Florida Health Care Coalition 2006 Dartmouth Atlas Data for Selected Florida Hospitals

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1 Florida Health Care Coalition 2006 Dartmouth Atlas Data for Selected Florida Hospitals March 6, 2007 Each year the Center for Evaluative Clinical Sciences (CECS) at the Dartmouth Medical School in Hanover New Hampshire produces a report and data base probing variations in the quality, cost and accessibility of heath care services in the United States. Dr. Jack Wennberg using these Dartmouth Atlas reports and earlier studies has shown wide and persistent differences between states and communities in these measures of health system performance for more than thirty years. In 2006 the Dartmouth Atlas report reached a major milestone. It added hospital-specific data for Medicare enrollees during their end of life care. These new data will assist the Florida Health Care Coalition in working with hospitals, physicians and other members to find opportunities for improving the value of health services for Florida residents. The 2006 Dartmouth Atlas reports significant problems with the overuse of hospital and physician services that provide no value for chronic illness patients during the last months of life. The report estimates that Medicare could reduce its total spending for chronic illness patients by 30% during the last two years of life and increase the quality of their care. The executive summary of the 2006 Dartmouth Atlas is attached to this report. Using the reporting tools at this report will analyze the 2006 Atlas database for central and southern Florida and offer some suggestions for using these data in collaboration with multiple stakeholders in the health care sector. We first look at the total Medicare expenditures for hospital and other services at the state level to see how they compare with measures of clinical quality. We find higher cost areas have more costly quality problems and therefore lesser health system performance. Katherine Baicker and Amitabh Chandra of Dartmouth correlated Medicare spending per enrollee in each state with a composite of twenty-four health care quality measures computed at the state level by Dr. Stephen Jencks of Center for Medicare and Medicaid Services during These quality measures were primarily tracking underuse, so one might expect less underuse to create more costs.

2 Association between Medicare spending and quality ranking -- U.S. States New Hampshire Minnesota Maryland Florida Baicker and Chandra, Health Affairs, Web Exclusives 7 April 2004 W4-184 The image above shows this surprising relationship. States are ranked according to their aggregate quality scores on the left axis and Medicare cost variations are across the bottom. The spending data are from traditional Medicare claims and are adjusted for inflation using the CPI, state-specific cost of living levels, and age/sex/race of Medicare enrolled populations. The picture is clear: Medicare enrollees residing in states in the upper left quadrant of this graph are receiving far better value for lower expenditures per person than those in states in the middle or in the lower right section. Florida s health system falls in the lower right corner of this graph indicating high underuse of evidence-based care and the resulting high expenses. The article Medicare Spending, The Physician Workforce, And Beneficiaries Quality of Care is in Health Affairs Web Edition of April 7, 2004 page W Drawing on this analysis of cost and quality, we can assume areas and institutions reporting higher costs for serving Medicare patients may in fact have lower use of evidence-based care and a higher incidence of overuse of acute and tertiary care services to deal with avoidable problems. CECS has also reported for many years that areas with a greater supply of hospital and ICU beds and physician specialists also produce a pattern of care that uses those capacities. We will look at some of these factors to see where opportunities for reducing health service waste may be found. Now let us look at the variation in total Medicare expenditure for patients who die in Florida hospitals with Cancer (solid tumors), Lymphoma and Leukemia, Chronic Pulmonary Disease, Coronary Artery Disease, Congestive Heart Failure, Peripheral Vascular Disease, Severe Chronic Liver Disease, Diabetes w/ End Organ Damage, Chronic Renal Failure, Nutritional 2

3 Deficiencies, Dementia and/or Functional Impairment. The graph below shows the total Part A and Part B expenditure during the last six months of life for patients who died in Florida hospitals during Red dots (or black dots in black and white printing) match selected Orlando and Southern Florida hospitals in order by reimbursements per decedent in the chart on the next page. Each dot represents a hospital in Florida for which Dartmouth has compiled enough data to yield a reliable measure of the statistic. We see a variation of almost three times between the lowest cost hospitals at the bottom of the graph and the highest cost ones at the top. Medicare reimbursements for physician and other services covered in Part B were combined with hospital reimbursements for these deceased patients to produce this statistic. 3

