Healthcare Transparency Index Q1 2014
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Transcript of Healthcare Transparency Index Q1 2014
Change Healthcare Corporation • 216 Centerview Drive, Suite 300 • Brentwood, Tennessee 37027 • 888.920.5234 • [email protected] • www.changehealthcare.com
© 2007-2014 Change Healthcare CorporationHCTI 2014 Q108/01/14
Healthcare Transparency Index2014 Q1 ReportAugust 2014
2 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Table of Contents
Consumers Need Actionable Information on Cost and Quality ..............................3
Facility Costs, Not Professional Fees, Drive Variability in Healthcare Costs ...........4
Identifying Target Opportunities by High Cost and High Variability ........................6
About the Healthcare Transparency Index ..............................................................7
About Change Healthcare .......................................................................................7
Transparency Matrix™ ............................................................................................8
Appendix .................................................................................................................9
Category Guide ......................................................................................................... 10
Matrices ..................................................................................................................... 11
National Data Set ...................................................................................................... 16
Glossary .................................................................................................................... 55
3 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
3 Healthcare Transparency Index
The healthcare cost and quality transparency movement
is contributing to a new age of healthcare consumerism
in which patients will achieve what government and
business have not – better, more affordable healthcare.
Powering this transformation are patients who are
expected to cover a growing share of their healthcare
costs, and, thus, are increasingly motivated to shop
for care.
According to the Kaiser Family Foundation, 38 percent
of covered employees have a deductible of $1,000 or
more for single coverage (up from 18 percent five years
ago), and 15 percent have a deductible of $2,000 or
more (up from 5 percent in 2008)1. These consumers
want to assess and compare the cost and quality – or
the value – of their healthcare services before they buy.
While cost and quality transparency is critical to their
understanding of value, it is not sufficient. To achieve
true consumerism in healthcare, individuals need to
know where the best opportunities are for value-based
information that is timely, personalized and actionable.
Such objective cost and quality information empowers
them to save money for themselves, their employers and
their health plans.
This isn’t just a theory. When working with health plans
and self-insured employers nationwide to proactively
alert consumers of potential cost savings on recurring
medical services and prescription medications, Change
Healthcare has seen more than $500 in yearly cost
savings per purchaser2.
In fact, a recent analysis by West Health Policy Institute
suggests that transparency initiatives could cut $100
billion over 10 years from health spending3. While this is
a small step towards meaningfully impacting the trillions
of dollars we spend on healthcare in this country each
year, it is a step in the right direction.
Consumers Need Actionable Information on Cost and Quality
38%
of employees have a deductible of
$1,000 or more
15% of employees have a
deductible of $2,000 or more
transparency initiatives could cut
$100B over the next 10 years
Change Healthcare has seen more than
$500 in yearly cost savings
per purchaser
1. The Kaiser Family Foundation and Health Research & Educational Trust. Employer Health Benefits 2013 Annual Survey. http://kaiserfamilyfoundation.files.wordpress.com/2013/08/8465-employer-health-benefits-20131.pdf
2. Based on a Change Healthcare case study with Cerner Corporation. Results may vary by client.
3. White C, et al. Healthcare Price Transparency: Policy Approaches and Estimated Impacts on Spending. West Health Policy Center Policy Analysis, May 2014. http://www.westhealth.org/sites/default/files/Price%20Transparency%20Policy%20Analysis%20FINAL%205-2-14.pdf
4 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
In an effort to keep a pulse on cost variability across
various medical and dental services, Change Healthcare
aggregates its in-network claims from credentialed
providers across its client base, which has geographic
coverage that spans nationally and covers 7 million
lives. The prices reported are the actual costs paid
for procedures, as opposed to billed amounts. This
data collection results in the quarterly Healthcare
Transparency Index (HCTI), which identifies the largest
opportunities for savings – both for the consumer and
the plan sponsor.
As part of the release of the HCTI for the first quarter
of 2014, Change Healthcare analyzed the relationship
between professional fees, such as those charged by a
radiologist or physician, and facility fees across
four high-frequency inpatient procedures and four
imaging services.
As one can see from the table below, the analysis
found that the largest variations in cost came from the
facility fees, not the professional fees. This conclusion
is especially interesting given that doctors’ fees often
receive the bulk of the blame for escalating
healthcare costs.
Since the facility fees vary so widely, patients should be
encouraged to ask their doctor at which area hospitals
he or she has privileges to perform a surgery or deliver
a baby. Once the patient is informed about their facility
options, they can comparison shop among facilities and
still use their same doctor.
