MHDO Healthcare Procedure Cost Drivers

This report was originally developed in response to a request from the Task Force on Health Care Coverage for All of Maine to provide information on cost drivers for medical procedures in the State, separately for inpatient and outpatient procedures, by insurance markets. The report is based on the MHDO All-Payer Claims Data. Visit the Methodology Notes to learn more.

The interactive report below includes two views:

  1. Top 25 Cost Drivers for Hospital Inpatient Procedures Among Commercial Payers
    The most common procedures that are driving the cost of inpatient procedures - among commercial payers.
  2. Top 25 Cost Drivers for Outpatient Procedures and Services Among Commercial Payers
    The most common procedures and services that are driving the cost of outpatient procedures and services in hospital and non-hospital settings, among commercial payers.

The procedures are ranked by the total payments cumulated in a calendar year.

Use the tabs "Hospital Inpatient Procedures" and "Outpatient Procedures and Services" at the top of the dashboard to select a view. Filter results by Time Period, Market Category, and County (based on servicing provider’s location), and roll-over column headers for detailed information.

Summary of Changes from CY 2018 to CY 2019

Inpatient: Statewide, across all market categories, the inpatient procedure category that ranked the highest based on Total Payments in CY 2019 is “Respiratory intubation and mechanical ventilation”; procedures in this category rank higher than in CY 2018 (3rd), primarily driven by an increase in the volume of procedures performed. Another notable change is that hip replacements and knee arthroplasty procedures are ranked lower in CY 2019 than in CY 2018, which appears to be driven both by decreases in volume and decreases in the estimated average cost per procedure.

Outpatient: The top 3 outpatient procedure and service categories have maintained the same ranks in CY 2019 as in CY 2018, for overall statewide procedures across all market categories. Among the top 10 procedure categories driving the Total Payments statewide in CY 2019, each category had a higher volume of procedures when compared to CY 2018, with the highest percent increases for durable medical equipment (DME) and supplies (23% volume increase) and mammography procedures (19% volume increase).