4 SUM of inpatient reimbursements and Part B payments per decedent during the last six months of life Hospital Level Rates ( ) Hospital Area Population Rates Ratio to Surplus/ Benchmark Deficit Cedars Medical Center Inc. Miami, FL 1,735 34, ,611,504 Jackson Memorial Hospital Miami, FL , ,536,818 Mount Sinai Medical Center Miami Beach, FL 3,109 31, ,757,463 Miami Average Miami, FL 33,468 28, ,427,799 Baptist Hospital of Miami Inc. Miami, FL 2,275 25, ,234,110 Broward General Medical Center Fort Lauderdale, FL , ,642,185 Boca Raton Community Hospital Inc. Boca Raton, FL 5,554 22, ,133,762 Fort Lauderdale Average Fort Lauderdale, FL 45,579 21, ,016,612 JFK Medical Center Atlantis, FL 3,637 20, ,798,891 Orlando Regional Medical Center Orlando, FL 4,787 20, ,518,555 Florida Hospital-Orlando Orlando, FL 8,598 20, ,623,353 North Broward Medical Center Pompano Beach, FL 1,859 20, ,603,484 Martin Memorial Medical Center Stuart, FL 3,662 19, ,188 *Florida Average Florida 303,630 19, Holy Cross Hospital Fort Lauderdale, FL 2,475 19, ,406 - National Average United States 4,692,623 18, ,523,448,885 Palm Beach Gardens Medical Center Palm Beach Gardens, FL 1,353 18, ,079 Orlando Average Orlando, FL 56,121 18, ,252,785 Lakeland Regional Medical Center Lakeland, FL 6,127 17, ,945,627 Holmes Regional Medical Center Melbourne, FL 5,191 16, ,504,420 Tallahassee Memorial Hospital Tallahassee, FL 2,984 12, ,125,531 * Benchmark Area *When hospitals are compared to HRR or state averages in the Medical Care Cost Equation and Benchmarking tools, the geographic measures are represented by weighted averages of the included hospitals in the region. They are not the regional population-based measures used in the other Data Tools, which include members of the chronically ill population who were not hospitalized during the last two years of life and could not be reliably assigned to hospitals. This was done in order to provide comparable measures that use the same patient populations. Hospitals with fewer than 80 deaths among their assigned populations were not included in the weighted average calculations for Part A events; hospitals with fewer than 400 deaths among their assigned populations were not included in the weighted average calculations for Part B events. The table above lists hospitals and other geographical averages for this statistic in order by the total Medicare reimbursement per decedent shown in the Rates column. The population is the total number of decedents recorded during this time period. The Rates are compared to the average reimbursement for all Florida decedents in the Ratio to Benchmark column. In the Surplus/Deficit column is an estimate of how much more or less was spent in hospitals/areas for these patients than would have been spent applying the Florida average reimbursement to 4

