relative price · 2020-04-01 · 1 relative price | may 2017 center for health information and...

PROVIDER PRICE VARIATIONIN THE MASSACHUSETTSCOMMERCIAL MARKET

REL ATIV E

CENTER FOR HEALTH INFORMATION AND ANALYSIS

M AY 2017

PRICE

iii Relative Price | May 2017 center for health information and analysisCHIA

Table of Contents

About this Report . . . . . . . . . . . . . . . . . . . . . . 1

Executive Summary . . . . . . . . . . . . . . . . . . . . 2

Acute Hospital Payer-Specific Relative PriceDistribution of Acute Hospital Commercial Payments by Relative Price (RP) Quartile, 2012-2015 . . . . . . . . . 3

Distribution of Acute Hospital Commercial RP Among Top 7 Payers, 2015 . . . . . . . . . . . . . . . . . . . 4

Acute Hospital Statewide (Cross-Payer) Relative PriceDistribution of Acute Hospital S-RP by Insurance Category, 2015 . . . . . . . . . . . . . . . . . . 5

Acute Hospital S-RP and Share of Commercial Payments by Cohort, 2015 . . . . . . . . . . . . . . . . . . . 6

Acute Hospital S-RP and Share of Commercial Payments by System, 2015 . . . . . . . . . . . . . . . . . . . 7

Academic Medical Center Share of Commercial Payments and S-RP, 2015 . . . . . . . . . . . . . . . . . . . 8

Teaching Hospital Share of Commercial Payments and S-RP, 2015 . . . . . . . . . . . . . . . . . . . 9

Community Hospital Share of Commercial Payments and S-RP, 2015 . . . . . . . . . . . . . . . . . . 10

Community-High Public Payer Hospital Share of Commercial Payments and S-RP, 2015 . . . . . . . . . . 11

Physician Group Payer-Specific Relative PriceDistribution of Physician Group Commercial Payments by RP Quartile, 2011-2014 . . . . . . . . . . . . . 12

Distribution of Physician Group Commercial RP Among Top 6 Payers, 2014 . . . . . . . . . . . . . . . . 13

Physician Group Share of Commercial Payments and Composite RP Percentile, 2014 . . . . . . . . . . . . . 14

1 Relative Price | May 2017 center for health information and analysisCHIA

In 2016, the Center for Health Information and Analysis (CHIA) developed a new metric, statewide relative price (S-RP), to facilitate analysis of provider price variation across payers. CHIA’s previous publications on provider price

variation used payer-specific relative prices (RP) to compare provider prices within a payer’s network. S-RP allows for

provider price comparison across payers within an insurance category.

A hospital’s S-RP is calculated using payer-specific inpatient payments per case-mix adjusted discharge and payer-

specific outpatient RP values. For each hospital, CHIA converted these payer-specific values into cross-payer relativities

and then blended these inpatient and outpatient values together to achieve a single S-RP value. When blending across

payers and across inpatient and outpatient spending categories, CHIA weighted these elements according to the

provider-specific share of payments. A commercial S-RP for a given acute hospital of 1.20 indicates that the hospital is

paid 20 percent higher than average S-RP among acute hospitals across commercial payers. For additional information

on the S-RP methodology, see CHIA’s Methodology for the Calculation of Statewide Relative Prices, available here.

This publication includes analysis of acute hospital CY 2015 S-RPs within the Commercial, Medicaid Managed Care

Organization, and Medicare Advantage insurance categories. S-RP values are calculated for individual acute hospitals,

and average S-RP values are calculated for multi-acute hospital systems, and acute hospital cohorts. This report also

includes information on payer-specific acute hospital RP and physician group RP.

For detailed data, please see accompanying databook. For questions on Statewide or Payer-Specific RP, please contact

Erin Bonney, Manager of Payer-Provider Performance, at (617) 701-8235 or at [email protected].

