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MEDICARE HOSPITAL COMPARE RATINGS, UTILIZATION AND PAYMENTS

The CMS Data app displays hospital-specific ratings and charges for the more than 4,000 U.S. hospitals that receive Medicare payments. This information is made public by the Centers for Medicare & Medicaid Services’ (CMS’).  

Medicare publishes an overall star rating for hospitals and compares the hospital to the national average for mortality, safety of care, readmissions, patient experience, effectiveness and timeliness of care. This app allows comparison ratings to other hospitals within a region, county or state.

The app displays hospitals charges for inpatient and outpatient procedures and what Medicare reimburses the hospital for those services. Compare reimbursement for hospitals within a region, county or state.

GENERAL INFORMATION 

Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare & Medicaid Services’ (CMS’) long-standing effort to link Medicare’s payment system to a value-based system to improve healthcare quality, including the quality of care provided in the inpatient hospital setting.

CONSUMER RATINGS (HCAHPS)

The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Patient Survey is a survey instrument and data collection methodology for measuring patients’ perceptions of their hospital experience. The survey is administered to a random sample of adult inpatients after discharge. The HCAHPS survey contains patient perspectives on care and patient rating items that encompass key topics: communication with hospital staff, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of hospital environment, quietness of hospital environment, and transition of care.

READMISSIONS 

The 30-day unplanned readmission measures are estimates of unplanned readmission to any acute care hospital within 30 days of discharge from a hospitalization for any cause related to medical conditions, including heart attack (AMI), heart failure (HF), pneumonia (PN), chronic obstructive pulmonary disease (COPD), and stroke (STK); and surgical procedures, including hip/knee replacement and cornary artery bypass graft (CABG). The 30-day unplanned hospital-wide readmission measure focuses on whether patients who were discharged from a hospitalization were hospitalized again within 30 days. The hospital-wide readmission measure includes all medical, surgical and gynecological, neurological, cardiovascular, and cardiorespiratory patients. Hospitals’ rates are compared to the national rate to determine if hospitals’ performance on these measures are better than the national rate (lower), no different than the national rate, or worse than the national rate (higher).

HEALTHCARE-ASSOCIATED INFECTIONS

The Healthcare-Associated Infections (HAI) Measures show how often patients in a particular hospital contract certain infections during the course of their medical treatment, when compared to like hospitals. HAI measures provide information on infections that occur while the patient is in the hospital and include: central line-associated bloodstream infections (CLABSI), catheter- associated urinary tract infections (CAUTI), surgical site infection (SSI) from colon surgery or abdominal hysterectomy, methicillin-resistant Staphylococcus Aureus (MRSA) blood laboratory-identified events (bloodstream infections), and Clostridium difficile (C.diff.) laboratory-identified events (intestinal infections). The HAI measures show how often patients in a particular hospital contract certain infections during the couse of their medical treatment, when compared to like hospitals.

COMPLICATIONS AND DEATHS

The 30-day death measures are estimates of deaths within 30-days of a hospital admission from any cause related to medical conditions, including heart attack (AMI), heart failure (HF), pneumonia (PN), chronic obstructive pulmonary disease (COPD), and stroke; as well as surgical procedures, including cornary artery bypass graft (CABG). Hospitals rates are compared to the national rate to determine if hospitals performance on these measures is better than the national rate (lower), no different than the national rate, or worse than the national rate (higher).

PAYMENTS AND VALUE OF CARE 

The payments included in this measure are price-standardized and risk-adjusted.
The payment measures for heart attack, heart failure, pneumonia, and hip/knee replacement include the payments made for Medicare beneficiaries who are 65 years and older. The measures add up payments made for care and supplies starting the day the patient enters the hospital and for the next 30 days or 90 days for hip/knee replacement. The measures are meant to reflect differences in the services and supplies provided to patients. You can see whether the payments made for patients treated at a particular hospital is less than, no different than, or greater than the national average payment.

INPATIENT PAYMENT DETAILS

This function displays hospital-specific data and charges published by Medicare for U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for discharges paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG).

Hospitals determine what they will charge for items and services provided to patients and these charges are the amount the hospital bills for an item or service. For these MS-DRGs, average charges, average total payments, and average Medicare payments are calculated at the individual hospital level. 

OUTPATIENT PAYMENT DETAILS

This function includes estimated hospital-specific charges for select Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS). The Medicare payment amount includes the APC payment amount, the beneficiary Part B coinsurance amount and the beneficiary deductible amount. The estimated average charges and the average Medicare payments are provided at the individual hospital level.

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