Financial Data (below)
Quality measures and mixed incentives
Readmission penalties or xls (6MB)
Biggest penalties (methods)
Previous data: Readmission Penalties (August 2013, 3 MB xls)
List of Accountable Care Organizations (many include hospitals)
Other Medicare data
Medicare Costs, Premiums, and Alternatives
Hospital Financial Statements
A spreadsheet (5MB) shows each hospital's financial statements, and many Medicare calculations at each hospital. It includes both Medicare and non-Medicare revenue and spending. It is compiled by Medicare to provide a context for Medicare spending in each hospital, and is called a "Medicare Cost Report"
The spreadsheet includes:
The spreadsheet has brief labels; fuller explanations are in the original Medicare form and instructions. Chapter 40 of Medicare's manual has the form (R6P240f), including work sheets S (p.1), A (p.22), E (p.84), and G (p.100). Chapter 40 also has the instructions (pr2_40, abbreviations are on pp.9-11), which can answer many questions about the entries on the form. The current format has been used since 2010, and other data are available back to 1995.
Another article shows helpful commands for the spreadsheet.
The source also has each hospital's occupancy rate for several departments: general, maternity, ICU, coronary care, burn, hospice, psychiatric, rehab, etc. These have not been put in this spreadsheet. If you would find the occupancy rates useful, please leave a comment below or send an email.
The original Medicare databases are available from 1995 to the present. They are far more complex than the spreadsheet, with 3 types of records, and millions of records, since every number and answer on each form has a separate record. For those who need it, a CMS documentation page has record counts, a spreadsheet of hospitals covered, and layouts. The Medicare database averages 3,000 numeric records and 600 alpha records per hospital each year. 65 key items are in the spreadsheet, and others can be available if needed.
Other Hospital Financial Data
Electronic Municipal Market Access (EMMA) has PDF copies of operating expense and audited financial statements for each hospital (or other facility), if it has outstanding tax-free bonds. Put hospital name in their search box, to list its past & present bonds. Click any bond which is still outstanding (on right), accept the disclosure, then click "Continuing Disclosure" to see annual and sometimes quarterly data. The data are similar to the spreadsheet above, but in PDF, often with more data from the past, but fewer hospitals.
"Summary of audit findings and federal awards" is an Audit Clearinghouse form a few pages long for each hospital showing checkoffs for any audit findings, and the amount of each federal grant spent during a year ("awards"); it does not cover Medicare or Medicaid, since these are exempt from the federal "single audit" rules. It also shows address, Employer ID number (EIN) and DUNS number.
IRS form 990 is available from Guidestar or Foundation Center for US nonprofit hospitals. It shows total revenue and expense and highly paid staff (schedule J ) and contractors (VII-B). It also shows total received from Medicare and Medicaid in section VIII-2 "Revenue, Program Service," and several types of expenses in section IX, balance sheet in X, political spending in schedule C.
Canadian nonprofits (non-governmental organisations, NGOs) have financial information at donate2charities.ca
1. Hospital Quality measured by:
Medicare reports many issues as quality measures, and imposes financial penalties which are estimated in the hospitals' financial statements on this site: HAC, VBP, IQR, EHR, and readmissions. Unfortunately all these measures create incentives for hospitals to give less treatment to sicker patients, since sicker patients hurt the hospital's statistics and earn penalties.
Medicare reports the death rate within 30 days after a hospital stay. However their death rate excludes patients who go on hospice. This exclusion reduces the apparent death rate, and creates a strong incentive for hospitals and doctors to urge the sickest patients onto hospice, whether they have a real chance of cure or not, since deaths on hospice don't hurt the hospital's statistics. As with most medical incentives, medical staff who urge hospice do not reveal their incentives. (methods)
US News and World Report does not show an exact death rate, but shows hospital death rates (within 30 days) in deciles for particular diseases. They do not exclude hospice or palliative care, so they don't create an incentive for hospitals to hide deaths by referring to hospice. They generally omit transfers from other hospitals, to avoid high death rates in major hospitals which receive many transfers of the very ill. So they are trying not to penalize hospitals which serve the sickest patients. They adjust to reflect all patients, not just the elderly, and slightly adjust to reduce random variation in the smallest quarter of hospitals. (methods)
Consumer Checkbook (subscription $22 for 2 years) shows hospitals' exact risk-adjusted death rates (within 90 days), for medical patients, surgical patients, and combined, based on 10 serious medical diagnoses and 14 surgical. They use Medicare patients from Oct 2009 - Sept 2012, and do not exclude hospice or palliative care patients, so hospitals can't hide deaths by referring to hospice. They also show a combined "adverse outcomes" rate for surgical patients, the total of deaths, atypically long stays, which indicate major complications, and readmissions within 90 days of initial hospital discharge. Penalizing readmissions does penalize care for the sickest patients, who are more likely to need another hospital stay within 3 months. (methods)
Ratings of doctors by Checkbook, ProPublica and others are discussed on another page.