About this Report

1 RP data is reported to CHIA by private and public health care payers pursuant to 957 CMR 2 .00: Payer Data Reporting . Instructions for data submission are detailed in the data specification manual .

http://www.chiamass.gov/assets/docs/g/S-RP-Methods-Memo-2017.pdf

http://www.chiamass.gov/assets/docs/r/pubs/17/Relative-Price-Databook-2017.xlsx

mailto:erin.bonney%40state.ma.us?subject=

http://www.chiamass.gov/assets/docs/g/chia-regs/957-2-00-payer-data-emergency-adopted-reg.pdf

http://www.chiamass.gov/payer-data-reporting-apm-tme-rp/

http://www.chiamass.gov/payer-data-reporting-apm-tme-rp/

2 Relative Price | May 2017 center for health information and analysisCHIA

Pursuant to Massachusetts General Laws Chapter 12C, Section 10, CHIA reports annually on relative price to examine provider

price variation in the Massachusetts commercial market. Relative price (RP) standardizes the calculation of provider prices to

account for differences in patient acuity, the types of services providers deliver to patients and the different product types that

payers offer to their members. CHIA calculates both payer-specific RP and cross-payer statewide relative price (S-RP).

In 2015, $8.7 billion was paid to acute care hospitals in Massachusetts for inpatient and outpatient services provided to patients

with commercial insurance plans. Of those payments, 76.7% were to hospitals with above-average RP. This proportion was

slightly smaller than in prior years; in 2012, 80.6% of payments were to hospitals with above-average RP. For four of the top

seven commercial payers, the majority of commercial payments went to hospitals with RP values within 20% of the average of

their network.

Across the three reported insurance categories (Commercial, Medicaid MCOs, Medicare Advantage), the majority of payments

went to acute hospitals with S-RPs within 20% of the average. However, the share of payments to hospitals with S-RPs greater

than 20% of the average was more than double for Commercial insurance (38%) than Medicaid MCOs (19%) or Medicare

Advantage (14%). Among acute hospitals, Academic Medical Centers had the highest average commercial S-RP (1.17) and

community-High Public Payer (HPP) hospitals had the lowest (0.93).

In 2014, the most recent data year available, $5.5 billion was paid to physician groups for services provided to patients with

commercial insurance plans. Of that, 86% of the payments went to physician groups with above-average RP values. This trend

reflects a 5.0 percentage point increase from 2011, during which 81% of commercial payments to physicians were concentrated

among higher-than-average providers. The top 23 provider organizations represented 96% of total commercial payments to

physicians in 2014.

Executive Summary

Note: Physician payments includes only payments made to physician groups that were included in the relative price calculation after payment thresholds were applied, accounting for 90% of total commercial payments to physician groups . An additional $0 .58 billion was paid to individual physicians and groups for which relative prices were not computed .

3 Relative Price | May 2017 center for health information and analysis CHIA

Since 2012, commercial payments to acute hospitals have been concentrated among the highest-price hospitals (Q4). More than fifty percent of commercial payments to acute hospitals went to providers in the highest relative price quartile .

In recent years, however, the share of payments to hospitals in Q3 and Q4 (hospitals with above-average prices) declined slightly from 80 .6% in 2012 to 76 .7% in 2015—a 3 .8 percentage point decrease .

The share of payments to the lowest-paid hospitals (Q1) has steadily increased from 5 .6% of total payments in 2012 to 7 .9% in 2015 .

Source: Payer reported data to CHIANotes: Within each payer’s network, hospitals are ordered by blended relative price, and grouped into quartiles such that each quartile contains an equal (or as close to equal as possible) number of providers. For each payer, the first quartile (Q1) contains hospitals with the lowest RP values while Q4 contains those with the highest RP values in the network. Payments to hospitals assigned to Q1 are then summed across all payers to calculate total Q1 payments. Note that a specific hospital may be assigned to different quartiles in different payer networks. This figure includes only payments made to acute hospitals that were included in the relative price calculation after payment thresholds were applied, accounting for 99.1% of total commercial payments to acute hospitals . An additional $78 million was paid to hospitals for which relative prices were not computed in at least some payer networks . Percentages may not sum to 100% due to rounding .

