FAQs

Did You Know?

Quality Data

• What is the Price and Quality Transparency Initiative?

  The purpose of this initiative is to increase transparency of price and quality data in participating hospitals. By being transparent with this information, hospitals will continue to improve the quality and safety of care provided, improve health in their communities and increase the value of care received. This focus commonly is referred to as the Triple Aim — better health, better care and lower costs. The goal of the initiative is to provide current and complete information to consumers, while increasing statewide efforts to reduce variation in outcomes and better coordinate care across all settings through noncompetitive methods.

• Why is MHA pursuing the Price and Quality Transparency initiative?

  The industry and environment are changing. Consumers and others want more information about the cost and quality of health care services. Participating hospitals' leaders are voluntarily sharing information that is current, complete and correct. By being proactive, the hospital community can demonstrate its commitment to safe, affordable, quality care.

• Will this really have an effect on the quality of care provided?

  Research has shown that, through transparency, hospitals can improve quality care related to readmissions and reducing harm by approximately 15 percent.

• What data is included in the Quality Transparency Initiative?

  There are 23 measures included for consumers to review quality of care. These measures are categorized into four areas: managing chronic diseases, reducing readmissions, preventing infections and reducing harm. The information displayed is collected from patient discharge records or abstracted from hospital records. Some hospitals do not treat patients with these conditions or are not required to report the outcome, and therefore may not have information displayed in some categories. Children’s hospitals report three chart-abstracted measures in the preventing infections domain. These measures are specific to the population of those specialty hospitals.

• How often is the quality data reported?

  The quality data currently will be updated on Focus on Hospitals every three months.

• Will all hospitals have all information reported?

  No. If there are not enough cases for a particular measure, the data can be misleading. Therefore, information only will be shown if there are at least 25 cases per 12-month reporting period or 36-month reporting period for readmissions. If a hospital does not have the minimum amount of cases required, their data will not be displayed on Focus on Hospitals.

• Why do different websites have different values for quality of care?

  The specific definition of what is collected, the source of data and the time period collected all significantly affect the information displayed. For example, information available on Hospital Compare typically is older data and includes only patients 65 and older that receive Medicare benefits. The information displayed on this website includes all patients ages 18 and older that receive care, regardless of their source of insurance or method of payment.

• How were these measures selected?

  The quality of care measures were selected based on agreement from providers and national organizations and experts. The measures chosen represent the primary goal of quality care — do no harm. Infections, falls and unnecessary hospitalization or unplanned readmission are areas hospitals strive to improve.

• What factors may affect patients’ outcome of care?

  There are many factors that affect the outcome of any patient experience. For example age, race and ethnicity, education, community setting, environment, poverty, nutrition, and current health status all may affect how well a patient responds to treatment both immediately and long-term.

• Can you compare hospitals from different communities?

  Because different patient populations have different health outcomes, simply comparing the number or percentage of some quality measures will not provide an accurate comparison. To make a more accurate comparison, some measures are “adjusted.” This is a common statistical step so that comparison may be similar. However, even adjusting the data cannot guarantee an identical comparison of “apples to apples.”

• What do you mean when you say the data are “adjusted?”

  Adjusting data is a common statistical step to more accurately compare the outcomes among different hospitals. Some hospitals may serve patients that are sicker or poorer than other hospitals. Adjusting the data for the risk of needing care makes it possible to compare performance. For example, a hospital that provides care to older patients will have different outcomes for chronic diseases than a hospital that provides care to a younger group of patients. Therefore, the data for these two hospitals would be age-adjusted to allow comparison. Other common types of adjustments include existing illnesses and sex. In this report, quality information about preventable hospitalizations and readmissions have been adjusted to increase the comparability of data. The preventable hospitalizations have been adjusted for age group and sex. The information for readmissions is adjusted for several factors. Currently, the government agencies responsible for reviewing quality information adjust the readmission data for age, past medical history and other diseases or conditions. However, there is emerging national research that suggest poverty and other community factors increase the likelihood a patient will have an unplanned readmission to the hospital within 30 days of discharge. Based on new research and suggestions, the readmission data in this report have been adjusted for age, past medical history, other diseases or conditions, as well as Medicaid status and neighborhood poverty rate.

• What is the source of data for quality measures?