5 their care. For example, Cedars Medical Center in Miami was reimbursed $34, per decedent which is 77% greater than the Florida average of $19, per decedent. Had Cedars and its related physicians produced care costs at the state average; $25,611,504 would have been saved by Medicare. Holmes Regional Medical Center and related physicians in Melbourne were reimbursed $16, per decedent which is 15% less than the Florida average. Medicare saved $15,504,420 on care for the 5,191 decedents treated there during this period. Also in this chart are data for national and community averages compared to the Florida average. We see that the Orlando and national averages are slightly less than the Florida average. The Miami average is 46% greater and the Fort Lauderdale average is 10% greater than the Florida average. A pattern of significant overuse of acute care for Medicare enrollees at the end of life exists in the Miami area. The table below compares the same hospitals to the Total Part A & B Payments for end of life care at Tallahassee Memorial Hospital which has the lowest costs for this care in the state. SUM of inpatient reimbursements and Part B payments per decedent during the last six months of life Hospital Level Rates ( ) Hospital Area Population Rates Ratio to Surplus/ Benchmark Deficit Cedars Medical Center Inc. Miami, FL 1,735 34, ,313,178 Jackson Memorial Hospital Miami, FL , ,391,027 Mount Sinai Medical Center Miami Beach, FL 3,109 31, ,726,054 Miami Average Miami, FL 33,468 28, ,152,084 Baptist Hospital of Miami Inc. Miami, FL 2,275 25, ,577,804 Broward General Medical Center Fort Lauderdale, FL , ,307,549 Boca Raton Community Hospital Inc. Boca Raton, FL 5,554 22, ,592,609 Fort Lauderdale Average Fort Lauderdale, FL 45,579 21, ,423,304 Orlando Regional Medical Center Orlando, FL 4,787 20, ,804,385 Florida Hospital-Orlando Orlando, FL 8,598 20, ,612,399 North Broward Medical Center Pompano Beach, FL 1,859 20, ,141,473 Martin Memorial Medical Center Stuart, FL 3,662 19, ,015 State Average Florida 303,630 19, ,047,826,716 Holy Cross Hospital Fort Lauderdale, FL 2,475 19, ,551,184 National Average United States 4,692,623 18, ,125,857,005 Palm Beach Gardens Medical Center Palm Beach Gardens, FL 1,353 18, ,548,203 Orlando Average Orlando, FL 56,121 18, ,254,224 Lakeland Regional Medical Center Lakeland, FL 6,127 17, ,377,807 Holmes Regional Medical Center Melbourne, FL 5,191 16, ,506,180 *Tallahassee Memorial Hospital Tallahassee, FL 2,984 12, * Benchmark Area If care for terminally ill chronic care patients in Florida hospitals were delivered as done at Tallahassee Memorial Hospital, Medicare would have saved $2,047,826,716 during this period with $522,152,084 of that coming from the Miami area. 5

6 Why do hospitals costs vary from the Florida average? Dartmouth CECS shows us a number of factors that account for this variation. Looking into specific factors for each hospital may show opportunities for improvement. Data for Tallahassee Memorial in Tallahassee, Florida are shown here as a potential place to compare treatment practices, policies and system capacities within the state. Statistics used below are compared to the Florida average. They are listed in order by percentage variance from the Florida average. The statistics are from the last six months of life unless otherwise stated. For Federal fiscal year (FY) 2005, the existing fixed-loss outlier payment per case threshold is $25,800. (See 42 CFR Part 412.) Dartmouth CECS states the severity of illness for these patients is comparable since all of them died in the hospitals. Cedars Medical Center Inc. reimbursement per decedent was 77% higher because: o Outlier hospital payments per decedent at 2, were 114% higher o Primary care physician FTE staff numbers at were 105% higher o Total Part A reimbursements per decedent at 25, were 86% higher o ICU days per decedent at 9.71 were 78% higher o Primary care physician visits per decedent at were 73% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 68% higher o Percent of decedents admitted to the ICU at was 50% higher o Hospital days per decedent at were 45% higher o Medical specialist visits per decedent at were 43% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 42% higher o Medical Specialist FTE staff numbers at were 41% higher o Percent of decedents seeing 10 or more physicians at was 30% higher o Part A reimbursements per day at 1, were 29% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.41 were 25% higher o Percent of decedents enrolled in a hospice at was 29% lower Jackson Memorial Hospital reimbursement per decedent was 69% higher because: o Outlier hospital payments per decedent at 3, were 195% higher o Total Part A reimbursements per decedent at 28, were 106% higher o Part A reimbursements per day at 1, were 49% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.76 were 43% higher o Hospital days per decedent at were 39% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 38% higher o ICU days per decedent at 7.25 were 33% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 21% higher o Primary care physician FTE staff numbers at were 21% higher o Percent of decedents admitted to the ICU at was 21% higher o Primary care physician visits per decedent at were 8% higher o Percent of decedents seeing 10 or more physicians at was 3% lower o Percent of decedents enrolled in a hospice at was 17% lower o Medical Specialist FTE staff numbers at were 26% lower o Medical specialist visits per decedent at were 27% lower 6