Distribution of Acute Hospital Commercial Payments by Relative Price (RP) Quartile, 2012-2015

ACUTE HOSPITALSPAYER-SPECIFIC RP

52.3%28.3%13.8%5.6%

53.9%26.0%13.5%6.7%

54.7%25.6%12.8%6.9%

51.9%24.8%15.3%7.9%

2013

2012

2014

2015

23.3% of Payments($2.01 Billion)








Q1(Lowest RP)

Q2 Q3 Q4(Highest RP)50th Percentile


For four of the top seven commercial payers, more than one-third of total payments to acute hospitals went to hospitals with RPs at least 20% higher than average . For two payers, (Aetna and Neighborhood Health Plan—both reporting 56%), this reflected the majority of their commercial payments to acute hospitals .

Cigna (17%) and Fallon (20%) reported the smallest share of commercial payments to acute hospitals with RPs more than 20% above average .

For most payers, the majority of commercial payments were to acute hospitals with RPs within 20% of average .

In Cigna’s network, the majority (56%) of commercial payments to acute hospitals were concentrated among hospitals with RPs more than 20% below average . This trend was influenced by high-RP outliers. Neighborhood Health Plan also reported a larger share of payments to lower-priced acute hospitals (17%) .

Source: Payer reported data to CHIANotes: Percentages may not sum to 100% due to rounding . Top payers were determined by the payer’s share of total commercial payments to acute hospitals in 2015 .

Distribution of Acute Hospital Commercial RP Among Top 7 Payers, 2015

ACUTE HOSPITALSPAYER-SPECIFIC RP

0 0.5 1.0 1.20.8 1.5 2.0 2.5 3.0

BCBSMA(49%)

HPHC(17%)

Tufts(10%)

Aetna(5%)

Cigna(4%)

NHP(3%)

Fallon(3%)

Relative Price

Paye

r

n=104%

n=113%

n=189%

n=83%

n=4156%

n=1717%

n=189%

Number of hospitals (n) and percent of total network payments, within each relative price interval

n=937%

n=1339%

n=929%

n=1056%

n=1017%

n=1256%

n=1020%

NetworkAverage

n=4359%

n=3262%

n=3641%

n=2227%

n=3072%

n=3958%

n=628%

Payer share of total commercial hospital payments

One additional hospital in Tufts’ network not shown(RP = 3.5)

Three additional hospitals in Cigna’s network not shown(RPs = 3.5, 3.6, 8.5)


ACUTE HOSPITALS

In 2015, the majority of payments went to acute hospitals within 20% of average across the reported insurance categories: Commercial (58%), Medicaid MCOs (75%), and Medicare Advantage (83%).

The share of payments to acute hospitals with S-RPs more than 20% above average varied across insurance categories: Commercial (38%), Medicaid MCOs (19%), and Medicare Advantage (14%).

In all reported insurance categories, the ratio of the highest S-RP and lowest S-RP was 2.9.

Among commercial plans, the hospitals with the highest S-RPs were community/geographically isolated hospitals. Among Medicare Advantage and Medicaid MCO plans, the hospitals with the highest S-RPs were specialty and community-High Public Payer (community-HPP) hospitals.

Among commercial and Medicare Advantage plans, nine acute hospitals had S-RPs more than 20% above average. Among Medicaid MCO plans, 11 acute hospitals had S-RPs more than 20% above average.

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category. For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www.chiamass.gov/assets/docs/g/S-RP-Methods-Memo-2017.pdf.

