DataMatters - September 2023 Edition
In this Issue:
Publications and Data Releases
Opening Message
In this issue of DataMatters, we are excited to announce the publication of the hospital fiscal year (HFY) 2022 Annual Hospital and Health System Financial Performance report. Drop down to the “News You Can Use” section for details and key findings.
Since the last DataMatters in July, CHIA has released its latest analysis of provider price variation in the commercial health insurance market for calendar year (CY) 2021. We also published the latest report in our health care equity series assessing disparities in acute care utilization by race and ethnicity—including inpatient discharges and emergency department visits—for state fiscal year (SFY) 2021. See more details, as well as additional publications from CHIA, in the “Publications and Data Releases” section below.
In the “Data User Profile” section below, the Health Policy Commission (HPC) walks us through their use of CHIA data in the development of their 2023 Health Care Cost Trends Report. We’re proud to be part of this important process for the tenth year, as the HPC pulls together policy recommendations for Massachusetts policymakers and legislators.
As always, you can also see upcoming events related to health care and/or data that may be of interest to you.
We hope that you enjoy this newsletter and learn something new. If there’s something you liked or if you have suggestions for improvement, we welcome your feedback at newsletter@chiamass.gov.
News You Can Use
The Center for Health Information and Analysis (CHIA) today published the Annual Massachusetts Acute Hospital and Health System Financial Performance Report for hospital fiscal year (HFY) 2022. This publication reports on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, as well as the profitability of affiliated physician organizations.
To understand the impact of temporary labor expenses on hospitals and their health systems, CHIA began collecting temporary staffing expenses in August 2023. For the first time, this report includes the initial results of these filings, which were collected retrospectively for HFYs 2019 through 2022.
This report also incorporates the financial impact of COVID-19 on hospitals during HFY 2022. The majority of federal and state COVID relief funding was distributed and reported in HFY 2020, but some hospitals received and reported funding in HFYs 2021 and 2022.
Key Findings:
- Overall acute hospital profitability in HFY 2022, as measured by the median total margin, was -4.2%, a decrease of 9.2 percentage points in comparison to the prior fiscal year. All four cohorts reported a decrease in profitability.
- The statewide median acute hospital operating margin was -1.3%, a decrease of 2.1 percentage points compared to HFY 2021. The statewide median acute hospital non-operating margin was -0.4%, a decrease of 3.4 percentage points in comparison to the prior fiscal year.
- In HFY 2022, aggregate expenses exceeded aggregate operating revenues by $460 million at acute hospitals. Aggregate expenses increased 8.9%, while aggregate operating revenues increased 5.5%, as compared to the prior hospital fiscal year.
- Acute hospitals reported $1.5 billion in temporary staffing costs in HFY 2022, more than double the amount reported in the prior hospital fiscal year.
CHIA also released with this report an interactive dashboard containing information on five-year trend analyses for each acute hospital and their hospital health system. This report is accompanied by the databook used to calculate these metrics and a technical appendix.
While this report focuses on HFY 2022, CHIA has also released more recent quarterly hospital financial performance data through June 30, 2023, which represents three quarters of data for most hospitals and health systems. The latest data shows that overall acute hospital profitability—as measured by the median total margin—was 1.6%, an increase in comparison to the same period in the prior hospital fiscal year.
Data User Profile
In every DataMatters newsletter, we feature an interview with a user of CHIA data. For this month, we reached out to the Health Policy Commission (HPC), who utilized CHIA data as one of their sources in the production of the Annual Cost Trends Report. The 2023 report was released by the HPC on September 12, and features an analysis of health care cost drivers in Massachusetts during the past year, as well as a slate of policy recommendations. For this report they used data from the Massachusetts All-Payer Claims Database (MA APCD).
To see all meeting and report-related materials click here; to watch the recent HPC board meeting where the report was highlighted, click here.
We deeply appreciate the HPC for taking the time to answer our questions.
Please briefly describe the Cost Trends Report.
The Massachusetts Health Policy Commission (HPC) 2023 Annual Health Care Cost Trends Report provides an overview of health care spending and delivery in Massachusetts and quantifies excess health care spending due to high prices and potentially unnecessary utilization. The report also presents a set of comprehensive policy recommendations to improve oversight and accountability and promote affordability and equity in the health care system.
Which CHIA data do you use in the report?
The HPC used CHIA’s Massachusetts All-Payer Claims Database (APCD) from 2019 to 2021 to construct an analytic file of lab services at the procedure-code encounter level.