  The data used for the price and quality data measures is patient hospital discharge data. This source was used to ensure consistent data sources from all providers. However, this data source is not perfect. It is recognized that other data sources and calculations would provide more accurate rates, at the hospital level.  In particular, for infection rates, this source and method of calculation may result in higher rates than are reported with more exact and sensitive data sources and calculations. For example, the method used may not fully capture and exclude patients who come to the hospital with an early infection already in development. As national quality reporting is refined, MHA anticipates being able to improve the data source and calculation for infection rates in 2016. These measures do not fully explain the level of quality care provided in a hospital. If you have questions, please talk to your care provider.

• Do the state averages provide a comparison for all hospitals?

  The state averages for each quality measure includes data from hospitals that primarily provide acute care services to adult patients for a limited period of time. As a result, the state average may not represent the average for pediatric, psychiatric, rehabilitation and other hospitals that serve a specific and unique population.

• What is a critical access hospital (CAH)?

  Critical Access Hospital (CAH) is a designation given to eligible rural hospitals by the Centers for Medicare and Medicaid Services (CMS). Missouri has a total of 36 CAHs. Eligible hospitals must meet the following conditions to obtain CAH designation: Have 25 or fewer acute care inpatient beds; be located more than 35 miles from another hospital (exceptions may apply); maintain an annual average length of stay of 96 hours or less for acute care patients; and provide 24/7 emergency care services.

• What is a pediatric hospital?

  A pediatric hospital is a hospital that offers its services exclusively to children and adolescents. Most children's hospitals can serve children from birth up to the age of 18.

Pricing Data

• What factors should I consider when choosing a hospital?

  Hospitals of all sizes and locations have varying treatments, procedures, costs and quality ratings. Consider all of these factors when choosing which hospital is right for you.

• Why can’t I find the diagnosis or medical condition I’m looking for?

  Data is displayed for the 100 most common diagnoses and medical conditions admitted to participating hospitals. If you can’t find what you’re looking for, contact a hospital to inquire about your options.

• Why are ranges shown on the site?

  Every person is unique and can face a varying range of complications that affect cost, which is why you’ll see a charge range on your results page.

• What’s the difference between a charge and expected payment?

  A hospital "charge" is not the same as "expected payment." "Charge" is the amount billed for a service. In the vast majority of cases, hospitals are paid considerably less than the billed amount. Because each person's case is different based on that patient's medical condition, a given patient's charge will not necessarily be the same as the average or median charge. Furthermore, the actual amount paid by a patient will depend on that patient's insurance coverage.

• Why do hospital charges vary between hospitals?

  To learn more about how charges vary between hospitals contact your insurer to learn who is in your network and what your costs will be.

• Why is hospital billing so complex?

  Hospital billing is based on many factors such as staffing, equipment, maintenance costs and the differences in care needed by each patient. Every patient’s case is special and requires different levels of care. Hospitals are prepared with doctors, nurses and high-tech equipment 24/7 for illness or injury from a broken bone to a major accident.

• What’s the difference between Medicare, Medicaid and commercial insurance?

  Every insurer, whether Medicare, Medicaid or commercial, pays the hospital differently. If you have Medicare or Medicaid, the government sets the rates for how much is covered. Like commercial insurance, there may be some out-of-pocket costs.

• What is Medicare?

  Medicare is a health insurance program for people age 65 or older, or under 65 with certain disabilities or conditions. For Medicare, hospitals generally receive payment of only 86 cents for every dollar of actual cost of providing care (American Hospital Association).

• What is Medicaid?

  Medicaid is a joint federal and state program that helps with medical costs for people with low incomes. For Medicaid, hospitals generally receive payment of only 89 cents for every dollar of actual cost of providing care (American Hospital Association).

• What is commercial insurance?

  If you have commercial insurance, insurers negotiate payment rates with hospitals. These rates can differ among companies, and demands for discounts by commercial insurance companies create further complexity for hospitals and patients to determine the true cost of any given procedure.

• I have commercial insurance. How much will I have to pay?

  Commercial insurers do not pay full hospital charges. Numerous factors, such as the type of plan, co-pay amount, co-insurance amount, deductible, out-of-pocket maximums and other limitations will affect the individual’s financial responsibility to a hospital. Therefore, it is crucial that you begin by talking to your insurance company to understand all of the factors affecting your financial responsibility.

• What does self-payment mean?

