Frequently Asked Questions

Below, we've listed some of the questions that we're commonly asked. If you have a question that is not answered here, please feel free to Contact Us.

Hospital Charges / Pricing

Hospital Quality


Why do charges vary by patient?

PATIENT VARIATIONS

Severity of illness and intensity of care - Patients with the same diagnosis may have complications, more than one disorder or disease occurring at the same time, or other related difficulties and may need very different levels of service and staff attention, causing variation in charges. Hospitals that treat more severely ill patients are expected to have higher case severity ratings, longer lengths of stay, and higher charges.

Length of hospital stay - Longer hospital stays are likely to result in higher charges. Some patients, especially severely ill patients, may not respond as well to treatment or surgery and, therefore, may have to stay in the hospital longer. Other factors, such as older patients who require more services or who have more chronic or multiple conditions, also will require longer hospital stays.

Emergency admissions - Hospitals with no emergency services will likely have lower charges. One-third or more of hospital patients come through the emergency room. The costs of emergency services are included in patient charges.

Physician practice and treatment - Individual physician judgment based on patient needs influences treatment decisions. The kinds of diagnostic tests ordered or preferred treatments also vary somewhat from physician to physician and influence hospital charges.

Physician specialty - Because the education, training, and experience of each physician can vary significantly, a physician may involve other physicians in consulting roles. In these situations hospital charges can be generated by more than one physician for the same patient.

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Why do charges vary by hospital?

HOSPITAL VARIATIONS

Professional fees - Physician charges, including those of surgeons and anesthesiologists, are normally separate from hospital charges (commonly known as professional fees). The hospital charges listed on this website do not include such professional fees. The hospital charges may or may not include laboratory work, x-rays, and other professional services performed in conjunction with the diagnosis and service provided. The decision to include these services in the hospital charge varies by hospitals.

Payer mix and cross subsidization - Charges vary among hospitals because of cross subsidization, which is used to help fund care for government-paid patients (such as Medicare and TennCare) and the underinsured and uninsured where payments do not cover the costs to provide care. Cross subsidization, or cost shifting, means that charges also reflect an amount to help pay for the uncompensated care provided by the hospital to government-program patients and to indigent patients. The amount that needs to be subsidized or charged will vary from hospital to hospital. Hospitals that have a relatively high percentage of government-program patients or are in areas where there is less employer-sponsored health coverage, are forced to recover a greater percentage of their operational costs from privately insured and self-pay patients through subsidized charges.

New technology - The equipment hospitals use to provide services differ in age, sophistication, and frequency of use. Hospitals with the latest technology may have higher costs and may be reflected in higher charges than those with older, less sophisticated equipment.

Staffing costs - Salary costs differ by region. Shortages of nurses and other medical personnel affect regions differently. Where shortages are more severe, the competitive staffing costs may be higher, resulting in higher hospital costs and may be reflected in higher charges.

Types and range of services - Hospitals often offer different levels of care and specialize in one or more types of services. For instance, a hospital may specialize in heart procedures or psychiatric care, and may show higher median charges than other hospitals for these services because of the expense involved in treating severe cases. Also, hospitals differ in the range of services they provide to patients. Some may provide the full range of services required for diagnosis and treatment during the stay. Others may stabilize patients and then transfer them to another hospital for more specialized care.

Service frequency - The per-patient cost of services is generally higher if the type of hospitalization occurs infrequently at the hospital. Infrequently used services may cost more than services that are used more frequently.

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What time period does this data cover?

Tennessee state law requires each hospital in the state of Tennessee to report hospital charge data to the state. The data on this site will be updated annually at the time that data become available for a new complete federal fiscal year. For example, data for FFY2012 (October 1, 2011 through September 30, 2012) data will be posted in the summer of 2013.

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What are some common medical abbreviations?

AICD = Automatic Implantable Cardiac Defibrillator
AMI – acute myocardial infarction
CC = complications or comorbidities
Card = cardiac
CDE = common duct exploration
D&C = dilatation and curettage
dis = disease
FX = fracture
HF = heart failure
MCV = major cardiovascular
MSDRG = Medicare Severity Diagnosis Related Groups
O.R. = operating room
Pdx = principal diagnosis
PTCA = percutaneous transluminal coronary angioplasty
Sprn = sprain
ST = significant trauma
Strn = strain
Disl = dislocation
Wnd = wound
w = with
w/o = without
> = greater than

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What is a Trauma Center?

