• Oregonians only
• Oregon hospitals
• Inpatient claims
• Discharges from January 1, 2005 to December 31,
  2005
• Final bills (admit thru discharge)
• Carriers that earned at least 50 million in OR
  premiums
• About 50 of non-HMO commercial inpatient claims
  (e.g. no self-insured)
• Over 70 of the claims submitted by the
  represented carriers
• About 11 of all inpatient discharges during 2005
• Groupings of diagnoses or procedures (APR-DRG
  classifications)

12
Data table example-Researcher
13
Data Table Example-Consumer
14
Cost Quality
15
Web based, table creator
http//www.ohpr.state.or.us/OHPPR/RSCH/comparehosp
italcosts.shtml
16
Public Reporting

• Prior to public release
• Insurance carriers
• Verified data to be displayed
• Hospitals
• Provided aggregated hospital level data
• Was not required to verify data
• Encouraged to submit written comments to be
  posted
• Website approved by workgroup

17
Public release

• August 3, 2007
• Press releases
• Governors office
• Department of Consumer Business Affairs
• Coverage in major paper press and news affiliate

18
Limitations

• Data limitations
• Not all carriers
• Medicare or Medicaid claims
• Capitated health plans
• Claims for coordination of benefits
• Claims for patients treated in an outpatient
  clinic located at a hospital
• Synergy with quality data
• Bridging the gap between hospital payment and out
  of pocket cost to consumers

19
Future Directions

• Annual reporting requirement
• Legislation
• Display trending data
• Increase the scope of the insurance market
• Medicaid
• Medicare
• Include all commercial carriers
• Refine display with quality

20
Challenges to reporting cost

• Political will
• Must have high level champions
• Creating a display useful for consumers and
  research community
• Communicate data more effectively and broadly
• ALSO Health Reform efforts initial steps for
  more transparency in Oregons healthcare system

21
For more info, questions

• Office for Oregon Health Policy Research
• www.ohpr.oregon.gov
• Jeanene Smith
• 503-373-1625
• Jeanene.smith_at_state.or.us
• or
• Sean Kolmer, MPH
• Research Data Manager
• 503-373-1824
• Sean.Kolmer_at_state.or.us