Key result
Professional fee ratios for hospital admissions in 2016-2020 were 1.224 for commercial payers and 1.178 for Medicaid, representing a 9% and 3% decline respectively compared with 2004 estimates.
Why the study?
The latest comprehensive diagnosis-specific estimates of hospital professional fees relative to facility fees dated from 2004 to 2012.
Population
2016-2020 MarketScan inpatient admissions and ED treat and release claims
Comparison
Commercial vs Medicaid payers across diagnostic categories
Design
Cross-sectional analysis using generalized linear regression models
Authors
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Analyses using facility-only data require updated PFRs; extends 2004 benchmarks yet leaves generalizability and trends open.
Observational (n=50,800,000)
Professional fees comprise a declining proportion of hospital-based care costs compared to 2004 estimates, highlighting the need for updated adjustments when estimating total hospital care costs from facility-only data.
Peterson et al. (2023) conducted an observational in Hospital admissions and emergency department visits (n=50,800,000). Hospital care (inpatient admissions and ED visits) vs. 2004 estimates was evaluated on Professional fee ratio (PFR). Professional fee ratios for hospital admissions in 2016-2020 were 1.224 for commercial payers and 1.178 for Medicaid, representing a 9% and 3% decline respectively compared with 2004 estimates.
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