Distribution of Acute Hospital S-RP by Insurance Category, 2015STATEWIDE (CROSS-PAYER) RP

1.0 1.20.8Statewide Average

n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY

Academic Medical Center

Community Hospital

Community-HPP Hospital

Teaching Hospital

Specialty Hospital

Geographically Isolated

Insu

ranc

e C

ateg

ory

1.0 1.20.8(statewide average)

n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY


Community Hospital


Teaching Hospital

Specialty Hospital


Insu

ranc

e C

ateg

ory


n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY


Community Hospital


Teaching Hospital

Specialty Hospital


Insu

ranc

e C

ateg

ory


n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY


Community Hospital


Teaching Hospital

Specialty Hospital


Insu

ranc

e C

ateg

ory


n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY


Community Hospital


Teaching Hospital

Specialty Hospital


Insu

ranc

e C

ateg

ory

Multi−Acute System

Baystate Health System

Berkshire Health

Systems

Cape CodHealthcare

CareGroup Heywood Healthcare

Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care

Wellforce Unaffiliated

MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital



n=104%

n=4458%

n=938%

n=116%

n=4075%

n=1119%

n=94%

n=4383%

n=914%

Commercial

Medicaid MCO

Medicare Advantage

1.5 2.0

S−RP

KEY


Community Hospital


Teaching Hospital

Specialty Hospital


Insu

ranc

e C

ateg

ory



Acute Hospital S-RP and Share of Commercial Payments by Cohort, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf .For hospital cohort definitions, see http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/ .Specialty Hospitals are omitted because they serve a specific patient population, based on age or type of medical condition, and are not considered comparable to other hospital cohorts; therefore percentages will not add to 100% .

The Academic Medical Center cohort was the only cohort in which all hospitals had S-RP values above the statewide average across commercial payers .

Among hospital cohorts, Academic Medical Centers had the highest average commercial S-RP value (1 .17), while the community-High Public Payer hospital cohort had the lowest (0 .93) .

The community and teaching hospital cohorts had average S-RP values of 1 .05 and 0 .94, respectively . 1.0

.8

1.2

1.4

1.6

1.8

2.0

Cohort

S-RP

StatewideAverage


n = 639% of payments

CommunityHospitaln = 16

17% of payments

Community-HPP


TeachingHospital


Geographically Isolated Hospitals

ACUTE HOSPITALSSTATEWIDE (CROSS-PAYER) RP

1.0

.8

1.2

1.4

1.6

1.8

2.0

Cohort

S-RP

StatewideAverage



CommunityHospitaln = 16

17% of payments

Community-HPP


TeachingHospital


Geographically Isolated Hospitals


http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/


Acute Hospital S-RP and Share of Commercial Payments by System, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf .For a list of hospitals by system, see http://www .chiamass .gov/hospital-systems-and-parent-organizations/ .

Three systems had S-RP values for all their hospitals at or above the commercial statewide average: Partners HealthCare System (n=8), Cape Cod Healthcare (n=2), and Berkshire Health Systems (n=2) .

Two systems had S-RPs below the statewide average for all of their acute hospitals: Tenet HealthCare (n=2), and Heywood HealthCare (n=2) .

Partners HealthCare received the largest share of commercial payments to acute hospitals (32%), and had an average S-RP among its hospitals of 1 .35 .

Average S-RPs fell below 1 .0 across the other largest health systems: CareGroup (0 .92), Lahey Health (0 .92), UMass (0 .91), and Steward (0 .93) .

Hospitals not affiliated with a multi-acute hospital system had an average commercial S-RP of 0 .95 and accounted for 25% of commercial payments to all acute hospitals .


