Medicare's Public Measure for Hospital Cost of Pneumonia Care & Mortality

Medicare has a large number of publicly available hospital measures, some of which are more intuitive than others.   (For Medicare's sepsis management measure, here.) 

An unusual one I ran across is Payment and Value of Care. 

Online at CMS, you can download the "CSV" file at this website (most recent, 10/31/2018).   The file is called "Payment_and_value_of_care_-_Hospital.csv."  I recommend immediately opening and re-saving the file as "Excel Workbook." 

Generally, there are four metrics per hospital:  See Column J Payment in dollars over 30 days for AMI, or for heart failure, or for pneumonia, and payment 90 days for hip/knee replacement. 

In the snapshot below, column J is the measure, column K the summary result in words (e.g. above, below, or near the national average); column L is number patients and column M is average payment.  (I've hidden some additional columns for clarity).   Then it is interesting to see Column R is a summary metric for how mortality and payments compare.   This is rated categorically in Column S (e.g. average mortality + average payment, or worse mortality and higher payment, etc).  (Unlike payment, there is no absolute number shown for mortality, only a categorical rating.)

click to enlarge

Zooming in on Pneumonia With Worse Mortality

Once you have the Excel, you can do some basic sort-and-play maneuvers. 

For example, I made a copy of the worksheet page, sorted alphabetically by measure, and deleted all the measures except the 30-day-pneumonia measure.   Then I sorted it for performance on Value of Care. 

This gives you information like: CMS classified 240 hospitals out of 4794 with data as "Worse Mortality" for pneumonia. 

Of these 240 all labeled with "worse mortality," CMS subcategorized by payment costs.  54 of the 240 had worse mortality and lower payment, 58 had worse mortality and higher payment (whoops), and 127 had worse mortality and average payment.   (We can infer that CMS assesses worse and better as quartiles, with 50% in the middle).    In other sources, CMS states that mortality is propensity-corrected (e.g. by advanced age). 

Payment Level Range

Sorting pneumonia 30-day measures solely by average payment, the highest was $27,126 for a hospital in Oklahoma with 35 cases, the lowest was $10,816 for a hospital in Texas with 29 cases. 

Number of Case per Hospital

Sorting solely by number of cases per hospital, the highest was 3,328 for a hospital in Orlando, FL, which was one of only 8 hospitals with > 2000 cases for this pneumonia measure.  About 1850 hospitals had >400 cases.  (Hospitals with <11 are not reported). 

Medical Imaging, Spending Per Bene

CMS also publishes data on "use of medical imaging" by hospitals (outpatients) and "Medicare Spending by Beneficiary" or MSPB for all spending by any provider in Part B or Part B that is within 3 days prior or 30 days after a hospital discharge.   Cost standardization removes geographic wage index differences, etc, and there is "risk adjustment due to patient health status."  Explanation of these, here.  Data sources online here.   (The main zip file downloads a large bundle of Excel files, 277 MB).