The Commercial Price Trends Chartpack that accompanies the Cost Trends Report highlights the laboratory services commercial price index which quantifies price levels of common lab services in Massachusetts. The price index is a fixed-quantity market basket that allows for comparison of lab prices over time and across payers and providers. The market basket contains the 50 highest-cost lab services in terms of aggregate statewide spending in 2019 that were common across hospital outpatient departments (HOPDs), provider offices, and independent labs. The services are defined by procedure code encounters, and the prices include spending from associated professional and facility claims if they both exist using 2021 prices. The analysis presents each individual provider’s cost for this standard set of lab tests to highlight the variation between providers and between provider types.
What was your experience using CHIA data?
The APCD offers a unique level of detail that is well suited for price analysis work at the HPC. Previously, the HPC has reported price information for individual hospitals and hospital systems. However, using claim level detail in the APCD, the HPC labeled professional claims (for provider offices and independent labs) with the service provider and constructed a price for the market basket for these providers.
Additionally, the APCD is readily linkable to other data sources, such as the Medicare Clinical Laboratory Fee Schedule, which the HPC used to report the price Medicare would pay for the market basket.
Finally, reliable price information in the APCD allows the HPC to report on affordability implications of prices, such as associated cost sharing for the market basket to patients.
Please briefly describe some notable key findings from the report.
The cost of the lab market basket in 2021 varied by a factor of 4.3 across Massachusetts hospitals and varied by a factor of 7.4 across all providers, with higher price levels identified among HOPDs (Exhibit 1). The cost to purchase this market basket of lab services per 100 members per year ranged from $24,397 at a geographically isolated, community hospital to $3,279 at an independent lab. Medicare would pay $3,559 for this same set of labs. Higher costs for the market basket also translated to higher patient cost sharing.
Exhibit 1. Cost of the lab market basket, including cost sharing, by Massachusetts provider, 2021
Notes: For each provider, the same 50 procedure codes are evaluated using a fixed statewide volume (computed using 2019 data) and provider-specific mean service prices in 2021 for each procedure code. Providers with fewer than 20 service encounters for any individual procedure code have imputed values for that procedure code and are not included if more than 25 procedure codes would have to be imputed.
Sources: HPC analysis of Center for Health Information and Analysis Massachusetts All-Payer Claims Database, V2021, 2021
What "takeaway" information would you like to highlight from your research and/or experience using our data?
Although lab services are standardized, routine, and do not vary in quality across providers, the price index revealed wide variation in prices across settings of care. Hospital-based outpatient departments (HOPDs) charge higher prices for the same 50 lab services than provider offices and independent labs, reflecting relative negotiating leverage between a given insurer and provider and not necessarily the underlying costs of care.
High and variable prices drive additional problems in the health care system, such as unaffordable health care premiums and out-of-pocket costs.
Measuring price levels with reliable data is a first step to addressing these issues. The HPC’s Cost Trends Report includes policy recommendations to constrain excessive provider prices.
Publications and Data Releases
New! Quarterly Hospital Financial Performance through June 30, 2023
September 2023
CHIA today released its most recent quarterly acute hospital and health system financial performance report with data through June 30, 2023. Each quarter CHIA publishes this report on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, as well as the profitability of affiliated physician organizations.
New! HFY 2022 Annual Hospital and Health System Financial Performance Report
September 2023
CHIA released its latest annual report on Massachusetts hospital and health system financial performance. This publication reports on the profitability, liquidity, and solvency of hospital health systems and their affiliated acute hospitals, as well as the profitability of affiliated physician organizations. For the first time, this report also includes data on temporary staffing in Massachusetts hospitals. See more detail and key findings in the “News You Can Use” section above.
Enrollment Trends with Data through March 2023
September 2023
CHIA updated its Enrollment Trends analysis for the most recent two-year period to give researchers and policymakers insight into the market. The latest edition covers the period between March 2021 and March 2023 and includes breakouts by payers and product types in private commercial and public market sectors.
Mandated Benefit Reviews
August 2023
Last month, CHIA released reviews of two bills, H1084/S617 An Act relative to applied behavioral analysis therapy and S622 An Act relative to LGBTQ family building. CHIA regularly evaluates the impact of mandated benefit bills referred by the Legislature for review. The reports are comprised of a medical efficacy analysis and an estimate of the effect that the proposed mandated benefit would have on the cost of health insurance premiums.
An Act relative to applied behavioral analysis therapy, if enacted, would require coverage for the treatment of Down syndrome through Applied Behavior Analysis (ABA) therapy. An Act relative to LGBTQ family building would require that health insurance provides coverage for medically necessary expenses of diagnosis of infertility and fertility treatment and preservation, to the same extent that benefits are provided for other pregnancy-related procedures.
Hospital Utilization in Massachusetts: An Assessment by Race & Ethnicity
August 2023
In August, CHIA published a new report as part of its health care equity series. Hospital Utilization in Massachusetts: An Assessment by Race & Ethnicity analyzes differences in acute care utilization by race and ethnicity for Massachusetts residents, including inpatient discharges and emergency department visits from acute care hospitals, for SFY 2021.
