AdventHealth Palm Coast

Timely emergency care is essential for good outcomes. Delays can reduce the quality of care and increase risk and discomfort for patients with serious illnesses or injuries. Waiting times vary with the number of patients seen, staffing, efficiency, admitting procedures and the availability of inpatient beds.

Sepsis is a complication that occurs when the body has an extreme response to an infection. It damages organs and can be life-threatening. Sepsis can turn into septic shock, which has a higher risk of death. Identifying sepsis early and starting appropriate care quickly increases the chance of survival.

The septic shock measures focus on adults with severe sepsis or septic shock and check whether medically required interventions were given within three hours (first steps) and six hours (remaining steps).

Patients review their care using the HCAHPS survey, which covers overall rating, willingness to recommend, cleanliness, quietness, nurse and doctor communication, communication about medicines and more. CMS converts each set of responses to a number between 0 and 100 and averages them into a linear mean score that captures the full distribution of answers.

Average payment is what Medicare paid plus the patient’s deductible and coinsurance (and any other insurer), averaged over a hospital’s Medicare cases for one procedure. It covers the hospital’s part of the care: doctors and other professionals bill separately. For outpatient procedures it is Medicare’s allowed amount, which excludes the separate “outlier” payments Medicare makes for unusually costly cases (shown separately where CMS reports them). Billed charges are the hospital’s list prices before any discounts and are usually several times what is paid.

Inpatient stays are grouped into Medicare Severity Diagnosis Related Groups (MS-DRGs). Many come in versions “with MCC” (a major complication or comorbidity), “with CC” (a lesser one) or “without CC/MCC”, which are paid differently. Outpatient procedures are grouped into comprehensive Ambulatory Payment Classifications (APCs) of similar procedures, from “Level 1” (simplest) upward.

Medicare sets its payments by formula, adjusting for local wages, teaching programs, the share of low-income patients and unusually costly cases. Those adjustments drive most differences between hospitals, so a lower payment does not mean better or worse care. Maryland sets hospital rates for all payers, so its payments are higher and closer to its charges. Medicare Advantage, Medicaid and private insurance pay different prices.

CMS publishes these figures about 18 months after the year of care and leaves out any hospital with fewer than 11 Medicare discharges (inpatient) or services (outpatient) for a procedure. Averages, typical ranges (the middle half of hospitals) and comparisons cover the hospitals that are reported. Whether a procedure counts as a “surgery or procedure” is our classification from the CMS description.

The payment measures add up all payments for care starting the day the patient enters the hospital: payments to the hospital, doctor's office, skilled nursing facility and hospice, plus patient copayments. Risk adjustment accounts for patient age, medical history and other conditions, and removes differences unrelated to care such as geographic pricing.

Looking at payment together with quality-of-care measures such as death rates lets you compare the value of care between hospitals. Lower and to the left (low death rate, low payment) is the best combination.

Hospitals list charges that are usually much higher than what care costs them. The cost-to-charge ratio shows how far apart the two are. Values are calculated from the hospital’s annual Medicare cost report.