Professional Fee Ratios for US Hospital Discharge Data

Peterson, Cora; Xu, Likang; Florence, Curtis S.; Grosse, Scott D.; Annest, Joseph L.

doi:10.1097/mlr.0000000000000410

Cited by 77 publications

(76 citation statements)

References 16 publications

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“…Consequently, physician costs are not usually included in studies on cost of injury, although prior estimates suggest they account for 18%–26% of total treatment costs for all-cause hospitalizations. 13 Even the comprehensive Thompson study did not break out separately the physician costs. 11 The objective of this study is to provide cost estimates of treatment for TBI, including both hospital and physician charges, among older adults treated at a Level 1+ trauma center using data from 2008–2012.…”

Section: Introductionmentioning

confidence: 99%

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Albrecht

Slejko

Stein

et al. 2017

Journal of Head Trauma Rehabilitation

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Objective To provide charge estimates of treatment for traumatic brain injury (TBI), including both hospital and physician charges, among adults aged 65 and older treated at a trauma center. Methods We identified older adults treated for TBI during 2008–2012 (n=1,843) at Maryland’s Primary Adult Resource Center and obtained hospital and physician charges separately. Analyses were stratified by sex and all charges were inflated to 2012 dollars. Total TBI charges were modeled as a function of covariates using a generalized linear model. Results Women comprised 48% of the sample. The mean unadjusted total TBI hospitalization charges for adults aged 65 and older was $36,075 (standard deviation (SD) $63,073). Physician charges comprised 15% of total charges. Adjusted mean charges were lower in women than in men (adjusted difference −$894; 95% confidence interval (CI) −$277, −$1,512). Length of hospital and ICU stay were associated with the highest charges. Conclusions This study provides the first estimates of hospital and physician charges associated with hospitalization for TBI among older adults at a trauma center that will aid in resource allocation, triage decisions, and healthcare policy.

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Section: Introductionmentioning

confidence: 99%

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Albrecht

Slejko

Stein

et al. 2017

Journal of Head Trauma Rehabilitation

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“…The average CCR applied to HCUP-NEDS records was 0.396 (data not shown). PFR was assigned to injury records by primary three-digit ICD-9-CM code and primary payer (Medicare and Medicaid were assigned Medicaid-specific PFR, and private insurance, self-pay, no charge, other and missing payers were assigned commercial insurance-specific PFR) separately for ED visits and admissions using published estimates (from 2012, the most recent available) 15. If PFR was not available for a given ICD-9-CM code, the authors applied the all-diagnosis, payer-specific adjusted average PFR 15…”

Section: Methodsmentioning

confidence: 99%

Average medical cost of fatal and non-fatal injuries by type in the USA

Peterson

Florence

2019

Inj Prev

Self Cite

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ObjectiveTo estimate the average medical care cost of fatal and non-fatal injuries in the USA comprehensively by injury type.MethodsThe attributable cost of injuries was estimated by mechanism (eg, fall), intent (eg, unintentional), body region (eg, head and neck) and nature of injury (eg, fracture) among patients injured from 1 October 2014 to 30 September 2015. The cost of fatal injuries was the multivariable regression-adjusted average among patients who died in hospital emergency departments (EDs) or inpatient settings as reported in the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample and National Inpatient Sample, controlling for demographic (eg, age), clinical (eg, comorbidities) and health insurance (eg, Medicaid) factors. The 1-year attributable cost of non-fatal injuries was assessed among patients with ED-treated injuries using MarketScan medical claims data. Multivariable regression models compared total medical payments (inpatient, outpatient, drugs) among non-fatal injury patients versus matched controls during the year following injury patients’ ED visit, controlling for demographic, clinical and insurance factors. All costs are 2015 US dollars.ResultsThe average medical cost of all fatal injuries was approximately $6880 and $41 570 per ED-based and hospital-based patient, respectively (range by injury type: $4764–$10 289 and $31 912–$95 295). The average attributable 1-year cost of all non-fatal injuries per person initially treated in an ED was approximately $6620 (range by injury type: $1698–$80 172).Conclusions and relevanceInjuries are costly and preventable. Accurate estimates of attributable medical care costs are important to monitor the economic burden of injuries and help to prioritise cost-effective public health prevention activities.

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“…Heterogeneous production and cost functions would lead some hospitals to be more responsive to MFCU budget levels than others. (Peterson et al, 2015). Thus, hospital charges observed in the data are a credible way to proxy for provider decisions on treatment intensity.…”

Section: Heterogeneity By Hospital Typementioning

confidence: 94%

Should We Do More to Police Medicaid Fraud? Evidence on the Intended and Unintended Consequences of Expanded Enforcement

Perez

Wing

2019

American Journal of Health Economics

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We develop a model of hospital responses to the possibility of a MFCU investigation, which is similar to models of tax evasion and crime (Allingham and Sandmo, 1972;Yitzhaki, 1987;Becker, 1968). In our model, the conditional probability of a MFCU investigation is higher when the MFCU has a larger budget, and higher at hospitals that produce a large number of fraud prone claims. We assume that complying with the investigation imposes administrative costs on the hospitals, and we examine how profit-maximizing hospitals respond to these incentives.3 This share is capped at a maximum of 0.25% of the total cost of the state Medicaid program, but states tend to request less than this limit. 4 Figures are based on authors' own analysis of the data and are presented in 2016 dollars. 5 00130 2019If IG, IFG, IF , and IF F are all positive given the prevailing MFCU investigation rates, then we would expect that dF/dG < 0. Increases in the MFCU budget will lead hospitals to reduce their production of fraud prone health services. C. LEGITIMATE AND ILLEGITIMATE FRAUD PRONE SERVICESEven when focusing on fraud-prone health conditions, the MFCU cannot distinguish between legitimate and fraudulent services without investigating. It is unclear whether hospital management systems can independently control the hospitals production of fraudulent and legitimate fraud-prone health services. If the hospital does have independent control over illegitimate and legitimate activity, then an interesting question is how changes in MFCU budgets will affect the hospitals behavior with respect to these two separate types of activity. That is, in response to a MFCU expansion, will hospitals reduce only their fraudulent activities? Or will they also reduce their production of legitimate health services for the fraud-prone health conditions that attract MFCU attention? To study the possibility of such defensive practice patterns in more detail, we augment the basic model to allow hospitals to produce a mix of legitimate and illegitimate health services for fraud prone health conditions. Suppose that the MFCU's fraud prone activity index is Fi = li + zi, where li represents legitimate service production and zi represents illegitimate service production. Assume that the hospital receives the same revenue and incurs the same costs

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Professional Fee Ratios for US Hospital Discharge Data

Cited by 77 publications

References 16 publications

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Treatment Charges for Traumatic Brain Injury Among Older Adults at a Trauma Center

Average medical cost of fatal and non-fatal injuries by type in the USA

Should We Do More to Police Medicaid Fraud? Evidence on the Intended and Unintended Consequences of Expanded Enforcement

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