Facility Costs, Not Professional Fees, Drive Variability in Healthcare Costs
1,132%
Inpatient BundlesThe four inpatient procedures include hip replacement, knee replacement, C-section delivery and vaginal delivery. The orthopaedic procedures showed the
greatest variation in both facility and professional costs, although the variation was far higher in the facility costs than the professional costs.
HipReplacement
KneeReplacement
C-SectionDelivery
VaginalDelivery
$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000
$1,669
$2,613
$4,190
$32,1901,132%
151%
$1,669 $4,190127%
$1,803 $32,2251,687%
$5,300 $15,962201%
$2,613 $10,679319%
$2,097 $3,28457%
$2,179 $3,03339%
Professional Facility % Cost Variability
5 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Given that facility fees can greatly impact the overall
cost of the procedure, how can patients find out how
much any given procedure will cost based on their
individual plan, network and location?
Change Healthcare offers a Cost Lookup tool that
provides expected costs for more than 81 percent of
medical services and 75 percent of prescriptions used
by our client population; we also provide pricing on a
number of dental and vision services. For instance, if a
doctor performs a procedure at three different facilities,
the associated costs for that doctor at each of those
facilities would give the consumer a clear idea of the
costs associated with each option.
Users can search for a prescription, medical, dental
or vision service, receiving accurate pricing matched
for their location, plan design and network; a personal
view of total cost, member cost and plan cost; bundled
pricing that reflects the comprehensive instance of care;
and quality ratings for facilities and providers from both
public and private data sources, including patient
satisfaction surveys.
For the patient, facility shopping will have the greatest
economic impact when the services fall within the
individual or family deductible. For example, if the
individual has a deductible of $2,500, and the facility
cost of MRIs range from $596 to $2,529, choosing
a facility that costs less than the average of $1,494
could mean a reduction of out-of-pocket costs for the
consumer of $1,000 or more (assuming the provider
cost is near the median of $144 and there are no other
medical costs to contribute to the deductible).
Given the wide variation even between the average
facility cost for a knee replacement and the highest cost,
a consumer who is informed about facility costs could
save their employer/health plan a significant amount of
money. While the patient may not directly benefit from
the cost savings, since even those with high-deductible
plans will likely already have met their deductibles, they
may eventually benefit since rising healthcare costs for
employers and health plans will affect premium rates
paid by consumers in the long-term.
ImagingThe four imaging services analyzed in this iteration of the HCTI included MRIs, CT scans, ultrasounds, and mammograms. Of the four, the CT scans,
ultrasounds and MRIs showed the greatest variance, especially in facility costs.
Professional Facility % Cost Variability
MRIs
CT Scans
Ultrasounds
Mammograms
0 $500 $1,000 $1,500 $2,000 $2,500 $3,000
324%
230%
202%
469%
350%
163%
$596
$85 $280
$410
$71
$34-$92
$38-$84
$124 $559
$347$132
$213
$2,334
$2,529
121%
175%
6 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
This release of the HCTI for the first quarter of 2014
includes a series of charts that plot services into
high/low-cost and high/low-cost variability quadrants to
help identify services that could be targets for
intervention. Change Healthcare has found that
even within a given network, charges for pharmacy,
medical and dental services often vary by more than
300 percent. Both low-cost and high-cost services can
show wide variability.
In an effort to identify high-cost, high-variability services,
Change Healthcare created the Change Healthcare
Transparency Matrix (see page 8). The vertical axis
represents the average cost of the service, while the
horizontal axis is the variability in pricing of that service.
The healthcare services clustered in the top right of the
quadrant, called the Target quadrant – high-cost, high-
variability services – provide the richest opportunities
to reduce costs for plan sponsors and consumers.
Examining data from the first quarter of 2014, eight
services fell into the Change Healthcare Transparency
Matrix’s Target quadrant. The idea is to alert healthcare
consumers – as well as health plans and employers – to
where the greatest healthcare costs and cost variability
is occurring.
The analysis identified hip replacement, knee
replacement, all MRIs and all CT scans as targets in the
Transparency Matrix – not surprising, given that we have
seen them consistently carry high costs and
high variability.
Other services that fall into the Target matrix for their
respective procedure categories include women’s health,
high-level specialists, tooth extraction and cavities.
