By: Debasish Choudhury  Jun. 01, 2021

MemorialCare Saddleback Medical Center, Laguna Hills, CA, reported a CMS Value Based Purchasing (VBP) adjustment factor of 0.9923 in the year 2021, which could result in an estimated penalty of $260,696. Medicare Spending Per Beneficiary (MSPB) accounts for 25% of overall VBP score and is a significant factor in driving VBP payments. MSPB costs include the costs from 3 days before hospitalization, index hospital stays, and 30 days post-discharge. The measure score of the Efficiency & Cost Reduction domain for MemorialCare Saddleback Medical Center during the period was 0/10. Dexur is an approved purchaser of CMS Medicare claims data and based on our simulator, we estimate that MemorialCare Saddleback Medical Center can avoid VBP penalties by reducing MSPB Cost by 8.5%.

By: Sruthy Iype  May. 13, 2020

Dexur’s analysis of Medicare Claims of hospitals in the Los Angeles area, California, revealed that MemorialCare Saddleback Medical Center, Hoag Memorial Hospital Presbyterian, and Mission Hospital Regional Medical Center had the lowest cost of care over a 90-day episode for Heart Failure. For the period between, April 2016 to March 2019, the study tracked the patient journey from the date of admission for 90 days, including the index hospitalizations, rehospitalization, home health, nursing home, and ED costs. The total cost of care helps patients make appropriate choices and helps local ACOs such as Adventist Health Accountable Care ACO, Premier ACO Physicians Network, Family Choice ACO, UC Irvine Health Accountable Care Organization and CareConnectMD ACO make appropriate referrals choices. The analysis was risk-adjusted and was done at the DRG level (specifically DRG 291: Heart Failure And Shock With Major Complication Or Comorbidity (MCC)) to adjust for complications and comorbidities.