Commonwealth Health Care Provider of Massachusetts Price Variation in the Center for Health Massachusetts Commercial Market Information and Analysis Data Appendices Áron Boros Executive Director November 2012 This report was developed by the Division of Health Care Finance and Policy and published by the Center for Health Information and Analysis. Center for Health Information and Analysis Health Care Provider Price Variation in the Massachusetts Commercial Market Data Appendices Table of Contents Appendix A – Acute Hospitals Appendix A1 – Acute Hospitals – Acute Hospital Relative Prices: Commercial Plans – Acute Hospital Relative Prices: Commonwealth Care Plans – Acute Hospital Relative Prices: Medicaid MCO Plans – Acute Hospital Relative Prices: Medicare Advantage Plans Appendix A2 – Multiple Regressions for Acute Hospital Relative Prices: Commercial Plans Appendix A3 - Relative Price versus Relative Payments for Acute Hospital Commercial Plans Appendix B – Physician Groups – Physician Group Relative Prices: Commercial Plans – Physician Group Relative Prices: Commonwealth Care Plans – Physician Group Relative Prices: Medicaid MCO Plans – Physician Group Relative Prices: Medicare Advantage Plans Appendix C – Psychiatric Hospitals and Acute Hospital Behavioral Health Units – Psychiatric Hospital/Unit Relative Prices: Commercial Plans – Psychiatric Hospital/Unit Relative Prices: Commonwealth Care Plans – Psychiatric Hospital/Unit Relative Prices: Medicaid MCO Plans – Psychiatric Hospital/Unit Relative Prices: Medicare Advantage Plans Massachusetts ce n t e r f o r he a l t h In f o r M a t I o n a n d an a l y s I s • no v e M b e r 2012 i Health Care Provider Price Variation in the Massachusetts Commercial Market Data Appendices Appendix D – Rehabilitation Hospitals – Rehabilitation Hospital Relative Prices: Commercial Plans – Rehabilitation Hospital Relative Prices: Commonwealth Care Plans – Rehabilitation Hospital Relative Prices: Medicaid MCO Plans – Rehabilitation Hospital Relative Prices: Medicare Advantage Plans Appendix E – Chronic Hospitals – Chronic Hospital Relative Prices: Commercial Plans – Chronic Hospital Relative Prices: Commonwealth Care Plans – Chronic Hospital Relative Prices: Medicaid MCO Plans – Chronic Hospital Relative Prices: Medicare Advantage Plans Appendix F – Other Providers – Other Providers Relative Prices: Commercial Plans – Other Providers Relative Prices: Commonwealth Care Plans – Other Providers Relative Prices: Medicaid MCO Plans – Other Providers Relative Prices: Medicare Advantage Plans Massachusetts ce n t e r f o r he a l t h In f o r M a t I o n a n d an a l y s I s • no v e M b e r 2012 ii Appendix A1 Acute Hospitals – Acute Hospital Relative Prices: Commercial Plans – Acute Hospital Relative Prices: Commonwealth Care Plans – Acute Hospital Relative Prices: Medicaid MCO Plans – Acute Hospital Relative Prices: Medicare Advantage Plans Aetna Health Inc. (PA) - Aetna Health Ins. Co. Acute Hospital Commercial (self and fully insured) Inpatient Outpatient Hospital Blended Blended Inpatient Percent of Outpatient Percent of Percent of Quartile Relative Relative Hospital Relative Hospital Network Hospital Price (4 - High) Price Payments Price Payments Payments System A C D G S T Network Average 1.00 1.00 39.83% 1.00 60.17% Anna Jaques Hospital 1.47 4 0.97 25.35% 1.85 74.65% 0.56% x Baystate Franklin Medical Center 0.88 2 0.72 23.84% 1.01 76.16% 0.35% BYHS x x x Baystate Mary Lane Hospital --- --- --- 9.39% 0.57 90.61% 0.09% BYHS x Baystate Medical Center 0.88 2 1.18 48.91% 0.65 51.09% 2.88% BYHS x x Berkshire Medical Center 1.06 3 0.96 27.43% 1.13 72.57% 0.86% BKHS x x x Beth Israel Deaconess Hospital - Needham --- --- --- 7.47% 0.72 92.53% 0.23% CG x Beth Israel Deaconess Medical Center 1.16 4 1.29 45.07% 1.07 54.93% 4.58% CG x Boston Medical Center 1.00 3 1.22 28.30% 0.83 71.70% 0.98% x x Brigham and Women's Hospital 1.66 4 1.63 65.57% 1.68 34.43% 15.31% PHS x Cambridge Health Alliance 0.70 1 0.85 32.23% 0.59 67.77% 0.50% x x Cape Cod Hospital 1.12 3 1.24 29.28% 1.04 70.72% 1.51% CCHS x x x Children's Hospital Boston 1.52 4 1.75 60.90% 1.35 39.10% 10.40% x x Clinton Hospital --- --- --- 8.68% 1.52 91.32% 