Hospitalinspections.org counts and describes "deficiencies cited during complaint inspections at acute-care, critical access or psychiatric hospitals throughout the United States since Jan. 1, 2011. It does not include results of routine inspections or those of long-term care hospitals. It also does not include hospital responses to deficiencies cited during inspections." (emphasis added)
Healthgrades does not show an overall death rate, but reports hospital death rates for over 20 diagnoses. For non-surgical diagnoses, they ignore deaths of patients discharged to hospice. Starting in 2014 they no longer ignore deaths of patients who saw a palliative care doctor in the hospital. Through 2013, for half of diagnoses, they omitted patients from the death rate who saw a palliative care doctor in the hospital (methods: 2014 and 2013).
Healthgrades has a risk calculator for 6 common surgeries, which shows hospitals near you with low rates of death and complications, and it shows high-volume doctors at those hospitals. Their definition of high volume is a mix of high volume on the procedure you need along with total volume for all procedures. You can get more specific information on experience with these 6 and all other procedures on another page.
NICHE (Nurses Improving Care for Healthsystem Elders) lists hospitals which have adopted strong programs in Geriatric nursing, so they offer better care and healing for seniors. Many of these hospitals have Acute Care for the Elderly (ACE) units. They encourage walking, try not to interrupt sleep, and they minimize prescriptions. They encourage hospitals to help caregivers as well as patients. The search function at NICHE does not show which hospitals have exemplary programs, nor even the closest programs, so here is a spreadsheet.
Leap Frog Group asks hospitals how well they comply with certain quality standards, and has answers for about a quarter of hospitals. (methods)
Dartmouth Atlas has multiple lists with unique information on hospitals:
- Types of health care used during last 2 years of life by Medicare patients who died in 2010. Also some earlier years. This shows use of doctors, hospitals, nursing homes, hospice, home health: average days and spending. (methods)
- Readmission rate, and use of doctors during 30 days after discharge from a hospital, for Medicare patients who were admitted in 2010. Also some earlier years (methods)
Truven, (subscription) formerly part of Thomson Reuters, now uses Medicare data on deaths and readmissions (methods) at hospitals.
Consumer Reports (subscription $7/month or $30/year) groups Medicare data on readmissions into categories, and shows many hospitals at once, so it may be easier to use though less precise than the Medicare site. (methods). They also have heart surgery data on hospitals, described in the next paragraph.
Heart surgeons show 3-star ratings on about 500 hospitals and 500 group practices (typically the group of surgeons operating at a hospital), for
- Coronary artery bypass grafts (CABG) and
- Aortic valve replacements (AVR).
- For 60 hospitals they rate surgery on congenital heart defects
Cardiologists show 4-star ratings for use of recommended drugs by a few hospitals after
- Implanting Cardiac Defibrillators, and
- Diagnostic Catheterization and Percutaneous Coronary Intervention (PCI/Angioplasty)
California rates hospital quality on:
- hip/knee replacments: Medicare 30-day unplanned readmissions, all ages' surgical site infections, and 8 Medicare patient complications: heart attack-7 days, pneumonia-7 days, sepsis/shock-7 days, surgical site bleeding-30 days, pulmonary embolism-30 days, death-30 days, mechanical complications-90 days, joint/wound infections-90days
- childbirth: cesareans (spelling), episiotomies, breastfeeding in hospital, vaginal birth after cesarean, cesarean infections.
- colorectal cancer screening of adults 50-75
- lower back pain patients who had X-ray, MRI, or CT scan within 28 days of the diagnosis (fewer is considered better)
- diabetes/blood: kidney function screenings, HA1c blood sugar testing, HbA1c <8.0%, blood pressure <140/90, cholesterol screenings, cholesterol LDL-C <100
Luxury Suites are available at many hospitals for $250 to $2,500 extra per day.
