Evaluation of Hospital Characteristics Driving High Private Payer Prices

This project aims to understand how individual hospital-level characteristics are correlated with and drive high commercial hospital prices. The project will: 1) create a dataset of the average commercial-to-Medicare price ratios and data on potentially predictive hospital characteristics driving those prices over time for all U.S. hospitals; 2) analyze the dataset to identify the most important factors associated with high commercial hospital price ratios; and 3) explore specific hospital and market case studies of high or low outliers to qualitatively assess the relationship between high or low prices and hospital and market characteristics. Specific hospital individual characteristics could include hospital type; ownership status; system affiliation; payer mix; service-line mix; wage, administrative, and capital cost structures; rankings of quality and public perception; and penetration of alternative payment models. Data are primarily from the Centers for Medicare and Medicaid Services (CMS) Medicare Cost Report data, but will also draw from market concentration data, quality and public ranking data, payment model participation data from CMS, and hospital data from publicly available sources and the American Hospital Association as appropriate.