  Self-payment is when a patient pays for a health-related service when they don’t have insurance to cover their medical treatment or surgery. Currently, about 173,000 adults in Missouri don’t have insurance. Oftentimes, hospitals will provide a discount for self-pay patients.

• What if I don’t have insurance?

  For patients who do not have insurance, hospitals typically have financial assistance programs for patients who qualify. Contact your hospital to determine if you qualify for any programs they may offer.

• For what procedures is there price information?

  The low, median and high charges for the top 100 diagnosis related groups (statewide) and five levels of emergency department services are posted. This data represents all hospital types.

• What other information is listed for those procedures?

  In addition to the low, median and high charges, information on those procedures is listed for average length-of-stay, volume and self-pay discount.

• Is there a minimum threshold for price reporting?

  Yes. The minimum threshold for reporting is 20 cases for the 12-month reporting period. These hospitals will not be displayed, but will be included in the state-aggregate calculation. It is noted that they are participating in the program.

• How often is the price data reported?

  The price data will be updated quarterly.

• How are number of cases per year determined?

  The number of cases per year displayed for each medical diagnosis reflects the total number of encounters with patients the hospital experienced for a specific time period.

• Why are charges at pediatric hospitals different from other hospitals?

  Charges for services performed at a dedicated pediatric hospital reflect the unique needs of this patient population and tend to be higher than those at adult or other hospitals. Contributing factors include: lower staff to patient ratio, more required resources per patient, technology and equipment specially designed and sized to care for children preemie to 21 years old and higher level of staff specialization required to meet the often complex patient needs.

Community Investment Data

• What is community benefit?

  Hospitals’ value to the communities they serve is much broader than the delivery of health care services. Their total community benefit includes charity care, absorbing bad debt and the unpaid costs of treating beneficiaries of Medicare and Medicaid, helping educate and train the health care workforce, offering free clinic services, and donating to local causes.

• What is economic impact?

  Hospitals are a key component of Missouri’s economy, providing a significant economic boost to the communities they serve. Spending on employees, supplies and capital projects support local and statewide economic activity.

• What is charity care?

  All hospitals have charitable care policies that provide free medical care to individuals who don’t have insurance and/or the ability to pay. This amount is the free care provided by the hospital.

• What is bad debt?

  A hospital may incur a significant amount of bad debt for several reasons. Patients with insurance have a co-pay, or out-of-pocket amount, for which they are responsible. However, some patients have difficulty paying their out-of-pocket costs. In additional, many patients who work are uninsured. When they encounter an unexpected illness or injury, they often plan to pay for the care themselves. Many times, the cost of care is much higher than they expected or their illness left them unable to work, resulting in an unpaid hospital bill. In addition, many hospitals may have different accounting practices and classify some free care as bad debt.

• What is uncompensated care?

  Uncompensated care is the combined total of bad debt and charity care provided by the hospital.

• What is unpaid costs of treating Medicare beneficiaries?

  The cost of providing care to Medicare patients that is more than those costs that are allowable in the Medicare cost report

• What is unpaid costs of treating Medicaid beneficiaries?

  The cost of providing care to Medicaid patients that is more than those costs that are allowable in the Medicaid cost report

• What are donations?

  Donations are funds and in-kind services donated to individuals and the community at large. This includes contributions to not-for-profit community organizations, the Missouri Regional Poison Control Network, sponsorship of charity events to not-for-profit organizations after subtracting value of participation.

• What is meant by “education of health professions?”

  This is the costs incurred in providing clinical or classroom settings for vocational, technical and professional education programs and/or the services provided to support those programs that lead to degrees or certifications. It includes graduate medical education programs, clinical settings for undergraduate training, internships, clerkships and residencies, and continuing medical education offered to physicians outside the medical staff on subjects for which the hospital has special expertise. It also includes scholarships for professional education provided to volunteers and nonemployees that are not provided as an employee benefit or that have no obligation for work repayment.

• What are medical clinic services?

  The costs of bad debt and free or low-cost health care to medically uninsured persons resulting from the operation of physician offices or free clinics and/or through the use of volunteer physicians and health care professionals who donate their time if the hospital incurs the cost of their salary; includes hospital subsidies such as grants, costs for staff time, equipment, overhead costs, lab and medication costs; also includes services provided to free clinics operated by other agencies if the hospital incurs a cost