Some hospitals have a designation as a Trauma Center which means it is a hospital or has a department in the hospital that is specially equipped and staffed to treat patients who have sustained complex, life-threatening injuries such as multiple gunshot wounds or severe internal injuries. Trauma Centers may be classified into levels indicating the presence of a different level of specialty equipment or staffing. The presence of the specialty equipment and staffing may result in increased charges. In Tennessee there are three levels of Trauma Centers. A level 1 designation is the highest.

Tennessee Trauma Centers

Level I
  • Erlanger Medical Center
  • Johnson City Medical Center
  • Regional Medical Center at Memphis
  • University of Tennessee Medical Center
  • Vanderbilt University Hospitals
  • Wellmont Holston Valley Medical Center

Level II
  • Wellmont Bristol Regional Medical Center

Level III
  • Athens Regional Medical Center
  • Blount Memorial Hospital
  • Woods Memorial Hospital

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What is a Regional Perinatal Care Program?

The Tennessee Department of Health has established a Regional Perinatal Care Program which requires the diagnosis and treatment of certain life-threatening conditions present in the perinatal period. The program assists pregnant women and their fetuses and newborn infants by developing a regionalized system of care, including highly specialized personnel, equipment and techniques that will decrease the existing high mortality rate and the life-long disabilities that currently prevail in surviving newborn infants. The presence of the specialty equipment and staffing may result in increased charges.

Tennessee Regional Perinatal Centers

  • Erlanger Medical Center/T.C. Thompson Children’s Hospital
  • Johnson City Medical Center Hospital
  • Regional Medical Center at Memphis
  • University of Tennessee Medical Center
  • Vanderbilt University Hospitals/Vanderbilt Children’s Hospital

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What is an SIR?

The Standardized Infection Ratio (SIR) is a summary measure that takes into account differences in the types of patients a hospital treats. This calculation compares the number of central line infections in a hospital’s intensive care unit to a national benchmark based on data reported to the Centers for Disease Control (CDC) National Healthcare Safety Network (NHSN)

A confidence interval is a statistical definition that describes a range of data that is likely to include a measure such as the average value of a population. The size of the confidence interval is an indication of how reliable the measure is; a small confidence means high reliability and a large confidence a low reliability. Hospitals with SIRs where both ends of the confidence interval are below one are displayed as better than the US national benchmark, hospitals with both ends of the confidence interval above one are worse than the US national benchmark, and hospitals whose confidence interval includes one are statistically no different from the US national benchmark. Hospitals with zero infections for the reporting time period are shown as zero infections and will not have a SIR. Hospitals labeled too few cases had insufficient data to calculate the confidence intervals used to determine if performance is different than expected.

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Frequently Asked Questions – Central Line Associated Bloodstream Infections

Background. One patient in twenty gets an infection while receiving medical care. In 2009 about 41,000 bloodstream infections occurred in hospital patients with central lines1. The Center for Disease Control and Prevention estimates that thousands of lives and millions of dollars are saved every year through the efforts of health care professionals reducing infections.

What is a central line/catheter? A tube placed into a patient’s large vein in the neck, chest, arm or groin. The tube is used to give medications or fluids.

How can you get a central line infection? There are three common ways: 1) the skin where the central line is placed can be dirty; 2) A caregiver’s hand or glove can be dirty while touching the line or, 3) the point where medicines are injected can be dirty.

What you can do to help.

Ask your doctors and nurses to tell you 1) why the central line is needed; 2) how long the central line will be in place and 3) how they will keep it from getting infected.

Make sure that family, friends and healthcare providers clean their hands with soap and water or an alcohol-based hand rub like Purell® before and after they help you.

Tell a nurse or a doctor if the area around the central line is sore or red, or if the bandage falls off or becomes wet or dirty.
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1CDC Vitalsigns, March 2011. Making Health Care Safer: Reducing bloodstream infections. Available at: http://www.cdc.gov/vitalsigns/pdf/2011-03-vitalsigns.pdf

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