Hospital Costs > In Maine > Southern Maine Health Care, procedure costs
| Procedure | Discharges | Avg Covered Charges | Avg Total Payment | Avg Medicare Payment | ||||
|---|---|---|---|---|---|---|---|---|
| Count | Rank | Amount | Rank | Amount | Rank | Amount | Rank | |
| Septicemia Or Severe Sepsis W/O Mv 96+ Hours W Mcc | 249 | 267 / 2 | $26.334,80 | 604 / 7 | $11.057,70 | 1053 / 3 | $10.265,40 | 1040 / 4 |
| Major Joint Replacement Or Reattachment Of Lower Extremity W/O Mcc | 154 | 410 / 5 | $26.897,50 | 124 / 2 | $12.623,70 | 1189 / 2 | $11.360,60 | 1161 / 5 |
| Chronic Obstructive Pulmonary Disease W Mcc | 119 | 83 / 1 | $14.706,90 | 297 / 4 | $7.022,07 | 721 / 3 | $5.989,09 | 716 / 2 |
| Heart Failure & Shock W Mcc | 108 | 176 / 2 | $18.640,90 | 351 / 6 | $8.708,96 | 639 / 3 | $7.862,36 | 639 / 3 |
| Septicemia Or Severe Sepsis W/O Mv 96+ Hours W/O Mcc | 102 | 105 / 2 | $16.342,60 | 468 / 6 | $6.426,25 | 766 / 3 | $5.452,69 | 764 / 3 |
| Simple Pneumonia & Pleurisy W Mcc | 91 | 114 / 2 | $20.667,20 | 433 / 8 | $8.610,08 | 798 / 3 | $7.652,19 | 798 / 2 |
| Heart Failure & Shock W Cc | 90 | 188 / 3 | $15.906,40 | 675 / 10 | $6.037,78 | 1022 / 4 | $5.306,40 | 1020 / 4 |
| Pulmonary Edema & Respiratory Failure | 87 | 116 / 2 | $22.064,00 | 543 / 10 | $7.655,68 | 976 / 3 | $6.909,76 | 975 / 4 |
| Renal Failure W Cc | 81 | 140 / 3 | $14.588,10 | 426 / 7 | $5.774,22 | 592 / 3 | $4.835,37 | 586 / 2 |
| G.I. Hemorrhage W Cc | 68 | 150 / 4 | $16.207,50 | 413 / 6 | $6.076,00 | 612 / 2 | $5.014,75 | 611 / 3 |
| Kidney & Urinary Tract Infections W/O Mcc | 68 | 165 / 2 | $12.404,10 | 563 / 7 | $4.696,71 | 701 / 3 | $3.755,06 | 697 / 2 |
| Esophagitis, Gastroent & Misc Digest Disorders W/O Mcc | 65 | 210 / 4 | $12.740,40 | 479 / 5 | $4.660,60 | 869 / 2 | $3.673,03 | 864 / 4 |
| Intracranial Hemorrhage Or Cerebral Infarction W Cc Or Tpa In 24 Hrs | 65 | 117 / 3 | $16.994,40 | 280 / 6 | $6.343,80 | 704 / 1 | $5.439,34 | 703 / 3 |
| Renal Failure W Mcc | 55 | 140 / 2 | $21.636,20 | 302 / 4 | $9.352,82 | 750 / 2 | $8.448,51 | 750 / 2 |
| Cellulitis W/O Mcc | 54 | 135 / 5 | $15.884,10 | 979 / 10 | $5.254,91 | 1035 / 3 | $4.291,35 | 1029 / 4 |
| Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W/O Mcc | 54 | 112 / 3 | $12.439,40 | 602 / 6 | $4.413,07 | 793 / 3 | $3.515,89 | 790 / 4 |
| Simple Pneumonia & Pleurisy W Cc | 46 | 157 / 7 | $15.715,30 | 644 / 11 | $5.979,91 | 1037 / 2 | $5.110,35 | 1034 / 4 |
| Acute Myocardial Infarction, Discharged Alive W Cc | 38 | 53 / 3 | $17.241,70 | 188 / 8 | $6.155,63 | 391 / 3 | $5.297,53 | 390 / 3 |