7 Mount Sinai Medical Center reimbursement per decedent was 61% higher because: o Outlier hospital payments per decedent at 3, were 172% higher o Medical specialist visits per decedent at were 85% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 80% higher o Hospital days per decedent at were 72% higher o Total Part A reimbursements per decedent at 23, were 68% higher o Medical Specialist FTE staff numbers at were 64% higher o ICU days per decedent at 8.36 were 53% higher o Percent of decedents admitted to the ICU at was 37% higher o Percent of decedents seeing 10 or more physicians at was 35% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 32% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.29 were 19% higher o Primary care physician FTE staff numbers at were 16% higher o Primary care physician visits per decedent at were 16% higher o Part A reimbursements per day at were 2% lower o Percent of decedents enrolled in a hospice at was 18% lower Baptist Hospital of Miami Inc. reimbursement per decedent was 35% higher because: o Outlier hospital payments per decedent at 2, were 89% higher o Medical specialist visits per decedent at were 52% higher o Medical Specialist FTE staff numbers at were 50% higher o Percent of decedents seeing 10 or more physicians at was 36% higher o Total Part A reimbursements per decedent at 18, were 35% higher o Hospital days per decedent at were 25% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 23% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.31 were 20% higher o Percent of decedents enrolled in a hospice at was 8% higher o Part A reimbursements per day at 1, were 8% higher o ICU days per decedent at 5.82 were 7% higher o Percent of decedents admitted to the ICU at was 4% higher o Primary care physician FTE staff numbers at were 1% lower o Primary care physician visits per decedent at were 2% lower o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 3% lower Broward General Medical Center reimbursement per decedent was 22% higher because: o Outlier hospital payments per decedent at 2, were 106% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 41% higher o ICU days per decedent at 7.44 were 36% higher o Total Part A reimbursements per decedent at 17, were 29% higher o Primary care physician visits per decedent at were 23% higher o Medical Specialist FTE staff numbers at were 20% higher o Primary care physician FTE staff numbers at were 18% higher o Medical specialist visits per decedent at were 18% higher o Hospital days per decedent at were 17% higher o Percent of decedents enrolled in a hospice at was 15% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 12% higher o Part A reimbursements per day at 1, were 11% higher o Percent of decedents admitted to the ICU at was 3% higher o Percent of decedents seeing 10 or more physicians at was 3% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.66 were 14% lower 7

8 Boca Raton Community Hospital Inc. reimbursement per decedent was 19% higher because: o Medical specialist visits per decedent at were 83% higher o Medical Specialist FTE staff numbers at were 58% higher o Percent of decedents seeing 10 or more physicians at was 58% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.40 were 24% higher o Outlier hospital payments per decedent at 1, were 23% higher o Hospital days per decedent at were 18% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 17% higher o ICU days per decedent at 6.33 were 16% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 10% higher o Percent of decedents enrolled in a hospice at was 10% higher o Total Part A reimbursements per decedent at 14, were 9% higher o Primary care physician visits per decedent at were 3% higher o Percent of decedents admitted to the ICU at was 1% lower o Primary care physician FTE staff numbers at were 6% lower o Part A reimbursements per day at were 7% lower JFK Medical Center reimbursement per decedent was 8% higher because: o Percent of decedents enrolled in a hospice at was 39% higher o Percent of decedents seeing 10 or more physicians at was 39% higher o ICU days per decedent at 7.08 were 30% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 25% higher o Primary care physician visits per decedent at were 19% higher o Primary care physician FTE staff numbers at were 15% higher o Outlier hospital payments per decedent at 1, were 15% higher o Medical specialist visits per decedent at were 14% higher o Total Part A reimbursements per decedent at 14, were 6% higher o Hospital days per decedent at were 4% higher o Medical Specialist FTE staff numbers at were 3% higher o Part A reimbursements per day at 1, were 3% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.93 were 0% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 1% lower o Percent of decedents admitted to the ICU at was 21% lower Orlando Regional Medical Center reimbursement per decedent was 8% higher because: o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 28% higher o Primary care physician visits per decedent at were 24% higher o ICU days per decedent at 6.76 were 24% higher o Primary care physician FTE staff numbers at were 23% higher o Percent of decedents admitted to the ICU at was 22% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.25 were 17% higher o Total Part A reimbursements per decedent at 15, were 13% higher o Part A reimbursements per day at 1, were 8% higher o Outlier hospital payments per decedent at 1, were 7% higher o Hospital days per decedent at were 6% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 4% higher o Percent of decedents enrolled in a hospice at was 3% higher o Percent of decedents seeing 10 or more physicians at was 3% higher o Medical Specialist FTE staff numbers at were 8% lower o Medical specialist visits per decedent at were 15% lower 8

