Medical service pricing:
The price information for hospital inpatient services was produced using proprietary computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3M APR™ Software, 3M APR™ DRG classification system, the 3M CRG™ Software, and 3M CRG™ (including the selection, coordination and arrangement of all codes) are owned by 3M. All rights reserved. Medical service pricing is reported for the hospital or outpatient center using the median price. Details on how the median price is calculated is found here.
Quality ratings for medical practices, hospitals, and statewide performance:
The WA-APCD medical practice and hospital quality measures use measures drawn from the Washington Statewide Common Measure Set –state performance measures for health care accountability and performance. The Common Measure Set is comprised of more than 50 measures of health care quality and value. Click here for a complete list of measures. Most of these measures are part of national measurement systems sponsored by the National Committee for Quality Assurance (NCQA) and the Centers for Medicare and Medicaid Services (CMS). Additionally, Washington state agencies have authored select measures and the results are derived from a variety sources including survey data. Some of the hospital quality measures are based on patients from across all insurance sectors (Medicare, commercial, or Medicaid), while some measures are derived from Medicare data only.
Details on how the quality ratings were scored for both medical practices and hospitals is found here.
Statewide performance results are reported by the nine Accountable Communities of Health (ACH) regions and by the major health insurance market sectors. Patients, based on residence, are grouped into the nine ACHs to produce the regional results. Similarly, patients, based on their insurance coverage, are grouped by their insurance coverage -- commercial, Medicaid and the Washington Health Benefits Exchange -- to produce results by these three types of insurance.
The measure results are derived from a variety of data sources and as a result, not all measures have a published target. For a handful of measures, some ACHs may have too little data to report accurate results and will instead have “No Result” listed for that measure score.
Performance results by insurance coverage are computed separately for the commercial and Medicaid populations. For a few measures, only Medicaid results are reported as the commercial population data is not available.