| Hip & Femur Procedures Except Major Joint W Cc | 37 | 106 / 3 | $29.165,30 | 200 / 4 | $11.557,10 | 695 / 2 | $10.414,60 | 690 / 2 |
| Syncope & Collapse | 37 | 132 / 4 | $12.202,80 | 207 / 2 | $4.565,95 | 468 / 3 | $3.522,05 | 466 / 3 |
| Chronic Obstructive Pulmonary Disease W Cc | 35 | 144 / 5 | $15.075,70 | 522 / 10 | $5.542,77 | 650 / 3 | $4.677,86 | 648 / 4 |
| Heart Failure & Shock W/O Cc/Mcc | 32 | 78 / 3 | $13.019,80 | 601 / 8 | $4.260,88 | 529 / 3 | $3.327,12 | 527 / 3 |
| Transient Ischemia | 32 | 93 / 2 | $14.991,20 | 296 / 6 | $4.422,41 | 490 / 3 | $3.365,41 | 488 / 3 |
| Cardiac Arrhythmia & Conduction Disorders W Cc | 32 | 129 / 7 | $12.428,50 | 263 / 3 | $4.877,81 | 700 / 3 | $4.010,81 | 697 / 4 |
| Chest Pain | 31 | 120 / 3 | $13.764,50 | 382 / 6 | $3.864,03 | 539 / 3 | $2.968,03 | 535 / 4 |
| Cardiac Arrhythmia & Conduction Disorders W/O Cc/Mcc | 30 | 120 / 6 | $9.509,80 | 301 / 3 | $3.587,33 | 733 / 4 | $2.619,87 | 729 / 4 |
| Acute Myocardial Infarction, Discharged Alive W Mcc | 30 | 95 / 5 | $24.561,30 | 277 / 7 | $9.913,07 | 568 / 2 | $9.150,40 | 567 / 2 |
| Respiratory Infections & Inflammations W Mcc | 30 | 106 / 5 | $24.962,10 | 231 / 6 | $10.916,20 | 417 / 1 | $10.299,10 | 416 / 2 |
| Cardiac Arrhythmia & Conduction Disorders W Mcc | 29 | 94 / 4 | $27.912,60 | 848 / 13 | $10.072,30 | 1615 / 13 | $9.277,83 | 1612 / 13 |
| Acute Myocardial Infarction, Discharged Alive W/O Cc/Mcc | 29 | 24 / 3 | $11.736,50 | 69 / 3 | $4.698,72 | 303 / 1 | $3.778,45 | 300 / 1 |
| Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W Mcc | 27 | 99 / 2 | $22.198,90 | 538 / 4 | $6.701,48 | 437 / 1 | $5.939,41 | 434 / 1 |
| G.I. Obstruction W Cc | 27 | 65 / 4 | $13.652,90 | 201 / 5 | $5.408,59 | 580 / 3 | $4.560,00 | 579 / 4 |
| Other Digestive System Diagnoses W Cc | 23 | 74 / 4 | $16.521,40 | 217 / 4 | $5.883,35 | 434 / 3 | $5.097,26 | 431 / 3 |
| Intracranial Hemorrhage Or Cerebral Infarction W/O Cc/Mcc | 22 | 80 / 4 | $14.474,30 | 215 / 3 | $4.662,59 | 486 / 2 | $3.615,32 | 483 / 2 |
| Intracranial Hemorrhage Or Cerebral Infarction W Mcc | 22 | 146 / 4 | $19.360,00 | 82 / 2 | $10.221,70 | 524 / 3 | $9.399,91 | 523 / 3 |
| G.I. Hemorrhage W Mcc | 20 | 101 / 4 | $26.259,20 | 205 / 2 | $10.664,60 | 627 / 2 | $10.002,20 | 628 / 1 |
| Seizures W/O Mcc | 19 | 89 / 5 | $10.971,90 | 97 / 1 | $4.726,11 | 369 / 1 | $3.867,16 | 367 / 1 |
| Respiratory System Diagnosis W Ventilator Support <96 Hours | 19 | 112 / 4 | $39.708,30 | 317 / 1 | $15.479,70 | 303 / 2 | $11.902,50 | 300 / 1 |
| Bronchitis & Asthma W Cc/Mcc | 19 | 57 / 1 | $11.876,50 | 91 / 1 | $5.659,79 | 293 / 1 | $4.310,11 | 290 / 1 |