0.09% UMHS x x Cooley Dickinson Hospital 0.91 2 0.79 27.12% 1.00 72.88% 0.65% x Dana-Farber Cancer Institute* 1.75 4 2.51 11.73% 1.17 88.28% 4.77% x x Emerson Hospital 0.90 2 0.82 13.25% 0.95 86.75% 1.17% x Fairview Hospital --- --- --- 18.29% 1.43 81.71% 0.18% BKHS x x Falmouth Hospital 1.03 3 0.84 30.47% 1.17 69.53% 0.47% CCHS x x x Faulkner Hospital 0.99 3 1.09 21.94% 0.92 78.06% 1.00% PHS x Hallmark Health 1.00 3 1.02 24.86% 0.99 75.14% 0.88% x Harrington Memorial Hospital* 0.92 2 0.82 12.46% 0.99 87.54% 0.42% x x Health Alliance Hospital 0.96 2 0.77 15.18% 1.10 84.82% 0.55% UMHS x Heywood Hospital --- --- --- 13.31% 1.10 86.69% 0.24% x A1 - 1 Aetna Health Inc. (PA) - Aetna Health Ins. Co. Acute Hospital Commercial (self and fully insured) Inpatient Outpatient Hospital Blended Blended Inpatient Percent of Outpatient Percent of Percent of Quartile Relative Relative Hospital Relative Hospital Network Hospital Price (4 - High) Price Payments Price Payments Payments System A C D G S T Network Average 1.00 1.00 39.83% 1.00 60.17% Holyoke Medical Center --- --- --- 18.57% 0.77 81.43% 0.10% x x Jordan Hospital 1.13 4 1.02 16.19% 1.21 83.81% 0.76% x Lawrence General Hospital 0.81 1 0.88 37.00% 0.76 63.00% 0.36% x x Lowell General Hospital 0.85 1 0.96 30.15% 0.77 69.85% 0.92% x Marlborough Hospital --- --- --- 13.60% 1.25 86.40% 0.30% UMHS x Martha's Vineyard Hospital --- --- --- 2.97% 1.36 97.03% 0.16% PHS x x Massachusetts Eye and Ear Infirmary --- --- --- 5.13% 0.86 94.87% 0.51% x x Massachusetts General Hospital 1.42 4 1.48 42.07% 1.38 57.93% 17.02% PHS x Mercy Medical Center 0.84 1 1.02 44.70% 0.71 55.30% 0.30% x x Merrimack Valley Hospital --- --- --- 20.41% 1.08 79.59% 0.24% EHC x x MetroWest Medical Center 1.51 4 1.04 24.95% 1.86 75.05% 1.39% VHS x Milford Regional Medical Center 0.94 2 0.93 7.81% 0.95 92.19% 0.82% x Milton Hospital --- --- --- 32.42% 0.62 67.58% 0.11% x Morton Hospital 0.83 1 0.81 15.81% 0.85 84.19% 0.35% x x Mount Auburn Hospital 0.95 2 0.78 21.71% 1.08 78.29% 1.14% CG x Nantucket Cottage Hospital --- --- --- 1.51% 1.28 98.50% 0.12% PHS x x Nashoba Valley Medical Center --- --- --- 6.21% 1.29 93.79% 0.21% EHC x New England Baptist Hospital 1.19 4 1.81 49.31% 0.72 50.69% 0.66% CG x x Newton-Wellesley Hospital 0.85 1 0.79 29.80% 0.89 70.20% 2.72% PHS x Noble Hospital --- --- --- 31.24% 0.54 68.76% 0.12% x x North Adams Regional Hospital --- --- --- 32.44% 1.07 67.56% 0.12% x x x North Shore Medical Center 1.03 3 1.22 29.27% 0.89 70.73% 2.16% PHS x Northeast Hospital 0.79 1 0.83 29.88% 0.76 70.12% 1.11% x A1 - 2 Aetna Health Inc. (PA) - Aetna Health Ins. Co. Acute Hospital Commercial (self and fully insured) Inpatient Outpatient Hospital Blended Blended Inpatient Percent of Outpatient Percent of Percent of Quartile Relative Relative Hospital Relative Hospital Network Hospital Price (4 - High) Price Payments Price Payments Payments System A C D G S T Network Average 1.00 1.00 39.83% 1.00 60.17% Quincy Medical Center --- --- --- 22.94% 0.70 77.06% 0.14% x x Saint Vincent Hospital 0.89 2 0.83 34.04% 0.93 65.96% 0.52% VHS x x Saints Medical Center --- --- --- 8.16% 1.02 91.84% 0.45% x x Signature Healthcare Brockton Hospital 0.63 1 0.78 31.64% 0.51 68.36% 0.30% x x South Shore Hospital 0.96 3 0.80 46.21% 1.08 53.79% 1.42% x Southcoast Hospitals Group 0.97 3 1.13 36.49% 0.86 63.51% 1.88% x x Steward Carney Hospital --- --- --- 26.90% 0.88 73.10% 0.12% SHS x x Steward Good Samaritan Medical Center 0.96 3 0.94 34.56% 0.98 65.44% 0.35% SHS x x Steward Holy Family Hospital 0.92 2 0.78 25.40% 1.02 74.60% 0.57% SHS x Steward Norwood Hospital 0.87 2 0.91 32.82% 0.85 67.18% 0.44% SHS x Steward Saint Anne's Hospital --- --- --- 9.86% 0.82 90.14% 0.23% SHS x x Steward St. Elizabeth's Medical Center 0.85 1 1.00 48.66% 0.74 51.34% 0.82% SHS x x Sturdy Memorial Hospital 0.78 1 0.75 20.61% 0.80 79.39% 0.46% x Tufts Medical Center 1.28 4 1.71 58.76% 0.96 41.24% 2.17% x UMass Memorial Medical Center 1.18 4 1.21 22.25% 1.15 77.75% 7.94% UMHS x Winchester Hospital 0.76 1 0.76 20.23% 0.76 79.77% 1.55% x Wing Memorial Hospital and Medical Centers --- --- --- 15.95% 0.95 84.05% 0.24% UMHS x x *This hospital met the revenue threshold for inpatient services.