Baystate Health Systemn = 5

4% of payments

Berkshire Health

Systemsn = 22%

Cape CodHealthcare

n = 22%

CareGroup

n = 611%

Heywood Healthcare

n = 2<1%

Lahey Health

n = 37%

Partners HealthCare

n = 832%

Steward Health Care

Systemn = 85%

Tenet Healthcare

n = 23%

UMass Memorial

Health Caren = 46%

Wellforce

n = 24%

Unaffiliated

n = 1725%

.8

1.2

1.4

1.6

1.8

2.0

1.0Statewide

Average

S-RP

KEY


Community Hospital

Community HPP Hospital

Teaching Hospital

Specialty Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Berkshire Health

Systems

Cape CodHealthcare


Lahey Health System

Partners HealthCare

System

Steward Health Care

System

Tenet Healthcare

UMass Memorial

Health Care


MEDIAN

20% ABOVEMEDIAN

1.0

.8

1.2

1.4

1.6

1.8

2.0

SRP

Valu

e

KEY


Community Hospital


Teaching Hospital




Baystate Health Systemn = 5

4% of payments

Berkshire Health

Systemsn = 22%

Cape CodHealthcare

n = 22%

CareGroup

n = 611%

Heywood Healthcare

n = 2<1%

Lahey Health

n = 37%

Partners HealthCare

n = 832%

Steward Health Care

Systemn = 85%

Tenet Healthcare

n = 23%

UMass Memorial

Health Caren = 46%

Wellforce

n = 24%

Unaffiliated

n = 1725%

.8

1.2

1.4

1.6

1.8

2.0

1.0(average)

S-RP

KEY


Community Hospital

Community HPP Hospital

Teaching Hospital

Specialty Hospital



http://www.chiamass.gov/hospital-systems-and-parent-organizations/


Academic Medical Center Share of Commercial Payments and S-RP, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf . For the definition of Academic Medical Centers, see http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/ .

In 2015, 39% of all commercial payments made to acute hospitals went to Academic Medical Centers .

Two hospitals collectively accounted for 24% of all commercial payments made to acute hospitals in 2015, Massachusetts General Hospital and Brigham and Women’s Hospital . Both hospitals had S-RP values of 1 .41, and are part of Partners HealthCare .

Among the six academic medical centers, UMass Memorial, Beth Israel Deaconess, and Tufts Medical Centers had tightly clustered S-RPs at 1 .07, 1 .06, and 1 .05 respectively .

Brigham and Women’sHospital

Boston Medical Center

Massachusetts General Hospital

Tufts Medical Center

UMass Memorial Medical Center

Beth Israel Deaconess Medical Center

Share of Total Payments S-RP

0% 5% 10% 15% 20%

10.5%

1.3%

13.9%

2.5%

5.0%

6.3%

1.01

1.05

1.06

1.07

1.41

1.41


Brigham and Women’sHospital

Boston Medical Center

Massachusetts General Hospital

Tufts Medical Center

0% 5% 15%10%

UMass Memorial Medical Center

Beth Israel Deaconess Medical Center


10.5%

1.3%

13.9%

2.5%

5.0%

6.3%

1.01

1.05

1.06

1.07

1.41

1.41




Teaching Hospital Share of Commercial Payments and S-RP, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf .For the definition of teaching hospitals, see http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/ .

In 2015, 12% of all commercial payments made to acute hospitals went to teaching hospitals, the smallest of all cohorts .

The teaching hospital cohort had a more closely distributed range of S-RP values for commercial payments than the other three cohorts .

Among teaching hospitals, Steward St . Elizabeth’s Medical Center had the highest S-RP (1 .08), and received 1 .2% of total payments to acute hospitals .


0% 5% 10% 15% 20%

0.2%

0.6%

1.5%

3.9%

3.3%

1.7%

1.2%

Steward Carney Hospital

Cambridge Health Alliance

Mount Auburn Hospital

Lahey Hospital & Medical Center

Baystate Medical Center

Saint Vincent Hospital

Steward St. Elizabeth’s Medical Center

1.08

1.01

1.01

0.89

0.84

0.80

0.94



0% 5% 10% 15% 20%

0.2%

0.6%

1.5%

3.9%

3.3%

1.7%

1.2%

Steward Carney Hospital

Cambridge Health Alliance

Mount Auburn Hospital

Lahey Hospital & Medical Center

Baystate Medical Center

Saint Vincent Hospital

Steward St. Elizabeth’s Medical Center

1.08

1.01

1.01

0.89

0.84

0.80

0.94




Community Hospital Share of Commercial Payments and S-RP, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf .For the definition of community hospitals, see http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/ .*An asterisk after a hospital name indicates a geographically isolated facility .