Identifying Target Opportunities by High Cost and High Variability
$72 - $241Average: $141
236% Variance
Women’s Health Of�ce Visit
$69 - $226Average: $133
229% Variance
High-Level Specialist Of�ce Visit
$65 - $205Average: $120
215% Variance
$70 - $185Average: $119
164% Variance
Tooth Extraction
Cavity
$7,875 - $30,185Average: $18,033
283% Variance
Hip Replacement
$6,247 - $31,160Average: $17,654
398% Variance
Knee Replacement
$475 - $2,517Average: $1,331
430% Variance
$343 - $2,283Average: $1,131
566% Variance
MRIs
CT Scans
7 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Established in 2007, Change Healthcare is on a mission
to transform the way Americans purchase and utilize
healthcare services by driving sustainable engagement
at the individual level. With a national client base of
health plans and self-insured employers covering lives
in all 50 states and more than 7 million lives on its
platform, Change Healthcare is the premier national
provider of healthcare cost transparency and consumer
engagement solutions that enable consumers to:
• Better understand and utilize their healthcare
benefits
• Make informed healthcare purchasing decisions
based on quality, cost and convenience
• Manage higher out-of-pocket responsibility and
realize savings
This, in turn, helps plan sponsors (both health plans and
self-insured employers):
• Control their healthcare cost growth trend
• Successfully migrate to more cost-effective
plan types
• Optimize existing wellness programs and
on-site clinics
• Improve member/employee satisfaction
and retention
The Change Healthcare Engagement Platform includes:
Healthcare University®, Targeted Engagement Alerts,
Ways to Save® Alerts and Cost Lookup. To learn more,
visit www.changehealthcare.com.
The costs of healthcare services change over time, and
Change Healthcare anticipates there will be changes
in which services qualify as target opportunities for
savings. As a result, Change Healthcare issues updated
HCTI reports quarterly and track changes in the
Transparency Matrix and variation in costs of common
healthcare services over time.
About the HCTIAbout Change Healthcare
The Change Healthcare Cost Lookup tool provides expected costs for more than
OF PRESCRIPTIONS
81%OF MEDICAL SERVICES
75%
used by our client population.
and
8 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Ave
rage
Cos
t ($
)
Lower
Hig
her
HigherVariability (%)
Transparency MatrixPremium Target
Base Emerging
3
10
15
16
911
8
12
14
62
51
4
20
191817
21
23
24
26
25
7
566
385
18,033
1,331
Behavioral Health Office Visit
Chiro/PT/OT Office Visit
Eye Care Office Visit
Pediatric Office Visit
Primary Care Office Visit
Specialist Office Visit
Women’s Health Office Visit
All Colonoscopies and Upper GI Endoscopies
C-Section Delivery
Hip Replacement
Knee Replacement
Vaginal Delivery
All CT Scans
All Mammograms
All MRIs
All Ultrasounds
Adult Preventive Exam
Adult Preventive Exam with Mouth X-Rays (4 Films)
Cavity
Crown
Pediatric Preventive Exam
Pediatric Preventive Exam with Mouth X-Rays (2 Films)
Tooth Extraction
Office Visit with Diabetes Screening
Office Visit with Lipid Screening
Office Visit with Pap Smear
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
22
0
Transparency Matrix™
The healthcare services in the Target quadrant – high-cost, high-variability services – provide the richest opportunities to reduce costs for plan sponsors and consumers.