9 Florida Hospital-Orlando reimbursement per decedent was 8% higher because: o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 44% higher o ICU days per decedent at 7.71 were 41% higher o Percent of decedents admitted to the ICU at was 17% higher o Primary care physician visits per decedent at were 16% higher o Primary care physician FTE staff numbers at were 14% higher o Percent of decedents seeing 10 or more physicians at was 12% higher o Medical specialist visits per decedent at were 8% higher o Hospital days per decedent at were 8% higher o Total Part A reimbursements per decedent at 14, were 8% higher o Medical Specialist FTE staff numbers at were 7% higher o Percent of decedents enrolled in a hospice at was 6% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 5% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.98 were 3% higher o Part A reimbursements per day at were 0% higher o Outlier hospital payments per decedent at 1, were 5% lower North Broward Medical Center reimbursement per decedent was 4% higher because: o Percent of decedents enrolled in a hospice at was 37% higher o Medical specialist visits per decedent at were 18% higher o Percent of decedents seeing 10 or more physicians at was 18% higher o Medical Specialist FTE staff numbers at were 15% higher o Primary care physician visits per decedent at were 15% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 8% higher o Primary care physician FTE staff numbers at were 8% higher o Hospital days per decedent at were 8% higher o Total Part A reimbursements per decedent at 14, were 4% higher o Outlier hospital payments per decedent at 1, were 3% lower o Part A reimbursements per day at were 3% lower o Percent of decedents admitted to the ICU at was 9% lower o ICU days per decedent at 4.55 were 17% lower o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 24% lower o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.43 were 26% lower Martin Memorial Medical Center reimbursement per decedent was the same because: o Percent of decedents enrolled in a hospice at was 32% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 29% higher o Medical Specialist FTE staff numbers at were 24% higher o ICU days per decedent at 6.55 were 20% higher o Medical specialist visits per decedent at were 15% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.06 were 7% higher o Percent of decedents seeing 10 or more physicians at was 5% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 1% higher o Hospital days per decedent at were 0% the same o Total Part A reimbursements per decedent at 13, were 5% lower o Part A reimbursements per day at were 5% lower o Outlier hospital payments per decedent at 1, were 9% lower o Primary care physician FTE staff numbers at 8.74 were 18% lower o Percent of decedents admitted to the ICU at was 20% lower o Primary care physician visits per decedent at were 21% lower 9

