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FAQ

Why is my hospital not listed?

Hospitals are listed if they had a certain number of episodes of care that took place within the specific timeframe and population studied. In the analysis of 2014/2015 commercial claims data, for example, a hospital was only listed if it had the following number of episodes of care among its commercially insured patients in 2014/2015:

Hip replacement: 20 episodes or more
Knee replacement: 20 episodes or more
Hysterectomy: 35 episodes or more
Vaginal delivery: 60 episodes or more
Some hospitals did not meet these minimum episode limits, and were excluded from the website display; however the episodes for these hospitals were included in the calculation of all statewide average measures.

What is a Potentially Avoidable Complication?

A potentially avoidable complication is an event that could cause harm to a patient and one that could have potentially been avoided.

What is an episode?

An episode of care brings together all of the treatment for a medical need. It includes all covered services across all the medical providers that treat a patient for a condition, procedure, or illness.

Many services are classified as typical because they are routine for the episode. Other services can be classified as complications from the procedure. That means the costs of services from hospitals, physicians, laboratories, pharmacies, rehabilitation facilities, and more can all be included in an episode as long as those services are associated with the same medical need. Episodes cover a period of time before the procedure is done and another period of time after the patient has been discharged.

What is a Hip Replacement Episode?

The Hip Replacement episode includes all covered services across all providers related to the procedure of a hip replacement or hip revision surgery. The procedure could be performed in a hospital or in an outpatient facility, and includes all investigations done prior to the surgery, services related to the procedure itself, and those that are provided after the surgery, and for a certain period of time after the patient has been discharged from the hospital / outpatient facility.

Who is included in a Hip Replacement episode?

Patients 18-65 years of age who have a claim for at least one of these three types of service:

A patient has a hospital admission for a Hip Replacement
A patient has an outpatient facility admission for a Hip Replacement
A patient has a professional service indicating that a Hip Replacement has been performed

What is a Vaginal Delivery Episode?

The Vaginal Delivery episode includes all covered services across all providers related to the birth of a baby normally. The birth may occur in the hospital or in a birthing center. Services included are those that are provided during the delivery of a baby and up to a certain period of time after the mother leaves the hospital/ birthing center.

Who is included in a Vaginal Delivery episode?

Patients 12-65 years of age who have a medical claim for at least one of these three types of service:

A patient has a hospital admission for a Vaginal Delivery
A patient has an outpatient facility service for a Vaginal Delivery
A patient has a professional service for a Vaginal Delivery

What is a Hysterectomy Episode?

The Hysterectomy episode includes all covered services across all providers related to the procedure of hysterectomy. The procedure could be performed in a hospital or in an outpatient facility, and includes all investigations done prior to the surgery, services related to the procedure itself, and those that are provided after the surgery, and for a certain period of time after the patient has been discharged from the hospital / outpatient facility.

Who is included in a Hysterectomy episode?

Patients 18-65 years of age who have a medical claim for at least one of these three types of service:

A patient has a hospital admission for a Hysterectomy
A patient has an outpatient facility admission for a Hysterectomy
A patient has a professional service indicating that a Hysterectomy has been performed

What is a Knee Replacement Episode?

The Knee Replacement episode includes all services related to that medical need, including the surgery or procedure, anesthesia, lab tests, radiology, and all relevant pharmacy services such as antibiotics or pain medicines. The procedure could be performed in a hospital or in an outpatient facility. Other services may include all investigations done prior to the surgery, services related to the procedure itself, services provided after the surgery, and any follow-up services for a certain period of time after the patient was discharged.

Who is included in a Knee Replacement episode?

Patients 18-65 years of age who have a medical claim for at least one of these three types of service:

A patient has a hospital admission for a Knee Replacement
A patient has an outpatient facility admission for a Knee Replacement
A patient has a professional service indicating that a Knee Replacement has been performed

What does this mean to you?

An episode captures the costs of all the care you receive from all medical providers, facilities, and prescriptions for a condition, procedure, or illness. When medical claims are grouped into an episode of care, costs become more transparent which enables you to compare the cost of the same care at different hospitals. It also allows medical providers to make the same comparison since the costs are adjusted for differences in the complexity and severity of the patients’ conditions they treat.

Higher cost of care is one reason that health insurance premiums are increasing. You can make a difference when you choose doctors and hospitals that give better care at a lower cost.This site empowers you by providing you the information you need to choose the facilities that will provide you a better quality of care at a lower cost. We urge you to take a more active role in your health care and add your voice to this growing movement by joining the conversation

What can I do about the high cost of an episode?

Talk to your doctor about all of the care that’s recommended for you. Ask how much you’re expected to pay and where you can find good care at a lower cost. Check out these articles for hints about the questions you can ask.

Talk to your insurance company and ask for help with finding good care at a lower cost.

Join the conversation!

We urge you to take a more active role in your health care and add your voice to this growing movement by joining the conversation.
Tell us about your experiences with finding good care at a lower cost by commenting on our blog.
You can share your stories, arm yourself with knowledge.
Learn how you can Wear the Cost to help start a conversaqtion about the cost of care.

How does Maryland Price and Quality Compared to Other States?

Compared to other states, the overall variation in the episode costs of selected procedures is lower in Maryland, and the average prices, for the most part, are also lower. Quality measure comparisons point to potential opportunities for improvement in Maryland compared to New Hampshire and Connecticut. In Maryland, as in other states, there is still a significant amount of variation in episode costs among facilities in the state.

Comparison of episode prices and potentially avoidable complication rates
PAC: Potentially Avoidable Complication Rate (lower is better), IQR: Interquartile Range

  Maryland New Hampshire Connecticut
Hip Replacement PAC Rate42.3%30.0%27.8%
Hip Replacement Episode Cost$30,779$34,215$34,757
Hip Replacement IQR[$24,960 – $36,674][$26,793 – $41,377][$30,241 – $39,917]
Knee Replacement PAC Rate40.1%32.0%29.3%
Knee Replacement Episode Cost$29,059$32,366$37,475
Knee Replacement IQR[$22,663 – $33,840][$23,444 – $42,410][$31,147 – $43,487]
Hysterectomy PAC Rate54.3%46.4%43.4%
Hysterectomy Episode Cost$16,381$19,038$17,700
Hysterectomy IQR[$13,895 – $18,357][$12,856 – $22,830][$13,182 – $20,977]
Vaginal Delivery PAC Rate28.2%27.1%29.0%
Vaginal Delivery Episode Cost$10,841$10,518$13,380
Vaginal Delivery IQR[$9,156 – $12,174][$8,132 – $12,511][$11,465 – $14,948]

Source: Altarum Institute