9 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Appendix
10 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Office Visits• Behavioral Health
- Psychiatrist
- Psychologist
� Therapist
� Counselor
� Licensed Clinical
Social Worker
� Licensed Family Therapist
� Behavioral Health Counselor
• Chiropractic/Physical Therapy/
Occupational Therapy
- Chiropractic
� Chiropractic (DC)
� Chiropractic Facility
- Occupational Therapy
� Occupational Medicine
� Occupational Therapist (OT)
- Physical Therapy
� Physical Medicine and
Rehabilitation
� Physical Therapist (PT)
• Eye Care
- Optician
- Optometrists (OD)
• Pediatrics
- Pediatric Primary Care
- Specialty Pediatrics
� Pediatric Allergy
� Pediatric Cardiology
� Pediatric Critical Care
� Pediatric Endocrinology
� Pediatric ENT - Otolaryngology
� Pediatric Gastroenterology
� Pediatric Hematology/
Oncology
� Pediatric Immunology
� Pediatric Neurology
� Pediatric Ophthalmology
� Pediatric Orthopaedics
� Pediatric Pulmonology
� Pediatric Radiology
� Pediatric Surgery
� Pediatric Urology
• Primary Care
- Family Medicine
- General Practice
- Internal Medicine
- Nurse Practitioner (NP)
- Nurse Practitioners (ARNPs)
- Physician Assistants (PAs)
• Specialist
- Cardiology
- Dermatology
- Endocrinology/Diabetes/
Metabolism
- Gastroenterology
- Nephrology
- Neurology
- Oncology
� Hematology/Oncology
� Medical Oncology
� Radiation Oncology
- Ophthalmology
- Otolaryngology
- Podiatrists (DPM)
- Pulmonary/Allergy/Immunology
- Rheumatology
- Sports Medicine
- Surgery
� Colorectal Surgery
� General Surgery
� Hand Surgery
� Neurosurgery
� Oral Surgery
� Orthopaedic Surgery
� Plastic Surgery
� Thoracic Surgery
� Vascular Surgery
- Urology
• Women’s Health
- Obstetrics
- Gynecology
Medical Procedures• C-section Delivery
• All Colonoscopies and Upper GI
Endoscopies
- Colonoscopy with Biopsy
- Colonoscopy with Removal of
Lesion(s) or Polyp(s)
- Upper GI Endoscopy
with Biopsy
• Hip Replacement
• Knee Replacement
• Vaginal Delivery
Imaging Services• All CT Scans
- Chest CT Scan
- Face/Jaw CT Scan
- Head/Brain CT Scan
- Pelvis/Abdomen CT Scan
• All Mammograms
- Diagnostic Mammogram
- Screening Mammogram (ACA)
• All MRIs
- Brain MRI
- Lower Extremity MRI
- Spine MRI
- Upper Extremity MRI
• All Ultrasounds
- Abdominal Ultrasound
- Breast Ultrasound
- Transvaginal Ultrasound
Dental Services• Adult Preventive Exam
• Adult Preventive Exam +
Mouth X-Rays (4 films)
• Cavity
• Child Preventive Exam +
Mouth X-Rays (2 films)
• Crown
• Pediatric Preventive Exam
• Tooth Extraction
ACA Services• Office Visit with Diabetes Screening
• Office Visit with Pap Smear
• Office Visit with Lipid Screening
• Screening Colonoscopy
• Screening Mammogram
Category Guide
11 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Cos
t ($
)
Lower
Hig
her
HigherVariability (%)
Office Visits
Primary Care
Behavioral Health
Chiro/PT/OT
Pediatrics
Eye Care
Specialist
Women’s Health
141
116
0 349
227
Office Visits
The following services are included in the Office
Visits category: Behavioral Health, Chiro/PT/OT,
Eye Care, Pediatrics, Primary Care, Specialist and
Women’s Health. Women’s Health and Specialist
visits are Target Opportunities within the Office Visits
category and are in the Emerging category within the
Transparency Matrix.
12 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Medical Procedures
Colonoscopy with Biopsy
C-section Delivery
Hip Replacement
Knee Replacement
Colonoscopy with Removal of Lesion(s) or Polyp(s)
Upper GI Endoscopy with Biopsy
0
17,806
4,827
19,000
329
178
500
Medical Procedures
The Medical Procedures category includes C-section
Delivery, Vaginal Delivery, Colonoscopy with Biopsy,
Colonoscopy with Removal of Lesion(s) or Polyp(s),
Upper GI Endoscopy with Biopsy, Hip Replacement
and Knee Replacement. Hip and Knee Replacements
were the costliest procedures analyzed and also had
a high variability rate, placing them firmly in the Target
quadrant. Patients should work with their doctors to
find high-quality options at a reasonable cost.
13 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
1,589
799
642
3820
Imaging
Multiple Imaging services fell into the Target
quadrant. As noted in the summary, MRI and CT
Scans are impacted by their facility costs and have
the most variance because of this.
14 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
0
358
86
800
194
153
250
Adult Preventive Exam with X-Rays (4 Films)
Pediatric Preventive Exam with X-Rays (2 Films)
Dental
Cavity and Tooth Extraction were, once again,
identified as Target opportunities in the Dental
category; Pediatric Preventative Exam fell just
outside of this quadrant. Targeted interventions
around any/all of these services could drive
significant cost savings.
15 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
0
1,756
612
318
179
Office Visit with Pap Smear
Office Visit with Lipid Screening
Office Visit with Diabetes Screening
ACA Services
ACA Services is a category that includes services
available at no out-of-pocket cost to patients – a
result of the Affordable Care Act. Office Visits with
Lipid Screening has a 185 percent variability and
is now in the Target quadrant. Screening
Colonoscopies should be watched, as the service is
high-cost and – in this iteration of the HCTI – showed
increasing variability in pricing. Office Visit with
Diabetes Screening – with its high variability –
should also be monitored and may benefit from
targeted intervention.