10 Holy Cross Hospital reimbursement per decedent was the same because: o ICU days per decedent at 7.07 were 29% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 24% higher o Percent of decedents enrolled in a hospice at was 20% higher o Outlier hospital payments per decedent at 1, were 19% higher o Medical specialist visits per decedent at were 17% higher o Medical Specialist FTE staff numbers at were 16% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 14% higher o Hospital days per decedent at were 14% higher o Percent of decedents seeing 10 or more physicians at was 10% higher o Hospital based physician Full Time Equivalent (FTE) staff numbers at 2.11 were 9% higher o Total Part A reimbursements per decedent at 13, were 2% higher o Primary care physician visits per decedent at were 3% lower o Primary care physician FTE staff numbers at were 5% lower o Percent of decedents admitted to the ICU at was 9% lower o Part A reimbursements per day at were 10% lower Palm Beach Gardens Medical Center reimbursement per decedent was 2% lower because: o Percent of decedents enrolled in a hospice at was 42% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 38% higher o ICU days per decedent at 7.05 were 29% higher o Primary care physician FTE staff numbers at were 28% higher o Primary care physician visits per decedent at were 17% higher o Hospital beds available per 1,000 decedents during the last two years of life at were 2% higher o Medical Specialist FTE staff numbers at were 1% higher o Percent of decedents admitted to the ICU at was 0% higher o Outlier hospital payments per decedent at 1, were 0% higher o Hospital days per decedent at were 0% the same o Total Part A reimbursements per decedent at 13, were 3% lower o Part A reimbursements per day at were 3% lower o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.84 were 5% lower o Percent of decedents seeing 10 or more physicians at was 5% lower o Medical specialist visits per decedent at were 11% lower Lakeland Regional Medical Center reimbursement per decedent was 10% lower because: o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.93 were 0% higher o Primary care physician visits per decedent at were 3% lower o Hospital days per decedent at were 3% lower o Hospital beds available per 1,000 decedents during the last two years of life at were 5% lower o Part A reimbursements per day at were 7% lower o Primary care physician FTE staff numbers at 9.71 were 9% lower o Total Part A reimbursements per decedent at 12, were 10% lower o Outlier hospital payments per decedent at 1, were 14% lower o Medical Specialist FTE staff numbers at were 18% lower o Percent of decedents seeing 10 or more physicians at was 19% lower o Percent of decedents admitted to the ICU at was 22% lower o Percent of decedents enrolled in a hospice at was 30% lower o Medical specialist visits per decedent at were 35% lower o ICU days per decedent at 2.36 were 57% lower o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at 9.12 were 60% lower 10

11 Holmes Regional Medical Center reimbursement per decedent was 15% lower because: o Medical Specialist FTE staff numbers at were 16% higher o Percent of decedents seeing 10 or more physicians at was 12% higher o Medical specialist visits per decedent at were 7% higher o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 1% higher o Percent of decedents admitted to the ICU at was 1% higher o Outlier hospital payments per decedent at 1, were 1% higher o ICU days per decedent at 5.19 were 5% lower o Part A reimbursements per day at were 9% lower o Hospital days per decedent at were 10% lower o Hospital beds available per 1,000 decedents during the last two years of life at were 11% lower o Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.67 were 13% lower o Percent of decedents enrolled in a hospice at was 16% lower o Primary care physician visits per decedent at were 17% lower o Total Part A reimbursements per decedent at 11, were 19% lower o Primary care physician FTE staff numbers at 8.23 were 23% lower Tallahassee Memorial Hospital reimbursement per decedent was 35% lower because: Hospital based physician Full Time Equivalent (FTE) staff numbers at 1.96 were 1% higher o Percent of decedents enrolled in a hospice at was 9% lower o Hospital beds available per 1,000 decedents during the last two years of life at were 15% lower o Hospital days per decedent at were 15% lower o Part A reimbursements per day at were 16% lower o Percent of decedents admitted to the ICU at was 20% lower o Primary care physician visits per decedent at were 25% lower o Primary care physician FTE staff numbers at 7.71 were 28% lower o Total Part A reimbursements per decedent at 9, were 29% lower o Percent of decedents seeing 10 or more physicians at was 39% lower o Medical Specialist FTE staff numbers at 8.54 were 40% lower o Medical specialist visits per decedent at were 50% lower o ICU bed inputs (Part A) per 1,000 decedents during the last two years of life at were 52% lower o ICU days per decedent at 2.63 were 52% lower o Outlier hospital payments per decedent at were 65% lower Suggested steps for use of this report: The Florida Health Care Coalition may wish to consult with executives, medical staff leaders and trustees in the hospitals selected for this report to compare these data with information available within the hospital. This analysis may reveal additional factors that explain the causes of these variations. These factors affect care for patients of all ages and are of interest to employers. If desired, representatives from Dartmouth CECS could be consulted to discuss the significance of these variations in more depth. Perhaps a special meeting in Florida could be arranged to facilitate this discussion. Benchmarking meetings and visits to hospitals reporting superior performance could be arranged to explore ways to improve care system processes and policies The Coalition may consider preparing information for the press or for distribution to Medicare enrollees through the Florida chapter of the AARP. This information may help these people to make better choices of doctors and hospitals for care that matches their personal values and to consider the merits of hospice care as part of their medical planning. Prepared by Jim Mortimer j.mortimer@earthlink.net 11