| G.I. Obstruction W/O Cc/Mcc | 18 | 53 / 3 | $9.734,17 | 122 / 3 | $3.843,28 | 561 / 1 | $3.039,72 | 560 / 3 |
| Organic Disturbances & Mental Retardation | 18 | 41 / 2 | $14.696,20 | 86 / 1 | $5.901,44 | 86 / 1 | $5.023,22 | 86 / 1 |
| Pulmonary Embolism W Mcc | 17 | 26 / 1 | $24.433,50 | 91 / 1 | $8.393,35 | 88 / 1 | $7.626,29 | 88 / 1 |
| Disorders Of Pancreas Except Malignancy W Cc | 17 | 44 / 3 | $14.886,70 | 117 / 1 | $5.648,41 | 340 / 1 | $4.867,24 | 339 / 1 |
| Psychoses | 17 | 258 / 5 | $15.710,20 | 200 / 3 | $6.132,88 | 87 / 1 | $5.059,94 | 87 / 1 |
| Red Blood Cell Disorders W/O Mcc | 16 | 127 / 4 | $14.892,90 | 444 / 3 | $5.018,44 | 769 / 2 | $4.262,44 | 764 / 3 |
| Chronic Obstructive Pulmonary Disease W/O Cc/Mcc | 16 | 104 / 6 | $10.977,60 | 352 / 2 | $4.523,12 | 573 / 3 | $3.387,12 | 572 / 2 |
| Kidney & Urinary Tract Infections W Mcc | 16 | 128 / 3 | $18.035,60 | 431 / 5 | $6.581,75 | 538 / 1 | $5.755,75 | 537 / 2 |
| Major Small & Large Bowel Procedures W Cc | 15 | 93 / 7 | $42.197,70 | 244 / 6 | $15.039,50 | 648 / 2 | $14.149,90 | 642 / 2 |
| Hip & Femur Procedures Except Major Joint W Mcc | 15 | 47 / 4 | $45.517,50 | 101 / 1 | $18.668,60 | 443 / 1 | $17.697,90 | 440 / 1 |
| Pulmonary Embolism W/O Mcc | 14 | 60 / 4 | $16.978,40 | 233 / 3 | $5.969,07 | 551 / 2 | $5.278,79 | 549 / 2 |
| Alcohol/Drug Abuse Or Dependence W/O Rehabilitation Therapy W/O Mcc | 14 | 110 / 7 | $15.364,30 | 357 / 7 | $4.098,29 | 105 / 1 | $3.238,86 | 105 / 1 |
| Diabetes W Cc | 14 | 78 / 5 | $13.825,00 | 258 / 3 | $5.057,14 | 582 / 2 | $4.369,14 | 582 / 3 |
| Disorders Of Liver Except Malig,Cirr,Alc Hepa W Cc | 14 | 56 / 2 | $14.154,90 | 69 / 1 | $5.520,14 | 118 / 1 | $4.914,43 | 118 / 1 |
| Esophagitis, Gastroent & Misc Digest Disorders W Mcc | 14 | 82 / 3 | $20.157,50 | 212 / 1 | $7.298,29 | 308 / 1 | $6.258,29 | 306 / 1 |
| Major Gastrointestinal Disorders & Peritoneal Infections W Cc | 14 | 59 / 4 | $14.105,90 | 92 / 1 | $6.201,57 | 84 / 1 | $5.509,00 | 84 / 1 |
| Poisoning & Toxic Effects Of Drugs W Mcc | 13 | 59 / 4 | $26.798,50 | 273 / 1 | $8.251,54 | 196 / 1 | $7.232,46 | 195 / 1 |
| Cellulitis W Mcc | 13 | 45 / 4 | $15.815,40 | 52 / 1 | $8.347,62 | 170 / 1 | $7.321,15 | 169 / 1 |
| Major Small & Large Bowel Procedures W Mcc | 13 | 72 / 5 | $59.668,40 | 65 / 1 | $27.718,20 | 227 / 2 | $26.689,40 | 225 / 2 |
| Signs & Symptoms W/O Mcc | 13 | 78 / 8 | $14.806,60 | 317 / 6 | $4.246,15 | 315 / 3 | $3.404,31 | 314 / 3 |
| Laparoscopic Cholecystectomy W/O C.D.E. W/O Cc/Mcc | 13 | 34 / 1 | $19.294,20 | 28 / 1 | $7.496,31 | 253 / 2 | $6.376,31 | 253 / 2 |