In 2015, 17% of all commercial payments made to acute hospitals went to community hospitals .

Among community hospitals, the two highest commercial S-RP values were Nantucket Cottage Hospital (1 .96) and Martha’s Vineyard Hospital (1 .93) . These are the only two hospitals in Massachusetts that are not on the mainland, and each received 0 .2% and 0 .3% of total payments to acute hospitals, respectively .

Anna Jacques Hospital and Beth Israel Deaconess Hospital – Milton had the lowest commercial S-RPs among community hospitals (0 .76), 24% below the statewide average across all hospitals .



2.7%

0.3%

1.2%

3.2%

0.8%0.1%

0.4%1.0%

0.7%1.6%

1.3%1.1%

1.1%

0.4%

0.5%

0.2% 1.96

1.93

1.11

1.04

1.01

1.00

1.00

0.98

0.91

0.90

0.89

0.87

0.85

0.84

0.76

0.76

Nantucket Cottage Hospital*

South Shore Hospital

Martha’s Vineyard Hospital*

Brigham and Women’s Faulkner HospitalNewton−Wellesley

HospitalCooley Dickinson

HospitalBaystate Mary Lane

HospitalBeth Israel Deaconess

Hospital − Needham

Hallmark Health

Steward Norwood Hospital

Winchester Hospital

Northeast Hospital

Emerson Hospital

Milford Regional Medical Center

Beth Israel Deaconess Hospital − Milton

Anna Jaques Hospital

0% 5% 10% 15% 20%


2.7%

0.3%

1.2%

3.2%

0.8%0.1%

0.4%1.0%

0.7%1.6%

1.3%1.1%

1.1%

0.4%

0.5%

0.2% 1.96

1.93

1.11

1.04

1.01

1.00

1.00

0.98

0.91

0.90

0.89

0.87

0.85

0.84

0.76

0.76

Nantucket Cottage Hospital*

South Shore Hospital

Martha’s Vineyard Hospital*

Brigham and Women’s Faulkner HospitalNewton−Wellesley

HospitalCooley Dickinson

HospitalBaystate Mary Lane

HospitalBeth Israel Deaconess

Hospital − Needham

Hallmark Health

Steward Norwood Hospital

Winchester Hospital

Northeast Hospital

Emerson Hospital

Milford Regional Medical Center

Beth Israel Deaconess Hospital − Milton

Anna Jaques Hospital

0% 5% 10% 15% 20%




Community-High Public Payer Hospital Share of Commercial Payments and S-RP, 2015

Source: Payer reported data to CHIANotes: Statewide RP (S-RP) represents a cross-payer relativity within a given insurance category . For more information on how S-RP is computed, see Methodology for the Calculation of Statewide Relative Prices, available at http://www .chiamass .gov/assets/docs/g/S-RP-Methods-Memo-2017 .pdf .For the definition of community-High Public Payer hospitals, see http://www.chiamass.gov/massachusetts-acute-hospital-cohort-profiles/ .*An asterisk after a hospital name indicates a geographically isolated facility .

In 2015, 19% of all commercial payments made to acute hospitals went to community-HPP hospitals .

Among all acute hospitals, the lowest S-RPs were in the community-HPP cohort .

Among community-HPP hospitals, Falmouth Hospital (1 .52), Fairview Hospital (1 .32), and Cape Cod Hospital (1 .31) had the highest commercial S-RPs; all of these hospitals are considered geographically isolated .