16 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Chiro/PT/OT
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$160
$140
$120
$100
$80
$60
$40
$20
$0
$127
$32
304%$134
$32
326%
$131
$32
315%$129
$32
302% $144
$32
349%
$138
$32
331%
Behavioral Health
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$200
$180
$160
$140
$120
$100
$80
$60
$40
$20
$0
$151
$68
123%
$129
$59
118% $141
$47
197%$150
$63
137%$158
$65
142%
$126
$56
124%
National Data SetHigh-Level Office Visits
17 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Eye Care$160
$140
$120
$100
$80
$60
$40
$20
$0
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$132
$45
194%$133
$47
182% $149
$45
228%
$134
$45
198%$143
$46
213%
$145
$46
215%
Pediatrics
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$164
$68
141%$170
$69
144%$175
$70
149%$207
$72
186%
$175
$71
$182
$72
152% 146%
High-Level Office Visits
18 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Primary Care
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$182
$68
169%$188
$68
175%$198
$67
196%
$193
$71
174%$228
$72
217%
$203
$69
196%
Specialist
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$191
$66
190%$198
$66
200%$200
$66
203%$207
$67
211% $226
$69
229%
$208
$67
208%
High-Level Office Visits
19 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Women’s Health
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$188
$72
161%$193
$70
176%$203
$70
189%$200
$69
189%$241
$72
236%
$211
$72
193%
Low-Level Office Visits Cardiology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$214
$70
205%
$70
$214
204%$216
$70
208%
$72
$219
205%
$72
$241
232%
$70
$229
228%
High-Level Office Visits
*Cardiology Actual Range: $72.45 to $240.51 with a 232% variability
*Women's Health Actual Range: $71.77 to $241.00 with a 236% variability
*
*
20 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Chiropractic
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$120
$100
$80
$60
$40
$20
$0
260%$105
$29
286%
$27
$105
255%$103
$29
252%
$30
$105
286%
$27
$104
259%
$30
$107
Colorectal Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
210%$211
$68
202%
$63
$191
203%$200
$66
215%
$64
$203
247%$69
$240203%
$66
$198
Low-Level Office Visits
21 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Dermatology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$160
$140
$120
$100
$80
$60
$40
$20
$0
173%$134
$49
170%$137
$51
182%
$139
$49
184%$138
$49188%
$157
$54
194%
$146
$50
Endocrinology/Diabetes/Metabolism
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
204%$214
$70
192%$223
$73
205%$239
$73
287%
$283
$73
227%$225
$73
280%
$297
$78
Low-Level Office Visits
22 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Family Medicine
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$178
$68
160%$183
$70
164%$196
$70
182%
$192
$71
172%$229
$72
218%
$201
$71
184%
Gastroenterology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
184%$194
$68
203%$207
$68
200%$208
$69
223%$219
$68
235%$241
$72
205%$212
$69
Low-Level Office Visits
23 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
General Practice
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
186%$191
$67
187%$189
$66
193%$195
$67
170%$179
$66
196%$201
$68
187%$192
$67
General Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
213%$202
$64
224%$210
$65
231%$209
$63
243%
$227
$66
243%
$226
$66
231%$214
$64
Low-Level Office Visits
24 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Hand Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
162%$182
$70
175%$188
$68
176%$179
$65
142%$160
$66198%
$213
$72
190%$187
$64
Hematology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
237%$228
$68
254%$253
$72
256%$258
$73243%
$262
$77
261%
$285
$79
256%$258
$72
Low-Level Office Visits
25 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Internal Medicine
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$187
$69
170%$194
$70
180%$203
$70
189%
$199
$72
174% $236
$72
225%
$209
$72
188%
Nephrology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$228
$72
217%
$217
$73
196%$225
$70
220%$233
$73
218% $263
$78
237%
$240
$71
237%
Low-Level Office Visits
26 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Neurology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$234
$73
220%$249
$73
240%
$239
$73
228% $257
$75
243%$263
$78
236%
$255
$73
250%
Nurse Practitioner
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$181
$64
183%
