For a long time if you wanted to know how health care costs varied by region or hospital you would turn to the Dartmouth Atlas. Last month CMS made a second reference publically available through Hospital Compare in the form of a Medicare Spending per Beneficiary (MSPB) measure.

MSPB is a ratio that compares the amount Medicare spends per patient for an episode of care at a hospital to the median amount Medicare spends per patient nationally. The national median for Medicare claims from May 15, 2010 through February 12, 2011 was $17,988. Hospitals with a MSPB ratio above one have an average Medicare expenditure per patient above the national median, while those with a ratio below one have average expenditures below the national median. The MSPB measure does control for factors such as patient case mix and geographic differences in Medicare payment levels.

A Kaiser Health News analysis of the MSPB data found some bright spots, that turn out to be NAPH member hospitals. When looking at teaching hospitals in the Washington, D.C. area, NAPH member Howard University Hospital had an average Medicare expenditure per patient 9% below the national median, while MedStar Georgetown University Hospital was 4% above the median. In Kansas City, Missouri, NAPH member Truman Medical Center-Lakewood had an average Medicare cost of $15,290 (15% below the national median), while fifteen miles away St. Joseph Medical Center had an average cost of $19,247 (7% above the national median).

Kaiser has an online interactive chart to compare hospitals’ MSPB ratios. Cook County-Oak Forest Hospital (MSPB=0.7) and Laguna Honda Hospital & Rehabilitation Center (MSPB=0.7) are two NAPH members with some of the lowest ratios in the country.

There is no clear explanation for the variation in MSPB ratios among hospitals. Some of the variation is consistent with past findings, like most hospitals in Las Vegas and Fort Lauderdale having high expenditures, but other findings conflict. For example, hospitals in McAllen, TX have MSPB ratios close to one (Range: 0.86-1.07), but in the Dartmouth Atlas, McAllen has an average Medicare expenditure almost twice the national average ($15,695 vs. $8,682 in 2007). The MSPB adjustments for patient case mix and the different data time periods contribute to the conflicting message, but may not account for everything. Have hospitals in McAllen altered the way they treat Medicare patients?

While the MSPB data brings with it more questions than answers, that is not necessarily a bad thing. It is from these questions we can take a deeper dive into trying to figure out what is done differently and better at various hospitals. Data should be used to guide the future, not blame. Additionally, we all know cost is not the only metric by which a hospital should be judged.