0% 5% 10% 15% 20%

0.1%0.1%

0.2%

0.2%

0.2%

0.2%

0.2%

0.3%

0.3%

0.4%

0.4%

0.5%

0.6%

0.1%

0.7%0.4%

0.7%

0.7%

0.8%

0.8%

0.8%

1.0%

1.5%

1.6%

1.6%

1.7%

2.1%

0.68

0.72

0.75

0.75

0.75

0.78

0.79

0.81

0.82

0.85

0.86

0.86

0.86

0.86

0.90

0.91

0.91

0.93

0.94

0.95

0.98

0.99

1.00

1.05

1.13

1.31

1.32

1.52Falmouth Hospital*

Baystate Noble Hospital

Holyoke Medical Center

Baystate Wing Hospital

Heywood Hospital

Lawrence General Hospital

HealthAlliance Hospital

Signature Healthcare Brockton Hospital

Mercy Medical Center

Lowell General Hospital

Marlborough Hospital

Morton Hospital

MetroWest Medical Center

Steward Holy Family Hospital

Beth Israel Deaconess Hospital − Plymouth

Harrington Memorial Hospital*

Steward Good Samaritan Medical Center

Southcoast Hospitals Group

Steward Saint Anne’s Hospital

Clinton Hospital

Athol Memorial Hospital

Baystate Franklin Medical Center*

Nashoba Valley Medical Center

North Shore Medical Center

Sturdy Memorial Hospital

Berkshire Medical Center*

Cape Cod Hospital*

Fairview Hospital*

0.7%


0% 5% 10% 15% 20%

0.1%0.1%

0.2%

0.2%

0.2%

0.2%

0.2%

0.3%

0.3%

0.4%

0.4%

0.5%

0.6%

0.1%

0.7%0.4%

0.7%

0.7%

0.8%

0.8%

0.8%

1.0%

1.5%

1.6%

1.6%

1.7%

2.1%

0.68

0.72

0.75

0.75

0.75

0.78

0.79

0.81

0.82

0.85

0.86

0.86

0.86

0.86

0.90

0.91

0.91

0.93

0.94

0.95

0.98

0.99

1.00

1.05

1.13

1.31

1.32

1.52Falmouth Hospital*

Baystate Noble Hospital

Holyoke Medical Center

Baystate Wing Hospital

Heywood Hospital

Lawrence General Hospital

HealthAlliance Hospital

Signature Healthcare Brockton Hospital

Mercy Medical Center

Lowell General Hospital

Marlborough Hospital

Morton Hospital

MetroWest Medical Center

Steward Holy Family Hospital

Beth Israel Deaconess Hospital − Plymouth

Harrington Memorial Hospital*

Steward Good Samaritan Medical Center

Southcoast Hospitals Group

Steward Saint Anne’s Hospital

Clinton Hospital

Athol Memorial Hospital

Baystate Franklin Medical Center*

Nashoba Valley Medical Center

North Shore Medical Center

Sturdy Memorial Hospital

Berkshire Medical Center*

Cape Cod Hospital*

Fairview Hospital*

0.7%




Distribution of Physician Group Commercial Payments by RP Quartile, 2011-2014

Source: Payer reported data to CHIANotes: Within each payer’s network, physician groups are ordered by relative price, and grouped into quartiles such that each quartile contains an equal (or as close to equal as possible) number of providers. For each payer, the first quartile (Q1) contains physician groups with the lowest RP values while Q4 contains those with the highest RP values in the network. Payments to physician groups assigned to Q1 are then summed across all payers to calculate total Q1 payments. Note that a specific provider may be assigned to different quartiles in different payer networks. This figure includes only payments made to physician groups that were included in the relative price calculation after payment thresholds were applied, accounting for 90% of Commercial total payments to physician groups . Percentages may not sum to 100% due to rounding .

Since 2011, there has been little change in the concentration of payments to higher-priced physicians among commercial payers . In fact, the share of commercial payments to lower-priced physicians has steadily declined from 19 .0% in 2011 to 14 .0% in 2014 .

From 2011 to 2014, commercial payments to physician groups were concentrated among the highest-priced (Q4) physician organizations . While the share of payments to Q4 physicians declined from 55 .3% in 2012, to 42 .9% in 2013, this share rose again to 57 .9% in 2014 .

The share of commercial payments to higher-priced physicians (Q3 and Q4) increased from 85 .2% in 2013 to 86 .0% in 2014 .

