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Payment and Value of Care

Medicare Spending per Beneficiary:

  • The "Spending per Hospital Patient with Medicare" (Medicare Spending per Beneficiary) measure shows whether Medicare spends more, less, or about the same on an episode of care for a Medicare patient treated in a specific hospital compared to how much Medicare spends on an episode of care across all hospitals nationally.  This measure includes any Medicare Part A and Part B payments made for services provided to a patient during an episode of care, which includes 3 days prior to the hospital stay, during the stay, and during the 30 days after discharge from the hospital.
  • This result is a ratio calculated by dividing the amount Medicare spends per patient for an episode of care initiated at this hospital by the median (or middle) amount Medicare spent per episode of care nationally.
  • A ratio equal to the National average means that Medicare spends ABOUT THE SAME per patient for an episode of care initiated at this hospital as it does per episode of care across all hospitals nationally.
  • A ratio that is more than the National average means that Medicare spends MORE per patient for an episode of care initiated at this hospital as it does per episode of care across all hospitals nationally.
  • A ratio that is less than the National average means that Medicare spends LESS per patient for an episode of care initiated at this hospital as it does per episode of care across all hospitals nationally.


Lower ratios means Medicare spends less per patient.

Data shown below for Carle Richland Memorial Hospital is from the most recent update of CMS Hospital Compare / Centers for Medicaid and Medicare Services.

Measure Our Ratio Illinois Av. U.S. Av. Notes:
Medicare hospital spending per patient (Medicare Spending per Beneficiary) Displayed in ratio. 0.94 1 0.98
 

Payment:

The payment measures add up all payments made for care starting the day the patient enters the hospital and continuing for the next 30 days.  This can include payments made to the hospital, doctors office, skilled nursing facility, hospice, as well as co-pays made during this time.  Payments can be from Medicare, other health insurers, or the patients themselves.  Looking at how payments vary is one way to see differences in how hospitals and other healthcare providers care for patients.

Data shown below for Carle Richland Memorial Hospital is from the most recent update of CMS Hospital Compare / Centers for Medicaid and Medicare Services.

Measure: Our Performance National Av. Payment Notes:
Payment for heart attack patients Number of cases too small $23,119
Payment for heart failure patients No different than the National average payment $16,190
Payment for hip/knee replacement patients Number of cases too small $22,567
Payment for pneumonia patients No different than the National average payment $17,026
 

Value of Care:

Looking at payment measures together with quality-of-care measures (such as death rates) allows you to assess the value of care in hospitals.
The payment measures add up the payments of care starting the day the patient enters the hospital and continuing for the next 30 days.  For example, this can include payments to the hospital, doctors office, skilled nursing facility, hospices, as well as patient co-pays made during this time.  The quality measures below look at death rates in the first 30 days after patients are hospitalized.

Data shown below for Carle Richland Memorial Hospital is from the most recent update of CMS Hospital Compare / Centers for Medicaid and Medicare Services.

Measure Our Performance National Rate
Death rate for heart attack patients Number of cases too small 13.6%
Payment for heart attack patients Number of cases too small $23,119
Death rate for heart failure patients  No different than the National rate 11.9%
Payment for heart failure patients No different than the National average payment $16,190
Rate of complications for hip/knee replacement patients Number of cases too small 2.8%
Payment for hip/knee replacement patients Number of cases too small $17,026
Death rate for pneumonia patients No different than the National rate 15.9%
Payment for pneumonia patients No different than the National average payment $17,026