Relative Price and Provider Price Variation
August 2023
CHIA published in August its annual update on provider price variation in the commercial health insurance market for CY 2021. This report includes an interactive dashboard, enabling users to explore relative price results for Massachusetts hospitals and physician groups.
Upcoming Events and Resources
Events and announcements of interest to our community, organized by CHIA, our data partners, and others
Betsy Lehman Center for Patient Safety
10th Annual Communication, Apology and Resolution (CARe) Forum
Friday, September 29, 2023, 9:00 AM – 1:00 PM
501 Boylston Street, 5th Floor, Boston, MA, 02116
This year’s Communication, Apology and Resolution (CARe) Forum will present case simulations and other material for live discussion in Boston, with an online option. Registration is free. Visit BetsyLehmanCenterMA.gov/CARe for more information.
CHIA Oversight Council Meeting
Thursday, October 12, 2023, 2:00 PM
CHIA’s appointed Oversight Council meets quarterly to discuss agency priorities and agenda-setting. The next meeting is scheduled for Thursday, October 12, at 2:00 p.m. and will stream live on CHIA’s YouTube channel.
MAHP Policy Forum: Severe Maternal Morbidity: Reducing Preventable Disparities with Education, Funding, and Systemic Changes
Wednesday, October 11, 2023, 9:15 a.m. – 11:30 AM
UMass Club, Boston, MA
MAHP will be holding a policy forum on Severe Maternal Morbidity. The Policy Forum will have presentation and a panel discussion to raise awareness of severe maternal morbidity rates in Massachusetts, with a focus on the challenges that exist, state efforts to address inequities, and solutions recommended by the Special Commission on Racial Inequities in Maternal Health for improving maternal health outcomes. Here’s a link to the full agenda. To register for the event, please contact Lynda Jackson at jackson@mahp.com.
CHIA Data User Workgroups
Tuesday, October 24, 2023, 3:00 PM
These ongoing meetings are designed for data users and other interested parties to connect with CHIA to discuss analytical techniques and best practices in research using CHIA's MA APCD and Case Mix databases.
The next virtual workgroup meeting will be on Tuesday, October 24, 2023, at 3:00 PM. For more information including past presentations and user support materials, visit the information page. To learn more about CHIA data, please visit https://www.chiamass.gov/chia-data/.
National Association of Health Data Organizations (NAHDO) 38th Annual Conference: Health Data Driving Policy
Pre-Conference Events: October 18, October 25, and November 1, 2023
Virtual Sessions: November 7 – 9, 2023
NAHDO is hosting its annual meeting with topic-driven sessions designed to identify solutions to some of the current challenges facing health data organizations. Registration is now available, which will be held virtually again this year.
Massachusetts Association of Health Plans (MAHP) 2023 Annual Conference: Health Care Affordability, Quality and Equity in a Post Pandemic World
SOLD OUT! Friday, November 17, 2023, 7:30 a.m. – 2:00 p.m.
Seaport Hotel, Boston, MA
Individual registration for MAHP’s 2023 Annual Conference has sold out. Please contact Jessica Lussier at lussier@mahp.com to be placed on the wait list. Visit MAHP’s Annual Conference webpage to view full agenda, sponsorship information and conference updates.
AcademyHealth & National Institutes of Health 16th Annual Conference on the Science of Dissemination and Implementation of Health: Raising Expectations for D&I Science: Challenges and Opportunities
Monday December 10 – Wednesday, December 13, 2023
Arlington, VA
The 16th annual conference will convene a growing network of peers in Washington, D.C. to explore the latest innovations in dissemination and implementation science to ensure that evidence is used to inform decisions that will improve the health of individuals and communities.
This year's in-person conference will concentrate on capitalizing on methodological progress while also focusing attention on areas needing growth. Registration details are available here.
Massachusetts Health Policy Commission
Board Meeting
Wednesday, December 13, 2023, 12:00 PM
The HPC’s 11-member Board meets approximately every six weeks throughout the year to review staff- (or guest)- presented overviews of the agency’s major workstreams, and other topics related to health care cost containment and reform. Major reports, statutory regulations, and publications are authorized by a majority vote at these meetings.
Join Our Team
A selection of open positions at CHIA. Please feel free to share broadly with your network. Follow CHIA on LinkedIn for more regular updates.
Senior Research Analyst
Strategy and Research Team
Associate General Counsel
Legal Team
Associate Manager of Health Services Pricing
Health Servicing Pricing Team
CENTER FOR HEALTH INFORMATION AND ANALYSIS
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