Comparing Private Payer and Medicare Payment Rates for Select Inpatient Hospital Services
Hospitalizations reported from March 1, 2020 to June 13, 2020 according to CDC data, https://gis.cdc.gov/grasp/COVIDNet/COVID19_5.html (accessed June 29, 2020).
Eric Lopez, Tricia Neuman, Gretchen Jacobson, and Larry Levitt, How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature (Washington, D.C: Kaiser Family Foundation, April 2020), https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/
“ICD-10 MS-DRGs Version 37.1 R1 Effective April 1, 2020,” Centers for Medicare & Medicaid Services, 2020, https://edit.cms.gov/files/document/icd-10-ms-drgs-version-371-r1-effective-april-1-2020-updated-march-23-2020.pdf
“CARES Act Provider Relief Fund: General Information,” Department of Health & Human Services, accessed May 15, 2020, https://www.hhs.gov/coronavirus/cares-act-provider-relief-fund/general-information/index.html#targeted
See the Methods section for the formal definitions used by the Centers for Medicare and Medicaid Services for each of these diagnosis-related group (DRG) codes.
Peterson, Eric D et al, “Contemporary mortality risk prediction for percutaneous coronary intervention: results from 588,398 procedures in the National Cardiovascular Data Registry,” Journal of the American College of Cardiology 55 (May 4, 2010): 1923-32. doi:10.1016/j.jacc.2010.02.005
“Non-Emergent, Elective Medical Services, and Treatment Recommendations,” Centers for Medicare & Medicaid Services, 2020, https://www.cms.gov/files/document/cms-non-emergent-elective-medical-recommendations.pdf; “Hospital volumes hit unprecedented lows $1.4B daily revenue losses mean long recovery ahead,” Crowe, May 1, 2020, https://www.crowe.com/news/hospital-data-analysis-examines-the-financial-impact-of-covid-19.
“Opening Up America Again: Centers for Medicare & Medicaid Services (CMS) Recommendations, Re-opening Facilities to Provide Non-emergent Non-COVID-19 Healthcare: Phase 1,” Centers for Medicare & Medicaid Services, 2020, https://www.cms.gov/files/document/covid-flexibility-reopen-essential-non-covid-services.pdf
Examining the Impact of Health Care Consolidation: Statement before the Committee on Energy and Commerce Oversight and Investigations Subcommittee, 115th Cong. (2018), https://docs.house.gov/meetings/IF/IF02/20180214/106855/HHRG-115-IF02-Wstate-GaynorM-20180214.pdf
The annual averages of the Consumer Price Index for all Urban Consumers (CPI-U) were 236.736 and 245.120 in 2014 and 2017, respectively.
The value of the relative weight for MS-DRG 177, respiratory infections and inflammation with major comorbidities or complications, decreased from 1.9934 in FY 2014 to 1.8672 in FY 2017—a 6.3 percent change decrease.
Rabah Kamal, Daniel McDermott, and Cynthia Cox, How has U.S. spending on healthcare changed over time?(Washington, DC: Kaiser Family Foundation, December 2019), https://www.healthsystemtracker.org/chart-collection/u-s-spending-healthcare-changed-time/#item-start
The value of the relative weight for MS-DRG 470, knee and hip replacement, decreased from 2.1463 in FY 2014 to 2.0671 in FY 2017—a 4 percent change decrease.
Eric Lopez, Tricia Neuman, Gretchen Jacobson, and Larry Levitt. How Much More Than Medicare Do Private Insurers Pay? A Review of the Literature (Washington, DC: Kaiser Family Foundation, April 2020), https://www.kff.org/medicare/issue-brief/how-much-more-than-medicare-do-private-insurers-pay-a-review-of-the-literature/
Zack Cooper, Stuart V Craig, Martin Gaynor, John Van Reenen, “The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured,” The Quarterly Journal of Economics 134, no. 1 (Feb. 2019): 51–107, https://doi.org/10.1093/qje/qjy020