New Hampshire Finds No Hospital Medicaid Cost Shifting

Costs at high-quality hospitals were comparable to costs at low-quality hospitals, but hospitals with high occupancy rates and high percentages of patients with commercial coverage seemed to charge more than other hospitals.

"One reason for this finding may be that hospitals that have higher demand for their beds may command higher prices from insurers," the researchers say.

Having a high percentage of Medicaid patients had no significant effect on overall inpatient prices, but hospitals with large percentages of Medicaid patients offered much lower outpatient prices than other hospitals did, the researchers found.

"Hospitals with a higher public payer mix likely utilize a variety of strategies to compensate for lower public prices, including accepting reduced margins or reducing their costs," the researchers say.

The UMass also looked at the correlation between the amount of free care a hospital provided for the uninsured and the prices it charged insured patients.

New Hampshire hospitals wrote off about 2009 discharges as charity care, the researchers say.

The researchers' analysis "showed no correlation between the hospital inpatient price per [casemix-adjusted discharge] and each hospital's percent of uninsured charges," the researchers say.

About half of the hospitals that treated an above-average percentage of uninsured patients charged above-average prices and about half charged below-average prices, the researchers say.

Similarly, at least in New Hampshire, "the analysis did not indicate any significant relationship between the number of total beds or occupied beds at a hospital and its commercial price per [casemix-adjusted discharge," the researchers say.