$62
$181
191%$199
$61
227%
$62
$197
218%
$66
$245
271%
$62
$203
230%
Low-Level Office Visits
27 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Ob/Gyn
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$188
$72
167%
$70
$193
176%$203
$70
189%
$69
$200
189%
$72
$241
236%
$72
$211
193%
Occupational Therapy
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$153
$53
189%
$79
$178
127%$175
$37
371%
$50
$135
170%
$49
$96
97%
$83
$232
180%
Low-Level Office Visits
28 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Oncology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$235
$69
239%
$68
$248
263%$245
$69
254%
$73
$250
242%
$72
$261
264%
$70
$252
259%
Ophthalmology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$184
$67
177%
$66
$194
194%
$183
$63
188%
$69
$202
193%
$69
$201
189%
$67
$189
184%
Low-Level Office Visits
29 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Optometry
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$200
$150
$100
$50
$0
$143
$46
213%
$46
$145
215%
$132
$45
194%
$47
$133
182%
$45
$149
228%
$45
$134
198%
Oral Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$185
$60
208%
$61
$200
227%
$189
$60
216%
$59
$225
280%$55
$188
244%
$70
$219
212%
Low-Level Office Visits
30 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Orthopaedic Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$178
$65
172%
$67
$185
176%$183
$65
182%
$66
$186
180%
$68
$187
177%
$68
$187
177%
Otolaryngology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$182
$66
174%
$66
$185
181%$186
$66
182%
$68
$201
194%
$70
$217
208%
$68
$195
185%
Low-Level Office Visits
31 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Pediatric Specialist
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$350
$300
$250
$200
$150
$100
$50
$0
$242
$77
215%
$80
$300
275%$313
$80
289%
$73
$264
261%
$75
$305
307%
$77
$275
258%
Pediatric Primary Care
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$163
$68
139%
$69
$168
142%$175
$70
149%
$71
$174
146%
$72
$206
185%
$72
$182
151%
Low-Level Office Visits
32 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Physician Assistant
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$179
$64
179%
$63
$184
191%$196
$61
223%
$64
$199
212%
$69
$237
242%$63
$204
226%
Physical Therapy
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$212
$58
266%
$60
$214
256%
$65
$226
249%
$215
$60
256%
$62
$228
268%
$60
$225
275%Low-Level Office Visits
33 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Plastic Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$185
$67
178%
$68
$190
182% $213
$63
236%
$70
$206
192%
$65
$204
212% $231
$65
255%
Podiatrist
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$200
$150
$100
$50
$0
$133
$49
173%
$49
$133
175% $149
$49
203%
$47
$146
208%
$51
$181
257%$49
$154
214%
Low-Level Office Visits
34 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Psychiatrist
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$191
$60
218%
$162
$50
224% $190
$55
246%
$176
$55
219% $190
$56
239%$203
$55
268%
Psychologist
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$200
$180
$160
$140
$120
$100
$80
$60
$40
$20
$0
$173
$73
137%
$144
$60
140%$145
$53
174% $155
$73
112% $169
$73
131%
$126
$56
124%
Low-Level Office Visits
35 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Pulmonary/Allergy/Immunology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$216
$69
212%$219
$70
212%
$246
$72
240%
$230
$70
229%
$198
$68
190%$209
$68
206%
Rheumatology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$223
$71
215%
$214
$70
204%$224
$72
209% $252
$75
236%
$239
$72
234%
$299
$81
268%
Low-Level Office Visits
36 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Sports Medicine
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$201
$63
218%
$166
$66
152% $180
$72
149%
$135
$55
148% $156
$70
122%
$204
$69
196%
Surgery - Mid-Level
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$250
$200
$150
$100
$50
$0
$188
$66
187%$195
$67
193%$196
$64
204%$204
$66
209%$211
$68
211%
$203
$66
207%
Low-Level Office Visits
37 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Therapy
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$180
$160
$140
$120
$100
$80
$60
$40
$20
$0
$130
$65
100%
$122
$59
107%$129
$42
206%$127
$63
102%$135
$64
110%
$113
$56
100%
Thoracic Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$400
$350
$300
$250
$200
$150
$100
$50
$0
$244
$70
246% $280