PHYSICIAN GROUPSPAYER-SPECIFIC RP

52.8%28.3%13.3%5.7%

55.3%26.2%13.4%5.1%

42.9%42.3%9.8%5.0%

57.9%28.2%8.3%5.7%

2012

2011

2013

2014









Q1(Lowest RP)

Q2 Q3 Q4(Highest RP)50th Percentile


Distribution of Physician Group Commercial RP Among Top 6 Payers, 2014

Source: Payer reported data to CHIANotes: These top six payers were identified by the share of 2014 commercial member months.

The range of network provider RP values varied significantly among the top six payers .

Among the payers depicted, Health New England reported the largest share of physician group payments within 20% of average (81%), followed by Fallon (71%), Tufts (50%), and Harvard Pilgrim (46%) .

The remaining payers reported a majority of payments to physician groups with RPs more than 20% above average: United, 56%, and BCBSMA, 59% .


0.5 1.0 1.5 2.0 2.5 3.0

BCBSMA(50%)

HPHC(23%)

Tufts(12%)

Fallon(3%)

HNE(2%)

United(2%)

Number of physician groups (n) and percent of total network payments, within each relative price interval

1.0 1.20.8(average)

Payer share of total commercial physician payments

Relative Price

Paye

r

n=45%

n=64%

n=62%

n=810%

n=813%

n=42%

n=2146%

n=1950%

n=781%

n=2142%

n=1636%

n=1771%

n=459%

n=350%

n=448%

n=519%

n=46%

n=556%


Physician Group Share of Commercial Payments and Composite RP Percentile, 2014

Source: Payer reported data to CHIANotes: The top physician groups were identified by the share of total commercial payments in 2014. Because RPs are not comparable across payers, physician groups are examined cross-payer in this chart using a “composite RP percentile.” To compute this value, each physician group is first ranked within a payer’s network. This percentile rank is then averaged across payers, weighted by the payer share of the providers’ total payments, to achieve the composite RP percentile depicted here .

In 2014, 23 physician organizations represented 96% of total commercial payments to physician groups .

The physician groups receiving the most commercial payments in 2014 were Partners Community HealthCare (27%), Atrius Health (13%), and Steward Health Care Network (11%) .

The physician groups with the highest composite RPs were Children’s Hospital Physicians (100th percentile), Partners Community HealthCare (93rd percentile), and Atrius Health (91st percentile) . Collectively, these three physician groups accounted for nearly half of total commercial payments to physician groups in 2014 .


0.4%0.1%0.1%

0.8%0.4%

1.9%0.9%0.8%

4.0%0.3%0.4%0.4%

2.2%1.5%

5.1%6.6%

10.6%1.8%

7.6%1.5%

12.6%27.3%

9.1%

0% 5% 10% 15% 20% 25% 30%

Sturdy Hospital Physicians

Harrington HealthCare

St. Vincent Hospital Physicians

Cooley Dickinson PHO

Anesthesia Associates of Mass.

South Shore PHO

Boston Medical Center Physicians

Central Mass. IPA

Baycare Health Partners

Acton Medical

Signature Healthcare Brockton

Riverbend Medical

Lahey Health

Northeast PHO

UMass Memorial Health Care

Beth Israel Deaconess Care Organization

Steward Health Care Network

Mount Auburn Cambridge IPA

New England Quality Care Alliance

Lowell General PHO

Partners Community HealthCare

Atrius Health

Children’s Hospital Physicians

Share of Total Payments Composite RP

100

93

91

82

79

72

69

68

67

65

58

58

54

54

42

41

26

34

35

25

24

13

11

For more information, please contact:

CENTER FOR HEALTH INFORMATION AND ANALYSIS

501 Boylston Street www.chiamass.govBoston, MA 02116 @Mass_CHIA

(617) 701-8100

Publication Number 17-122-CHIA-01

http://www.chiamass.gov

https://twitter.com/mass_chia?lang=en

relative price · 2020-04-01 · 1 relative price | may 2017 center for health information and...

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