Medicare PPO and HMO
To determine the average bed days or inpatient length of stay for Medicare advantage PPO's.
MEDICARE PPO HOSPITAL DAYS
- In California, the average number of inpatient bed days for PPOs statewide is 1,184.4 per thousand member per year (PTMY). This figure varies per region with Los Angelos-East having the highest number (1,640.5 PTMY) and San Mateo having the lowest number (785.4 PTMY).
- The number of inpatient bed days per 1,000 member per year in 2015 was on average 237.6 days. For medical and surgical PPO the number was 236.8 days while for full service this was 244.5 days. The overall average increased with 1.4% in comparison to 2013.
- The average length of stay per PPO hospitalization in 2015 for medical and surgical procedures was 3.8 days, in 2016 this was 3.9 days, and in 2017 this was 4.0 days.
- The average length of stay per PPO hospitalization in 2015 for psychiatric and substance abuse was 6.9 days, in 2016 this was 7.2 days, and in 2017 this was 7.0 days.
MEDICARE HMO HOSPITAL DAYS
- The average number of HMO Medicare hospital days per 1,000 members was in 2017 was 1,646.4 days. This varied per state with Kansas having the highest number of days (2,526.1 days) and Maine having the lowest number of days (816.7 days)
SUMMARY OF FINDINGS
- The number of inpatient bed days for PPOs for California was found. This figure was also found nationwide, but for 2015. This was the most recent figure that could be found in hour of research.
- Furthermore, the average length of stay per PPO was found. Figures up to 2017 were found for this metric.
- The average number of HMO Medicare hospital days was available for 2017 and provided as well.
Proposed next steps:
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Wonder can continue the research by providing a comparison of the difference between Medicare PPO and HMO patients in terms of costs, coverage, size of the plan network, and access to specialists.
Furthermore, as suggested in the previous strategy, Wonder could identify the differences in patients who select a Medicare PPO or a Medicare HMO.