$73
284%
225%$234
$72
426%$355
$68
$312
$63
398%
$283
$73
287%
Low-Level Office Visits
38 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Urology
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$197
$67
194%$202
$68
196%$203
$68
199%$217
$70
208% $234
$70
235%
$210
$69
204%
Vascular Surgery
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$208
$66
216%
$191
$62
208%$202
$63
219%
$256
$62
310%
$208
$63
232% $231
$69
236%
Low-Level Office Visits
39 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Medical Procedures
Colonoscopy with Biopsy
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$6,000
$5,000
$4,000
$3,000
$2,000
$1,000
$0
190%
$4,413
$1,523
188%
$4,697
$1,630
164%
$4,483
$1,699
202%
$4,392
$1,453216%
$5,104
$1,613
199%
$4,352
$1,455
C-section Delivery$24,000
$20,000
$16,000
$12,000
$8,000
$4,000
$0
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
174%$20,139
$7,348
211%
$23,741
$7,623
128%$19,822
$8,685
164%
$17,619
$6,680
134%
$18,296
$7,804
284%
$23,526
$6,128
40 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Colonoscopy with Removal of Lesion(s) or Polyp(s)
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$5,000
$4,000
$3,000
$2,000
$1,000
$0
149%
$4,461
$1,792
183%
$4,425
$1,565
171%
$4,525
$1,668
206%
$4,742
$1,549
192%
$4,193
$1,435
230%
$4,722
$1,433
Hip Replacement
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$40,000
$35,000
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$0
$37,921
$7,268
422%
$31,403
$7,129
340%$33,180
$7,744
328%
$30,185
$7,875
283%
$29,751
$6,907
$26,699
$6,443
314%331%
Medical Procedures
*Extrapolated based on a midpoint between the 10th and 90th percentile
*
41 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Upper GI Endoscopy with Biopsy
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$5,000
$4,000
$3,000
$2,000
$1,000
$0
197%
$4,286
$1,443
222%
$4,451
$1,383
155%$3,610
$1,415188%
$4,355
$1,513
209%
$4,026
$1,304
226%
$4,502
$1,381
Knee Replacement
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$40,000
$35,000
$30,000
$25,000
$20,000
$15,000
$10,000
$5,000
$0
$28,469
$9,011
216% $33,207
$8,792
278%
$30,605
$6,064
405%$31,160
$6,247
399%
$29,326
$6,226
$32,627
$6,105
434%371%
Medical Procedures
42 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Vaginal Delivery$20,000
$16,000
$12,000
$8,000
$4,000
$0
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
250%
$18,570
$5,299
201%$15,985
$5,319
178%$14,913
$5,356
189%$12,613
$4,359
142%$13,570
$5,609
168%$14,363
$5,369
Imaging Services Abdominal Ultrasound
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$1,200
$1,000
$800
$600
$400
$200
$0
$997
$131
659%
$133
$878
559%
$847
$127
568%
$123
$807
558%
$147
$698
375%
$111
$905
714%
Medical Procedures
43 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Brain MRI
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
496%$3,378
$567
434%
$600
$3,204400%$3,023
$604
478%
$619
$3,579
349%
$635
$2,850
609%
$515
$3,652
Breast Ultrasound
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$600
$500
$400
$300
$200
$100
$0
442%$468
$86
412%
$87
$447
440%$447
$83
420%
$86
$500434%
$87
$466 326%
$100
$427
Imaging Services
44 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Chest CT Scan
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$2,500
$2,000
$1,500
$1,000
$500
$0
$1,911
$317
504%
$332
$1,940
484%
$1,904
$375
408%
$363
$2,031
460%
$338
$1,814
437%
$325
$1,913
489%
Diagnostic Mammogram
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$700
$600
$500
$400
$300
$200
$100
$0
215%$396
$126
238%
$114
$385227%$372
$114
200%
$128
$384
168%
$154
$413229%
$114
$374
Imaging Services
45 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Face/Jaw CT Scan
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$1,800
$1,600
$1,400
$1,200
$1,000
$800
$600
$400
$200
$0
335%$1,087
$250
469%
$267
$1,517
345%$1,200
$270
319%
$258
$1,079
378%
$270
$1,291
464%
$255
$1,437
Head/Brain CT Scan
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$2,000
$1,600
$1,200
$800
$400
$0
384%$1,475
$305
395%
$322
$1,595
426%$1,693
$322
449%
$297
$1,628 411%
$303
$1,549
476%
$320
$1,844
Imaging Services
46 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Lower Extremity MRI
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
395%$2,342
$473
371%
$497
$2,338355%$2,227
$489
398%
$470
$2,338 465%
$357
$2,017
359%
$488
$2,237
Pelvis/Abdomen CT Scan
