If you’re trying to decide where to go for dinner, you can easily compare restaurant expensiveness online. Inexpensive restaurants are usually designated with one dollar sign, while expensive restaurants have three or four.
But if you need to choose a hospital for inpatient care, how can you know which are the most and least affordable? Depending on where you live, you could have a handful or dozens of choices—and until now, there was no way to see who is generally expensive, inexpensive, or average.
Amino users now have access to Amino’s Inpatient Care Cost Rating. The Inpatient Care Cost Rating is an easy to understand, symbolic system of dollar signs ranging from one dollar sign denoting “inexpensive” to four dollar signs denoting “expensive.”
When you’re logged into your Amino account and search for inpatient care, you can see inpatient care cost ratings on facility profile pages. The rating is specific to the average cost to your health insurance carrier and the hospital, and it helps you see how your choice of hospital can determine how much you’ll pay for common inpatient care services.
You may also see hospitals with a “Smart Match” badge when you search. “Smart Match” options in your inpatient care search results are in-network, experienced providing inpatient care for the term you searched, and have an inpatient care cost rating of or — meaning they are more cost effective than at least 50% of other hospitals nationwide when it comes to providing inpatient care for people with your insurance.
Amino’s database includes inpatient cost data for about 55 national and local carriers that cover most of the hospitals in the United States along with their affiliated doctors.
To develop the Inpatient Care Cost Rating, we first map National Provider Identifier (NPI) codes to unique hospitals. These hospitals have attributes including name, address, and CCN (CMS Certification Number). We then identify all remitted insurance claims ("remits") in our database for each hospital using this mapping of payee NPIs to hospital CCNs.
Next, we identify a list of Diagnosis Related Group (DRG) target codes that are frequently billed by hospitals, such as major joint replacement and spinal fusion. For remits missing DRG codes, we use two sets of classifier models to impute the DRG codes based on diagnosis codes, procedure codes, and revenue codes. Each classifier model is trained for a specific DRG topic based on the remits which already have a valid DRG code.
Once all inpatient remits are labeled with a valid DRG code, we group similar and frequent DRG codes into 1 of the 29 inpatient search topics supported by Amino search. Within these Amino inpatient search topics, we model inpatient cases and group costs at the hospital and insurance carrier level. Each case represents the cost of an inpatient encounter at a specific hospital for a specific insurance carrier. We aggregate case level cost data into an overall cost rating, which is unique for each hospital and insurance carrier.
Using this overall cost rating, we rank all hospitals by expensiveness for each insurance carrier they accept. Each hospital may have a different rank for each carrier since costs often vary by carrier. This carrier-specific rank is used to determine the Inpatient Care Cost Rating, which is represented as a dollar sign rating scale on the hospital profile when you perform a search on Amino.
For more information about our methodology, contact us at firstname.lastname@example.org.