Reporting transparency: A comparison of data from the state and federal sources of hospital charges for Texas in 2011
The Patient Protection and Affordable Care Act (PPACA) is pushing for increased clarity about healthcare charges because of the complexity of medical billing. Consequently, the release in May 2013 of the national summary of Medicare Provider Charge Data for the Top 100 Diagnosis-Related Groups was made public. Similar state-level initiatives to provide information to the public about healthcare charges date back to the 1990s. Beginning in 1995 in Texas, the Texas Health Collection Information Center has collected claims data containing charge information from all Texas hospitals. As a result, hospital claim charge data for Medicare patients treated in Texas is recorded and stored electronically by two different entities, one federal, and one state. These two data repositories can now be compared for consistency. The purpose of this research is to analyze empirical data concerning the consistency of the reported information in these two repositories and to articulate these methods for future use. The research includes four aims: The first aim compares data for the year 2011 from the131 hospitals that report to both repositories, the Texas Health Collection Information Center – Texas Hospital Discharge Data Public Use Data Files and the Medicare Provider Charge Data, to assess whether reporting requirements for the same variables match between these two datasets. For matching comparison groups from those 131 hospitals, a Bland-Altman analysis is used to compare discharge numbers and a multilevel fixed-effect regression model is used to test for agreement of average total covered charges and to identify any statistically significant differences in the comparison of THCIC to MPCD. The second aim examines the trends of inconsistencies by hospital characteristics, acute care hospitals with specialty units, and teaching status. The third aim is to determine the role of stewardship theory on reporting accuracy. The fourth aim articulates the methods used for these processes as a step towards developing future metrics. The baseline consistency check reveals a strong level of agreement in the number of reported discharges, and a strong positive correlation between the THCIC and Medicare reported data. The results of the second and third aims show that acute care hospitals with skilled nursing facilities and teaching hospitals have 6.3% and 11.6% less accuracy than acute care hospitals without skilled nursing units and non-teaching hospitals when reporting discharges to the THCIC. The results of this research validate the consistency of Texas reported average total covered charge data to the THCIC and reinforce current oversight efforts, while advancing the development of reporting accountability metrics.
Health care management
Kite, Bobbie, "Reporting transparency: A comparison of data from the state and federal sources of hospital charges for Texas in 2011" (2013). Texas Medical Center Dissertations (via ProQuest). AAI3611276.