CMS unveils dataset on top hospital discharge payments

Liz Seegert


The public can now compare hospital-specific charges for the top 100 most frequently billed discharges at the 3000+ hospitals across the US that receive Medicare payments.  The Center for Medicare and Medicaid Services unveiled its free Medicare provider charge dataset which can be analyzed down to ZIP code level.

Jonathan Blum, acting principal deputy administrator of CMS, said in a webinar with AHCJ members that this effort has been years in the making, as part of the agency’s effort to be more transparent.

Data for FY 2011 is on the AHCJ website, downloadable as an Excel file (a CSV file is available from CMS). From there, it can be sorted by diagnosis related group (DRG) codes, city, state, ZIP and charges. This tool allows journalists, advocates and consumers to compare costs nationally, between or among states, cities, or counties. Data is only available for Medicare Inpatient Prospective Payment System (IPPS) — the fee-for-service component — based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG). These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges. It does not include data for U.S. territories or Puerto Rico, or for any Medicare Advantage payments.

Chris Powers, acting director of the Information Products Group, Office of Information Products and Data Analytics demonstrated the dataset by comparing the varying cost of a total joint replacement. Selecting the specific DRG code netted charges ranging from $321,000 to just over $20,000.

The goal is to empower consumers, particularly those who are uninsured and may have to bear the entire cost, who may be underinsured, or who have a high deductible, to ask about appropriate charges  for a given procedure and question discrepancies that cannot be explained by geography, patient population, or affiliation differences. Medicare IPPS pays a fixed cost to hospitals, however, this data can be used as a guideline for non-Medicare fee-for-service charges.

In the Q&A section of the webinar, I asked if there would be a similar data set compiled for Medicare Advantage payments so consumers insured under those plans can also compare charges. Powers said CMS is looking at what the next steps are in terms of data release. “That is a very good question and certainly those concerns are in our minds as we make those considerations.”

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Liz Seegert

Liz Seegert

Liz Seegert is AHCJ’s health beat leader for aging. She’s an award-winning, independent health journalist based in New York’s Hudson Valley, who writes about caregiving, dementia, access to care, nursing homes and policy. As AHCJ’s health beat leader for aging,