Highlight : Variation of Pricing for Inpatient Treatments in Washington State

Overview

The Alliance analyzed the commercially-contracted fees negotiated between insurers and providers, both physicians and facilities, for common inpatient treatments provided in 2016. We used the commercially-insured data in the Alliance All-Payer Claims Database and found wide variation in prices not only across the state, but within hospitals.

Key Findings

We analyzed price variations for 171 distinct inpatient treatments from January 1 – December 31, 2016 at hospitals across Washington state and found that seven inpatient treatments accounted for over half of that spending. Those seven inpatient treatments from highest total spending to lowest are:

• Vaginal delivery
• Knee joint replacement surgery
• Hip joint replacement surgery
• Cesarean delivery
• Dorsal and lumbar fusion surgery
• Normal newborn care
• Cervical spinal fusion surgery

 

Our report shows a wide range of prices for the same treatment. For example, the median price of dorsal and lumbar spinal fusion surgery in the state is $60,620. The highest price is $118,375 and the lowest is $30,897. That means a patient paying the highest price could pay up to four times more than the patient who pays the lowest price.

There are similar price variations for facilities. To see price variation by hospital, view our complete report here.

About the Visualization

To use this graph, go to the Select (3M) Major Diagnostic Category drop down menu and make a selection. You will see the various treatments reported under that category. For each, the low, median and high prices are reported in the columns to the right as well as represented on the line under the dollar amounts.

We analyzed common inpatient treatments in 2016 for the commercially-insured. To eliminate outliers, we excluded cases below the lower 5% and above the upper 95% of the price range. We limited our analysis to only those treatments with few or no complications. It does not include Medicaid and Medicare.

This anaylsis was produced using proprietary computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3M [APR^TM] Software, and to the 3M [APR^TM DRG] classification system(s) (including the selection, coordination and arrangement of all codes) are owned by 3M. All rights reserved.