Team "Sagents" - Charge vs Payment Correlation

Team "Sagents" - Charge vs Payment Correlation

Our visualization hinges on the use of detailed claims data to better understand the relationship between charge and actual price paid.
When CMS first came out with the results, many hospitals objected by saying that patients rarely pay the charge price. We wanted to see if this was actually the case.

We obtained free and publicly available New Hampshire Commercial claims data for 2011. While not specific to Medicare, this can be viewed as a case study.

Each visualization shows average charge, insurer payment, and member liability. Setting normalized = yes shows amounts relative to the maximum possible for that payment type. The first visualization shows by place of service, and the second by APC.

In the non-normalized view, we see a steep discount as charge greatly outweighs what was paid by both insurer and patient.

In the normalized view, we find that the member payments have little correlation to the billed amounts, though insurer does.

Our conclusion is that the most important person – the consumer – has been removed from the cost equation. While we by no means suggest that members ignore other important factors such as provider quality and access to care, when consumers are not aware of the actual costs, they cannot support a cost-conscious environment. If one person pays more, we all pay more.

We hope that this visualization is a step forward in providing price transparency to the consumers of health care so that individuals may be able to make more informed decisions that benefit all.

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Posted Aug 26, 2013
Views: 597
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Tools mysql, Tableau
New Hampshire Public Use Data Set - Claims Data
APC to HCPCS Mapping (found on CMS Website)
Medicare APC Outpatient Charges
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