Analytic Consulting & Research Services, Truven Health Analytics, Washington, DC, USA.
Health Serv Res. 2012 Oct;47(5):1814-35. doi: 10.1111/j.1475-6773.2012.01460.x. Epub 2012 Sep 4.
To demonstrate a refined cost-estimation method that converts detailed charges for inpatient stays into costs at the department level to enable analyses that can unravel the sources of rapid growth in inpatient costs.
Healthcare Cost and Utilization Project State Inpatient Databases and Medicare Cost Reports for all community, nonrehabilitation hospitals in nine states that reported detailed charges in 2001 and 2006 (n = 10,280,416 discharges).
We examined the cost per discharge across all discharges and five subgroups (medical, surgical, congestive heart failure, septicemia, and osteoarthritis).
DATA COLLECTION/EXTRACTION METHODS: We created cost-to-charge ratios (CCRs) for 13 cost-center or department-level buckets using the Medicare Cost Reports. We mapped service-code-level charges to a CCR with an internally developed crosswalk to estimate costs at the service-code level.
Supplies and devices were leading contributors (24.2 percent) to the increase in mean cost per discharge across all discharges. Intensive care unit and room and board (semiprivate) charges also substantially contributed (17.6 percent and 11.3 percent, respectively). Imaging and other advanced technological services were not major contributors (4.9 percent).
Payers and policy makers may want to explore hospital stay costs that are rapidly rising to better understand their increases and effectiveness.
展示一种经过改进的成本估算方法，将住院患者的详细费用转换为科室层面的成本，以便能够分析导致住院费用快速增长的原因。
九个州的医疗保健成本和利用项目州住院数据库和医疗保险成本报告，涵盖了 2001 年和 2006 年报告详细费用的所有社区非康复医院（n=10,280,416 例出院患者）。
我们检查了所有出院患者和五个亚组（内科、外科、充血性心力衰竭、败血症和骨关节炎）的每次出院的成本。
数据收集/提取方法：我们使用医疗保险成本报告为 13 个成本中心或科室级别的桶创建了成本与收费比（CCR）。我们将服务代码级别的收费映射到 CCR，使用内部开发的交叉索引来估算服务代码级别的成本。
在所有出院患者的平均每次出院成本增加中，供应品和设备是主要贡献者（24.2%）。重症监护病房和房间及床位（半私人）收费也有很大贡献（分别为 17.6%和 11.3%）。成像和其他先进技术服务的贡献不大（4.9%）。
支付方和政策制定者可能希望探索住院费用的快速增长，以更好地了解其增长原因和效果。
