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OCA recommends method to identify high‑cost hospitals; proposes lower growth targets for 11 outliers
Summary
OCA proposed identifying hospitals as disproportionately high cost if they sit above the 85th percentile for three of five years on both (1) a unit‑price measure (commercial inpatient net patient revenue per case‑mix‑adjusted discharge) and (2) a relative‑price measure (commercial‑to‑Medicare payment‑to‑cost ratio). Staff said that approach flags hospitals with ‘‘systematically higher costs’’ and that the office identified 11 repeat outliers using it.
The Office of Health Care Affordability (OCA) recommended a two‑part method for identifying hospital outliers and proposed lower annual spending growth targets for a group of 11 hospitals it found to be ‘‘repeat outliers.’
