Page 19 - 2013 Hospitals/Systems Digest US.NMH.13.02.007
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HOSPI TALS
SANOFI / MANAGED CARE DIGEST SERIES
®
/ WHERE INFORMATION BECOMES INTELLIGENCE.
™
HOSPITALS/SYSTEMS DIGEST 2013
Data source: IMS Health © 2013
Key Takeaway
As part of the Affordable Care Act’s Value-Based Purchasing Program, Medicare trimmed
reimbursement by 1% for all hospitals for fiscal year 2013, but allowed facilities to earn back the
amount cut by performing well on patient satisfaction criteria and 12 specific quality measures.
Though more than half of all facilities earned back at least part of that 1%,
2
many hospitals still
confronted reimbursement cuts resulting from high readmission rates.
• Inpatient Medicare charges for multiple sclerosis
cases grew in accordance with bed size in 2011.
For example, such charges were clearly highest
for hospitals with 250 or more beds, at $28,750.
• However, the percentage of Medicare charges
reimbursed for such cases was lower according
to hospital size, ranging from 56.9% at the smallest
facilities to just 19.3% at the largest hospitals.
Percentage of MS Inpatient Charges Reimbursed by Medicare Varies by Hospital Size
• Between 2010 and 2011, average inpatient
Medicare charges increased by at least 4%
for each of the 12 featured disease states.
Medicare charges per inpatient angina case
rose at the greatest rate, by disease, at 11.3%.
• Meanwhile, the amount Medicare reimbursed
for inpatient cases also grew for 11 of 12 diseases
(multiple sclerosis excepted), but at a slower rate
than the charges. Consequently, the share of
charges reimbursed fell for all 12 diseases states.
F INANCIALS
MEDICARE REIMBURSEMENT OF INPATIENT CHARGES
1
Average Inpatient
Medicare Charges
Average Inpatient
Medicare
Reimbursement
% of Inpatient
Medicare Charges
Reimbursed
disease state
2010
2011
2010
2011
2010
2011
Acute Coronary Syndromes (ACS)
$16,792 $18,221
$3,322
$3,569
19.8% 19.6%
Angina
15,589
17,348
3,052
3,205
19.6
18.5
Asthma
19,019
19,821
4,970
5,117
26.1
25.8
Atrial Fibrillation/Atrial Flutter
19,638
20,749
5,012
5,203
25.5
25.1
Breast Cancer
25,193
27,616
5,238
5,538
20.8
20.1
Depression
19,806
21,038
6,121
6,342
30.9
30.1
Diabetes Mellitus
23,089
24,543
6,686
6,843
29.0
27.9
Hypertension
14,169
15,333
3,339
3,514
23.6
22.9
Multiple Sclerosis (MS)
22,750
23,569
5,387
5,319
23.7
22.6
Osteoarthritis
46,216
48,700
10,647
10,975
23.0
22.5
Prostate Cancer
31,910
34,526
6,601
6,768
20.7
19.6
Stroke
24,549
25,956
6,723
6,969
27.4
26.8
medicare reimbursement of inpatient multiple sclerosis charges, by size, 2011
1
$0
$7,500
$15,000
$22,500
$30,000
Charges/Reimbursement
0–49 Beds
50–119 Beds
120–249 Beds
250+ Beds
$9,588
$5,458
56.9%
$18,359
$5,286
$22,990
$4,964
$28,750
$5,552
19.3%
Average Charges
Average Reimbursement
Percentage Reimbursed
28.8%
21.6%
1
Charge data are per-case averages for inpatients with a particular diagnosis of interest. Charges may be for treatment related to other diagnoses.
2
Rau, J. (2012). Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality. Kaiser Health News. Retrieved from
Growth in Medicare Charges Outpaces Reimbursement
CHRONIC DISEASE
