Augusta Georgia Hospital's Worksheet C Comparison
Welcome to Worksheet C. Here you find revenue or charges; that is charges allowable per CMS. So, non-reimbursable cost centers are not included here. This is where the cost report get interesting to me. Or where some of the smaller pieces start making more sense. Either way, it’s where we see cost-to-charge ratios by cost center for the first time.
What is a cost-to-charge ratio? First, you have costs. What does it cost to run an adults & pediatric department or nursery department, etc? And then there’s revenue. What does the hospital charge for a room in the adult & pediatric department? There’s probably multiple charge tiers in this single department. So, the cost-to-charge ratio (CCR) is simply the costs divided by the charges.
Let’s take a look at a couple of cost centers to see how this looks by facility.
Adults & Peds
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $129,419,483 | $125,515,048 | 1.031107 |
| University Hosp | $76,195,636 | $51,727,923 | 1.473008 |
| Doctors Hosp | $45,260,850 | $126,789,002 | .356978 |
| Burke Medical | $2,834,811 | $538,835 | 21.302222 |
| Univ-McDuffie | $4,164,307 | $3,154,259 | 1.320217 |
Here’s where you can clearly see each hospital has its own charge structure. This is a cost center that has room & board charges. Generally, that’s all the revenue reported in this cost center. When we get to the Worksheet D series, we’ll see more clearly what the room & board charges are for this cost center. For now, just notice how drastically different the CCRs are for each facility.
ICU
Most of these hospitals have multiple ICUs, so this is just the ICU amounts reported for cost center 31. The smaller hospitals do not have an ICU.
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $23,935,138 | $51,571,645 | .464114 |
| University Hospital | $56,124,097 | $65,840,371 | .852427 |
| Doctors Hospital | $11,478,383 | $32,756,977 | .350410 |
Interestingly, these CCRs are a little more in-line with each other.
Operating Room
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $112,224,285 | $223,988,118 | .500660 |
| University Hospital | $48,598,827 | $154,962,808 | .313616 |
| Doctors Hospital | $26,237,186 | $331,252,301 | .079176 |
| Burke Medical | $330,519 | $565,508 | .584464 |
| University Hosp McDuffie | $3,098,867 | $7,595,268 | .4080 |
Medical Supplies Charged to Patients
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $24,855,689 | $137,585,299 | .180657 |
| University Hospital | $189,129,836 | $224,212,869 | .181395 |
| Doctors Hospital | $53,279,181 | $366,349,267 | .145433 |
| Burke Medical | $185,633 | $426,182 | .435572 |
| University Hosp McDuffie | $1,869,377 | $7,374,835 | .253481 |
In case you were wondering, there might be a slight mark-up on those bandaids you receive at the hospital.
Implantable Devices
Implantable devices are high-cost supplies such as pacemakers and stents.
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $48,296,210 | $188,486,225 | .256232 |
| University Hospital | $72,801,249 | $97,801,249 | .534358 |
| Doctors Hospital | $16,662,025 | $46,486,926 | .358424 |
| University Hosp McDuffie | $892,849 | $2,937,042 | .303996 |
There’s a decent mark-up on these items as well. Note, this is just the item; the cost to insert these items is reported in a separate cost center.
Drugs Charged to Patients
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $140,803,376 | $985,779,431 | .142835 |
| University Hospital | $168,302,089 | $221,303,529 | .168173 |
| Doctors Hospital | $29,767,579 | $721,021,533 | .041285 |
| Burke Medical | $585,017 | $3,613,829 | .161883 |
| University Hosp McDuffie | $1,618,873 | $10,393,725 | .155755 |
Here’s where you can see the mark-up on aspirin as well as thousands of other drugs that are given in a hospital setting.
Emergency Room
These are the costs vs charges for Emergency Room care.
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $140,803,376 | $985,779,431 | .142835 |
| University Hospital | $168,302,089 | $221,303,529 | .168173 |
| Doctors Hospital | $29,767,579 | $721,021,533 | .041285 |
| Burke Medical | $585,017 | $3,613,829 | .161883 |
| University Hosp McDuffie | $1,618,873 | $10,393,725 | .155755 |
Observation
This is the cost vs charge for when you are in observation (UB Rev Code 762). This is prior to admission.
| Facility | Costs | Charges | CCR |
|---|---|---|---|
| AU Medical | $9,251,244 | $10,525,916 | .878902 |
| University Hospital | $8,060,998 | $14,540,314 | .554390 |
| Doctors Hospital | $3,262,513 | $11,272,855 | .289413 |
| Burke Medical | $1,076,634 | $478,210 | 2.251383 |
| University Hosp McDuffie | $899,615 | $622,720 | 1.444654 |
Musing Revelation
Each facility has their own charge structure; just as each facility has their own costs. At the macro level, it’s almost an apples vs oranges comparison. Newer buildings, newer equipment, higher salaries for staff - all of this would cause costs to be higher. And you can see that the cost-to charge ratio may be really high for one cost center, but much lower for another. I’ve never worked with a charge master, but just on the face-level here, I can see it’s a very complicated idea.
However complicated this idea is, though, it’s all we have for a comparison between facilities. Next, we’ll start going through the Worksheet D series. We will be able to see room & board charges as well as what was billed for Medicare patients. It should be fun. :)
University Hospital Worksheet C series
Doctors Hospital Worksheet C series