Hospital Costs > In Pennsylvania > Upmc Horizon, procedure costs
Procedure | Discharges | Avg Covered Charges | Avg Total Payment | Avg Medicare Payment | ||||
---|---|---|---|---|---|---|---|---|
Count | Rank | Amount | Rank | Amount | Rank | Amount | Rank | |
Major Joint Replacement Or Reattachment Of Lower Extremity W/O Mcc | 111 | 453 / 49 | $47.814,90 | 1181 / 69 | $12.601,20 | 389 / 44 | $10.153,90 | 388 / 31 |
Heart Failure & Shock W Cc | 68 | 210 / 49 | $16.549,00 | 749 / 41 | $6.126,97 | 411 / 48 | $4.802,38 | 411 / 30 |
Septicemia Or Severe Sepsis W/O Mv 96+ Hours W Mcc | 58 | 458 / 74 | $29.265,00 | 748 / 42 | $9.857,91 | 61 / 11 | $8.478,60 | 61 / 5 |
Cellulitis W/O Mcc | 47 | 142 / 42 | $15.601,10 | 932 / 53 | $5.470,62 | 440 / 55 | $3.826,38 | 437 / 32 |
Renal Failure W Cc | 41 | 180 / 46 | $16.918,40 | 663 / 38 | $5.981,27 | 368 / 42 | $4.615,27 | 365 / 28 |
Kidney & Urinary Tract Infections W/O Mcc | 40 | 193 / 52 | $16.434,10 | 1133 / 57 | $4.872,60 | 525 / 44 | $3.637,55 | 524 / 38 |
Chronic Obstructive Pulmonary Disease W Mcc | 40 | 162 / 35 | $20.666,20 | 775 / 41 | $6.924,80 | 320 / 29 | $5.586,15 | 319 / 28 |
Heart Failure & Shock W Mcc | 40 | 244 / 60 | $28.033,70 | 975 / 51 | $8.850,42 | 489 / 37 | $7.673,62 | 489 / 28 |
G.I. Hemorrhage W Cc | 37 | 181 / 45 | $19.672,10 | 722 / 43 | $6.272,41 | 476 / 43 | $4.883,43 | 475 / 33 |
Esophagitis, Gastroent & Misc Digest Disorders W/O Mcc | 35 | 240 / 68 | $19.002,10 | 1280 / 62 | $4.881,66 | 208 / 49 | $3.125,51 | 208 / 25 |
Cardiac Arrhythmia & Conduction Disorders W Cc | 34 | 127 / 33 | $13.927,50 | 411 / 21 | $5.100,74 | 487 / 40 | $3.809,03 | 486 / 38 |
Simple Pneumonia & Pleurisy W Cc | 32 | 171 / 50 | $17.896,70 | 902 / 42 | $6.111,06 | 671 / 44 | $4.797,88 | 668 / 46 |
Simple Pneumonia & Pleurisy W Mcc | 29 | 176 / 43 | $29.055,90 | 979 / 44 | $8.585,76 | 351 / 27 | $7.115,17 | 351 / 21 |
Intracranial Hemorrhage Or Cerebral Infarction W Cc Or Tpa In 24 Hrs | 28 | 154 / 46 | $21.029,30 | 536 / 29 | $6.572,04 | 388 / 37 | $5.092,25 | 387 / 26 |
Chronic Obstructive Pulmonary Disease W Cc | 27 | 152 / 48 | $18.271,50 | 831 / 39 | $5.960,81 | 363 / 48 | $4.386,30 | 362 / 29 |
Cardiac Arrhythmia & Conduction Disorders W/O Cc/Mcc | 26 | 124 / 41 | $11.045,00 | 460 / 24 | $3.790,58 | 464 / 44 | $2.412,62 | 461 / 42 |
Renal Failure W Mcc | 22 | 173 / 44 | $20.844,40 | 260 / 15 | $9.048,27 | 60 / 25 | $7.070,50 | 60 / 7 |
Hip & Femur Procedures Except Major Joint W Cc | 20 | 123 / 35 | $45.274,90 | 851 / 45 | $11.555,80 | 413 / 30 | $9.945,10 | 412 / 24 |
Acute Myocardial Infarction, Discharged Alive W Mcc | 19 | 106 / 37 | $27.469,40 | 350 / 27 | $9.065,63 | 111 / 16 | $7.959,74 | 111 / 16 |
