Estimating true resource costs of outpatient care for medicare beneficiaries: Standardized costs versus medicare payments and charges

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14 Scopus citations

Abstract

Objective To compare standardized estimates of the true resource costs of outpatient health care to the allowable and billed charges for that care among Medicare Fee for Service (FFS) beneficiaries. Data Sources/Study Setting Medicare Carrier and Outpatient Standard Analytic (SAF) files linked to participant data in the Study of Osteoporotic Fractures from 2004 through 2010. Participants were 3,435 female Medicare Fee for Service enrollees age 80 and older recruited in one rural and three metropolitan areas of the United States. Study Design We estimated standardized costs for Carrier and OP-SAF claims using Medicare payment weights, and compared them to allowable and billed charges for those claims. We used semilog linear regression to estimate the associations of age, race, bone mineral density, prior fracture, and geriatric depression scale score with allowable charges, billed charges, and standardized costs. Results Estimated associations of patient characteristics with standardized costs were not statistically different than the associations with allowable charges (chi-squared [χ2]: 8.6, p =.13) but were different from associations with billed charges (χ2: 25.5, p <.001). Conclusion Allowable charges for outpatient utilization in the Carrier file and OP-SAF may be good surrogates for standardized costs that reflect patient medical and surgical acuity.

Original languageEnglish (US)
Pages (from-to)205-219
Number of pages15
JournalHealth services research
Volume51
Issue number1
DOIs
StatePublished - Feb 1 2016

Bibliographical note

Funding Information:
This study was done primarily under funding from the National Institute for Aging/National Institutes of Health, primarily grant number R01 AG038415-01. The Study of Osteoporotic Fractures is also supported by the National Institute for Aging under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576.

Funding Information:
This study was done primarily under funding from the National Institute for Aging/National Institutes of Health, primarily grant number R01 AG038415-01. The Study of Osteoporotic Fractures is also supported by the National Institute for Aging under the following grant numbers: R01 AG005407, R01 AR35582, R01 AR35583, R01 AR35584, R01 AG005394, R01 AG027574, and R01 AG027576.

Publisher Copyright:
© Health Research and Educational Trust.

Copyright:
Copyright 2017 Elsevier B.V., All rights reserved.

Keywords

  • Carrier file
  • Medicare payment
  • Outpatient costs
  • health care costs
  • outpatient SAF file

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