| Urinary Stones W/O Esw Lithotripsy W/O Mcc | 13 | 33 / 2 | $11.906,80 | 34 / 1 | $4.385,15 | 95 / 1 | $3.174,08 | 95 / 1 |
| Renal Failure W/O Cc/Mcc | 12 | 44 / 3 | $10.493,30 | 135 / 3 | $4.620,92 | 150 / 2 | $2.831,42 | 149 / 1 |
| Simple Pneumonia & Pleurisy W/O Cc/Mcc | 12 | 81 / 6 | $11.986,70 | 416 / 4 | $4.449,67 | 723 / 3 | $3.436,33 | 719 / 3 |
| Fractures Of Hip & Pelvis W/O Mcc | 12 | 49 / 5 | $11.233,00 | 124 / 2 | $4.389,00 | 265 / 1 | $3.381,00 | 266 / 1 |
| Infectious & Parasitic Diseases W O.R. Procedure W Mcc | 12 | 112 / 6 | $62.003,90 | 118 / 2 | $29.016,70 | 310 / 2 | $28.068,70 | 310 / 2 |
| Respiratory Infections & Inflammations W Cc | 11 | 77 / 8 | $16.646,10 | 145 / 2 | $8.460,18 | 563 / 3 | $7.471,09 | 560 / 6 |
| Poisoning & Toxic Effects Of Drugs W/O Mcc | 11 | 50 / 5 | $12.120,00 | 176 / 1 | $4.594,18 | 153 / 1 | $3.023,00 | 152 / 1 | Total 67 procedures | 2.573 | discharges |
Source: Medicare Provider Utilization and Payment Data: Inpatient for FY2014
Average Covered Charges: The provider's average charge for services covered by Medicare for all discharges in the MS-DRG. These will vary from hospital to hospital because of differences in hospital charge structures.
Average Total Payments: The average total payments to all providers for the MS-DRG including the MSDRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Also included in average total payments are co-payment and deductible amounts that the patient is responsible for and any additional payments by third parties for coordination of benefits.
Average Medicare Payments: The average amount that Medicare pays to the provider for Medicare's share of the MS-DRG. Average Medicare payment amounts include the MS-DRG amount, teaching, disproportionate share, capital, and outlier payments for all cases. Medicare payments DO NOT include beneficiary co-payments and deductible amounts nor any additional payments from third parties for coordination of benefits. Note: In general, Medicare FFS claims with dates-of-service or dates-of-discharge on or after April 1, 2013, incurred a 2 percent reduction in Medicare payment. This is in response to mandatory across-the-board reductions in Federal spending, also known as sequestration
Hospital Rank: We have calculated the rank for each procedure within a hospital. The left number is the national ranking, the right one is the state ranking. For discharges, ranking is from highest # of discharges to lower (hospital with highest number of discharges ranks first). For charges and payments, lowest means a higher ranking.