Review article in 2010 covered similar information at that date. It recommended that hospital staff should learn how hospice and palliative care affect the ratings from each group, so each hospital can get ratings as high as possible.
2. Other Incentives to Leave Patients Untreated
- "Patients who are not receiving adequate preventive care will be excluded [by doctors, from getting care], and providers who take on care of these patients can be financially penalized.
- "The patients most in need of care coordination will be excluded, and providers who provide coordination to complex patients may be financially penalized.
- "Providers can be financially penalized for keeping their patients healthy...
- "[P]erverse incentive for a physician not to become involved with a patient who already incurred significant healthcare spending earlier in the year, even though these are the patients who may most need additional help...
- "Spending Measures Do Not Distinguish Appropriateness of Services ...
- "Risk Adjustment Systems Do Not Adequately Adjust for Patient Needs"
Medicare publishes death rates to help people choose safe hospitals. However they omit your death if you have been in hospice any time in the past year. It is in the hospital's interest (even if not the patient's) to promote hospice for at least a day per year to patients who they think are most likely to die. Hospice takes them out of the reported death rate. Hospitals cannot ethically suggest coming off hospice after a day, so the patient's treatment shifts to hospice.
Medical groups (ACO - Accountable Care Organizations) have a quality standard to avoid high hospital-wide readmissions (HWR) of their patients, but patients who die within 30 days of the first discharge are excluded from that standard (p.11 and p.53523). Hospitals were rated on the same measure starting October 2014. In either case when a patient is readmitted in less than 30 days, the group or hospital looks better if the patient dies within the same 30 days, so the readmission can be excluded.
Hospitals are rated on hospital-wide readmissions from all causes, and some procedures have more readmissions than others, especially among the elderly, so hospitals have an incentive to minimize these procedures.
Healthgrades death rates ignore your death if the hospital has sent a palliative care doctor to see you, or if you are discharged to hospice. Hospitals know that some consumers use Healthgrades to evaluate hospitals, so they have an incentive to promote palliative care and hospice.
Consumer Checkbook hospital data, ProPublica surgeon data, and US News and World Report do not exclude hospice or palliative, so they provide a more complete picture, and less incentive to push patients into hospice.
The US Department of Justice prosecutes hospitals and doctors for billing Medicare for care outside Medicare guidelines, even if appropriate under other expert guidelines. The investigations chill the willingness of doctors to provide care.
3. Doctors' Quality
- Download and open the spreadsheet of codes used at hospitals, Globe1234.org/hosp.xlsx
- After it opens, click "Enable editing" at the top, if it asks
- Click the B at the top of column B to highlight the whole column of procedure names
- Press Ctrl and F at the same time, or click Home/Find, or View/Find, or Menu/Find
- Type a search word in the Find box, like knee, and click "Find All." Use up and down arrows to see all the choices in the file.
- Note the codes and search before and after them for related work. For example a search on "knee" gives 10 codes between 466 and 489. Looking at this range you will see 469 and 470 are "Major Joint Replacement Or Reattachment Of Lower Extremity." That covers knee and hip replacements even though they don't use either word.
- They use abbreviations such as: Exc-except, Mcc-major complications and comorbidities (defined here), Mv-mechanical Ventilation, Pdx-principal diagnosis, W-with, W/O-without
- Copy down any codes you want
Download a detailed file of hospitals' experience, the Inpatient Charge Data at:
- Download the latest Detailed Excel data on that page.
- Double-click the downloaded zip file.
- Double-click the xlsx file inside it.
- Save it so you don't have to download it again: Click File/Save As and put it somewhere you can find it, like the desktop.
- Near the top of column A, click the small triangle to see the choices in that column
- Unclick "Select All" or click "Clear"
- Click one or more categories you need, such as 469 and 470
- Click OK if asked
- At the top of Column i - Total Discharges, click the small triangle and click "Sort Largest to Smallest"
- Now the highest volume hospitals are at the top
- You can also see the average amount Medicare allowed for each procedure, and the average charges each hospital submitted for the procedure. These costs do not include the doctor bills, which you would need to find on the Specialists page.
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Timing Of Penalties