Date of Award

January 2023

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Nihar Desai

Abstract

Our study seeks to use newly disclosed hospital price transparency data to understand associations between average payer-negotiated prices, outcomes and hospital characteristics. Data on prices, outcomes and hospital characteristics for 4 commonly hospitalized conditions - Acute Myocardial Infarction (AMI), Heart Failure (HF), Chronic Obstructive Pulmonary Disease (COPD) and Hip/Knee Replacements (THR/TKR) - were acquired from publicly available hospital chargemasters and Medicare’s Hospital Compare database. Mann-Whitney U and ANOVA tests were conducted comparing prices and key hospital characteristics (geography, urban/rural location, Medicare percentage, Medicaid percentage, and ownership). Linear regressions were conducted exploring the effect of outcomes (mortality, readmissions) and hospital characteristics on prices. Geography (Northeast) and urban location were the only hospital characteristics consistently significantly associated with lower prices across conditions even after adjusting for geographic differences in cost of care delivery. Higher prices were significantly associated with decreased readmissions in AMI, HF and COPD, and increased mortality in HF; however, predictive reliability was small with low R values. Subgroup analyses exploring how hospital characteristics are associated with prices and outcomes found that relationships between higher prices and lower readmissions persisted in urban but not rural hospitals, and persisted in the Midwest but not Northeast hospitals. No other subgroup analyses findings were consistent across conditions. Taking a cross-section of emergent to elective conditions requiring hospitalization, measures associated with hospital competitiveness (northeast geography and urban status) appear to be most clearly associated with lower prices, suggesting prices are set by hospital negotiating power. Hospitals with higher negotiated prices appeared to have decreased readmissions in conditions except hip/knee replacement, perhaps suggesting greater resources to coordinate high quality care to prevent readmission. Overall, no clear and consistent patterns emerge for hospital characteristics that vary with the relationship between prices and outcomes.

Comments

This is an Open Access Thesis.

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