Peripheral Vascular Disorders W Cc | 17 | 67 / 17 | $13.559,60 | 129 / 9 | $5.855,29 | 112 / 22 | $4.444,41 | 112 / 14 |
Septicemia Or Severe Sepsis W/O Mv 96+ Hours W/O Mcc | 17 | 190 / 64 | $21.498,10 | 918 / 49 | $6.683,18 | 492 / 46 | $5.192,12 | 490 / 31 |
Cardiac Arrhythmia & Conduction Disorders W Mcc | 17 | 106 / 40 | $31.031,40 | 1007 / 48 | $7.313,47 | 273 / 29 | $5.995,82 | 272 / 27 |
Other Kidney & Urinary Tract Diagnoses W Cc | 16 | 87 / 22 | $16.990,10 | 153 / 3 | $5.304,62 | 43 / 2 | $4.477,75 | 43 / 4 |
Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W/O Mcc | 16 | 150 / 52 | $12.476,90 | 608 / 27 | $4.544,06 | 370 / 43 | $3.209,44 | 370 / 35 |
Other Digestive System Diagnoses W Cc | 16 | 81 / 28 | $16.488,10 | 215 / 10 | $5.900,25 | 237 / 16 | $4.745,75 | 234 / 24 |
Chronic Obstructive Pulmonary Disease W/O Cc/Mcc | 16 | 104 / 36 | $17.363,80 | 1047 / 46 | $4.751,44 | 745 / 41 | $3.523,56 | 742 / 51 |
Respiratory Infections & Inflammations W Mcc | 16 | 120 / 36 | $27.276,70 | 305 / 18 | $10.859,90 | 189 / 15 | $9.700,12 | 189 / 16 |
Misc Disorders Of Nutrition,Metabolism,Fluids/Electrolytes W Mcc | 15 | 111 / 32 | $17.190,10 | 254 / 9 | $6.226,93 | 42 / 7 | $4.981,13 | 42 / 5 |
Acute Myocardial Infarction, Discharged Alive W Cc | 15 | 76 / 26 | $23.003,90 | 426 / 24 | $6.404,80 | 256 / 27 | $5.057,80 | 256 / 24 |
Red Blood Cell Disorders W/O Mcc | 13 | 130 / 39 | $12.949,20 | 276 / 17 | $5.110,38 | 271 / 35 | $3.723,85 | 271 / 24 |
Infectious & Parasitic Diseases W O.R. Procedure W Mcc | 13 | 111 / 40 | $74.151,40 | 209 / 10 | $22.572,90 | 5 / 1 | $20.445,10 | 5 / 2 |
Diabetes W Cc | 13 | 79 / 27 | $13.966,30 | 265 / 13 | $5.068,23 | 152 / 18 | $3.721,62 | 152 / 13 |
Esophagitis, Gastroent & Misc Digest Disorders W Mcc | 13 | 83 / 28 | $22.444,40 | 314 / 11 | $7.015,38 | 212 / 11 | $6.021,54 | 211 / 18 |
Other Circulatory System Diagnoses W Mcc | 13 | 103 / 31 | $24.222,50 | 104 / 3 | $10.854,80 | 192 / 12 | $9.565,46 | 192 / 15 |
Pulmonary Edema & Respiratory Failure | 12 | 191 / 52 | $17.372,00 | 245 / 16 | $7.584,75 | 95 / 36 | $5.670,42 | 95 / 14 |
Kidney & Urinary Tract Infections W Mcc | 12 | 132 / 40 | $20.546,50 | 606 / 31 | $7.103,92 | 294 / 38 | $5.417,67 | 293 / 22 |
Respiratory System Diagnosis W Ventilator Support <96 Hours | 12 | 119 / 41 | $39.830,40 | 321 / 16 | $11.288,50 | 15 / 2 | $9.932,17 | 15 / 2 |
Stomach, Esophageal & Duodenal Proc W/O Cc/Mcc | 11 | 37 / 9 | $37.258,90 | 90 / 3 | $8.637,73 | 29 / 1 | $7.245,00 | 29 / 1 |
Pulmonary Embolism W/O Mcc | 11 | 63 / 29 | $16.894,60 | 231 / 8 | $5.952,73 | 121 / 15 | $4.412,73 | 121 / 11 |
Signs & Symptoms W/O Mcc | 11 | 80 / 33 | $11.736,50 | 174 / 6 | $4.479,82 | 207 / 17 | $3.250,00 | 207 / 11 | Total 40 procedures | 1.049 | 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.