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
1,124%
$283
$3,463962%$3,187
$300
984%$3,252
$300
750%
$400
$3,399642%
$429
$3,180
988%
$300
$3,265
Imaging Services
47 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Screening Mammogram
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$500
$400
$300
$200
$100
$0
219%$402
$126
242%
$118
$402
242%$402
$118
193%
$135
$397147%
$156
$386
242%
$118
$402
Spine MRI
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
$451
$2,479
449%$2,513
$467
438%
$468
$2,515
437%
$464
$2,345
406%
$465
$2,374
410%$2,479
$443
460%
Imaging Services
48 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Transvaginal Ultrasound
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$600
$500
$400
$300
$200
$100
$0
$468
$105
346%
$107
$462
331%
$442
$103
329%
$102
$336
229%
$93
$431
365%
$103
$481
369%
Upper Extremity MRI
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
467%$2,576
$454 $485
422%$2,530
442%$2,651
$489
346%
$523
$2,333495%
$368
$2,191
416%
$468
$2,415
Imaging Services
49 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Dental Services Adult Preventive Exams
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$100
$80
$60
$40
$20
$0
74%
$94
$54
114%
$90
$4272%
$93
$54
79%
$95
$53
79%
$95
$53
79%
$95
$53
Adult Preventive Exams and Mouth X-Rays (4 Films)$350
$300
$250
$200
$150
$100
$50
$0
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$306
$95
222%
$285
$94
203%
$220
$96
129%
$149
$80
85%$190
$99
92%
$290
$89
226%
50 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Cavity$250
$200
$150
$100
$50
$0
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$205
$85
141%
$180
$85
112%$185
$70
164%$191
$85
125%122%$189
$85
139%$204
$85
Crown
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$1,200
$1,000
$800
$600
$400
$200
$0
$1,150
$680
69%
$1,013
$679
49%
$971
$515
89%$1,125
$685
64%$1,100
$695
58%$1,135
$680
67%
Dental Services
51 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Pediatric Preventive Exam
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$80
$70
$60
$50
$40
$30
$20
$10
$0
74%
$69
$40
88%
$69
$37
89%
$72
$3875%
$70
$40
180%
$70
$25
70%
$68
$40
Pediatric Preventive Exam and Mouth X-Rays (2 Films)
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$200
$180
$160
$140
$120
$100
$80
$60
$40
$20
$0
144%$161
$66
168%138%$157
$66
153%
$170
$67
101%$139
$69
132%$146
$63
180%$109
$39
Dental Services
52 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Tooth Extraction
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$300
$250
$200
$150
$100
$50
$0
$85
188%$245
$79
147%$195
$65
215%$205
$85
142%$206
$85
148%$211
$85
194%$250
ACA Services Office Visit with Diabetes Screening
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$550
$500
$450
$400
$350
$300
$250
$200
$150
$100
$50
$0
$462
$111
315%
$104
$468
350%$478
$108
342%
$121
$485
300%
$111
$463
318%
$118
$470
298%
Dental Services
53 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
Office Visit with Lipid Screening
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$550
$500
$450
$400
$350
$300
$250
$200
$150
$100
$50
$0
$445
$165
170%
$163
$515
215%
$517
$168
207%
$185
$523
183%
$178
$506
185%
$179
$506
182%
Office Visit with Pap Smear
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$700
$600
$500
$400
$300
$200
$100
$0
118%$501
$229
105%$598
$292
78%
$317
$563
93%
$608
$314
86%
$594
$319
87%$590
$315
ACA Services
54 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
90th Percentile 10th Percentile Median %Variability
2012 2013
Screening Colonoscopy
Q4 Q1 Q2 Q3 Q4 Q1
2014
$4,500
$4,000
$3,500
$3,000
$2,500
$2,000
$1,500
$1,000
$500
$0
185%
$3,966
$1,391
180%$3,465
$1,238
189%$3,599
$1,246
159%$2,783
$1,073
153%$2,955
$1,166
168%
$1,233
$3,306
Screening Mammogram
2012 2013 2014
Q4 Q1 Q2 Q3 Q4 Q1
$500
$400
$300
$200
$100
$0
219%$402
$126
242%
$118
$402
242%$402
$118
193%
$135
$397147%
$156
$386
242%
$118
$402
ACA Services
55 Healthcare Transparency Index
© 2007-2014 Change Healthcare Corporation
Cost: The average cost per instance of a service.
Cost Variability: The percent change between low-cost and high-cost providers for a service.
High cost: This cost is ranked in the 90th percentile. 90 percent of instances had a cost that was less than this amount.
Low cost: This cost is ranked in the 10th percentile. 90 percent of instances had a cost that exceeded this amount.
Glossary