By: Yosh Thomas  Oct. 30, 2020

Dexur analyzed Medicare Claims data to calculate the Medicare Spending per Beneficiary (MSPB) cost for hospitals in the Atlanta Metropolitan Statistical Area for Hip and Knee Replacement surgeries and ranked the hospitals based on cost outcomes. MSPB weighs 25% in the CMS Value-Based Purchasing (VBP) program and is the only measure under the Efficiency and Cost domain. Hospitals have to wait more than a year to get aggregate MSPB numbers with no insight into DRG or service line specific costs. Dexur replicates CMS algorithms to update DRG and service line MSPB costs on a quarterly basis and with only a 5-6 month delay. For the analysis, Dexur considered hospitals in the Atlanta Metropolitan Statistical Area that record more than 11 episodes of DRG 470 during the calendar year 2019. Dexur did the analysis based on Q1 2020 data but the index hospitalization discharge date was taken into account till December 2019 to accommodate the 30-day post-discharge period in calculating rehospitalization, SNF, and HHA costs. The analysis was risk-adjusted and was done for DRG 470: Major Joint Replacement or Reattachment of Lower Extremity without Major Complication or Comorbidity.

Twenty nine hospitals in the Atlanta Metropolitan Statistical Area met the prerequisites for the study. Emory Saint Joseph's Hospital, located in Atlanta city, had the lowest average MSPB cost per episode for DRG 470 with $13,906 during the 12-month period. The index hospitalization costs accounted for 81% of the overall MSPB costs with an average of $11,278 while the average post discharge cost per episode was $2,627. Among the post-discharge cost components, SNF cost was the major contributor with an average cost per episode of $1,238. It was followed by rehospitalization and HHA costs with the average cost per episode being $855 and $461.

Similarly, Northside Hospital Forsyth, located in Cumming city, and Piedmont Atlanta Hospital also had low average MSPB costs per episode of $14,740 and $15,221, respectively. The average index hospitalization cost of Piedmont Atlanta Hospital was lower than that of Northside Hospital Forsyth with $11,927 while the latter had an average of $12,635. Emory Johns Creek Hospital, located in Johns Creek, Eastside Medical Center, located in Snellville, and Piedmont Henry Hospital, located in Stockbridge, were some of the other hospitals that had lower average MSPB cost per episode for DRG 470 during the 12-month period.

Out of the 17 counties with 29 hospitals included in the study, three hospitals located in Fulton county had lower average MSPB cost per episode than the median of average MSPB costs in Metro Atlanta while four hospitals in the same county had higher than the median average. Similarly, Gwinnett county also had 3 hospitals with lower average MSPB cost than the median average. Douglas, Coweta, Spalding, and Newton had one hospital, each, whose average MSPB costs were higher than the median of average MSPB costs in the Metropolitan Statistical Area during the calendar year 2019.