Use of Risk Adjustment Models for Provider Reimbursements - Text Mining Techniques for Healthcare Provider Quality Determination - page 361

Figure 2. Vermont report card
along to payers.(Arias, 2008) Preventive measures will also add to costs, but not to reimbursements
without some negotiations between providers and payers. Figure 1 shows one such comparison provided
by Florida.(Anonymous-Floridareporting, 2008)
Note that Brandon Regional Hospital is identified as higher than expected at 0.37% whereas the H
Lee Moffitt Cancer Center has a higher rate of 0.40%, but is identified as expected. Does the H Lee
Moffitt Cancer Center have sicker patients, or is it just better at “gaming” the reporting? Given that it is
exclusively a cancer center that treats many with terminal conditions, the H Lee Moffitt Center undoubt-
edly has sicker patients, many of them terminal, and it can have a higher expected mortality rate.
Florida is the only state to offer such comprehensive information. Pennsylvania limits reporting to
infections that are device-related and publicizes reports based upon peer groups rather than individual
providers (Anonymous-Penn, 2008); Missouri limits reporting to central line-associated bloodstream
infections using a three-point scale of higher than expected, as expected, and lower than expected. The
rates are adjusted by patient severity, but the severity measure is not identified. (Anonymous-Missouri,
2008) Vermont reports central-line infections, and also surgical infection prevention measures. Vermont,
too, focuses upon inputs rather than infection rates (Figure 2). (Anonymous-Vermont, 2008)
However, mandatory reporting will only increase. As of 2007, the Centers for Medicare and Medic-
aid required the submission of specific data in order for the hospital provider to receive full Medicare
payments. Thus, it is no longer “voluntary”.
Healthgrades.com uses the Medpar data (publicly available for a fee) to provide information to the
public on quality ranking of providers. It will provide more details about the public information, but at
a small cost. Such public reporting will continue to increase as well. Therefore, providers must learn to
deal with this type of reporting.