To help consumers find information about the quality of health care provided in Vermont, the Health Department publishes an annual statewide comparative report containing information about quality of care, health care-acquired infection ratios, patient safety, nurse staffing levels, financial health and cost for services and other related information.
Vermont hospitals are also required to post community health needs assessment reports, implementation plans, annual progress reports, as well as other information such as hospital governance descriptions, discount and free care policies, and hospital complaint process, on their website.
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Inpatient Admissions (FY2015) – charges and counts for the top 20 inpatient diagnoses.
Outpatient Procedures (FY2015) – charges and counts for the top 20 outpatient procedures.
Physician and Hospital Pricing (FY2017): Common Outpatient Procedures and Visits – based upon gross charges and Common Procedural Terminology (CPT®) codes. CPT codes are defined as a “listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians."
The following data and information are available at the Green Mountain Care Board website.
- Budget and Financial Data – hospital finance, workforce, patient admission and visit information.
- Cost Shift Information – based upon amounts charged to private payers relative to the shortfall in payments from public payers.
- Financial Health Benchmarks and Indicators – cash and revenue, and productivity and cost indicators of hospital financial health, including the hospital’s ability to pay its bills, and how much it costs to run the hospital.
- Hospital Capital Indicators – capital indicators of hospital’s financial health, including the hospital’s ability to pay its bills, and how much it costs to run the hospital.
- Hospital Capital Investments – hospital capital spending plans for the next four years.
- Financial Glossary
Why does Vermont report charges for hospital and physician services?
Under Vermont law (18 V.S.A. § 9405b) all Vermont community hospitals are required to report charges for “high volume health care services.” The goal is to report “…valid, reliable, useful, and efficient information” to be used as a tool in helping the consumer make informed decisions about their health care.
Who would use these reports?
Consumers, the public at large, employers, the uninsured and any other purchasers of health care services.
What services are included in the charge lists?
There are three different lists: hospital charges for inpatient stays (DRG codes), hospital charges for outpatient procedures (CCS - Services and Procedures), and hospital and physician charges for common outpatient services (CPT codes). For inpatient stays and outpatient procedures, the hospital charges for higher volume procedures performed at each hospital. For common outpatient services, the list was selected from a review of other states’ websites, employer claims data, and data submitted by Vermont hospitals. Hospital and physician charges are shown for this list.
What is the difference between "price" and "charge," and how are they defined in the Act 53 reporting?
The words "price" and "charge" are often used interchangeably. They describe what the hospital seeks for payment for a health care service or product before the application of any discount, write-off, contract or plan adjustment/allowance, or other reduction to such amount.
Why do charges for certain procedures vary across hospitals?
Charges could vary because of the unique circumstances related to each patient’s illness. Also, hospitals have a unique mix of patients served, as well as different types and quantities of services that could be provided. All of these are factors that affect the charge for a given service.
What if I have insurance? How does that affect the charge, and how much I will have to pay?
What you will pay depends upon your insurance plan. If you are insured, you will pay only the co-payment, co-insurance, and/or deductible required by your plan, regardless of the total gross charge. Your insurance company will pay a negotiated amount to the hospital that represents some portion of the charge – generally less than the full charge. In some cases, a negotiated discount may be applied to your deductible.
Is the amount that’s listed for a procedure the actual amount that I will be charged and have to pay?
The amounts that are listed for inpatient DRGs and outpatient CCS - Services and Procedures are the average full charge for a given procedure. However, very few people actually pay full charges. The actual amount paid will depend upon many variables, including an individual’s insurance plan and the complexity of his/her procedure. The amounts that are listed for common CPT outpatient services are the actual price for that service as listed in the hospital charge master as of October 1 (some prices are established on January 1).
Do I have to pay the full charge if I don’t have insurance?
Some hospitals have discount policies for patients who have no insurance, under which the patient receives a discount off of the full charge, similar to the discounts negotiated by insurance companies. All hospitals have free care policies for low-income patients. You can call a hospital to learn about its policies and application process. Financial counselors are available at the hospitals to help answer specific questions and guide you through the process.
What is the charge master?
The charge master is a comprehensive and hospital-specific listing of each item and service that can be billed to a patient, insurance company, or other payer. Every item and service has a specific code and corresponding charge in the charge master. Since there are usually multiple health care services provided to a patient, the total invoice typically includes a list of multiple services for a given visit or admission. A patient’s bill is the sum total of this array of services. For example, selected medical events for a given patient may have one code or several codes included in the final invoice for patient care.
Are physician charges included in the prices shown?
Physician charges are included in the list of common CPT outpatient services (Tables 3A-3I). However, the amounts shown for inpatient stays and outpatient procedures (Tables 1A and 2A) do NOT include physician charges. Those charges only include hospital charges.
How do I find information on charges for procedures that are not listed in this report?
If you want to find charges on procedures that are not listed, call the hospital directly and talk to their consumer services representative or someone in the billing department. In nearly all cases, the hospital can provide an estimated charge, but will not be able to give you an absolute price. Individual circumstances can affect the final charges for care.
Should I make a decision based on the charges listed or are there other factors I should consider?
The gross charge is simply one factor in making a decision about your health care. Other factors that should be considered are the location of your doctor, the services offered by a particular hospital, how many of the procedures the hospital has performed, the quality reporting by a hospital, waiting times for the procedure, etc. You also may want to ask questions of your health care provider for a better understanding of options for your personal situation.
Where does the pricing information come from for these different hospital services?
The source of the inpatient (DRG) and outpatient (CCS - Services and Procedures) pricing information (Tables 1A, 1B, 2A, 2B) is the Vermont Uniform Hospital Discharge Data Set. Billing information is compiled into a database and the charges are taken from the database under a set of agreed upon standards. Hospital and physician pricing for outpatient diagnostic services are based upon Common Procedural Terminology (CPT®) code charges that are contained in each hospital’s charge master. The hospitals provide these prices directly to the Vermont Department of Health.
All Vermont community hospitals and psychiatric hospitals provide financial assistance for emergency and medically necessary care to people who are unable to pay. Visit the links below, and find out more about the program, including the application process and eligibility.
- Brattleboro Memorial Hospital
- Brattleboro Retreat
- Central Vermont Medical Center
- Copley Hospital
- The University of Vermont Medical Center
- Gifford Medical Center
- Grace Cottage Hospital
- Mt. Ascutney Hospital
- North Country Hospital
- Northeastern Vermont Regional Hospital
- Northwestern Medical Center
- Porter Medical Center
- Rutland Regional Medical Center
- Southwestern Vermont Medical Center
- Springfield Hospital
- Vermont Psychiatric Care Hospital
Prevention and Control of Infections
Health care-associated Infections (HAI) are infections that people acquire while receiving services at a health care facility. In a medical facility, bacteria, viruses and fungi can be passed from patient to health care provider to surfaces and back. Hospitals can reduce the risk of HAIs by implementing preventive steps developed by the Centers for Disease Control and Prevention and the Institute for Healthcare Improvement.
CLABSI is a serious infection that occurs when germs (usually bacteria or viruses) enter the bloodstream through the central line. CLABSIs result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system, yet these infections are preventable.
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. SSIs can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin, organs, or implanted material. You can find out more about SSI here.
Vermont reports on infection rates for three common surgeries:
The standardized infection ratio (SIR) is a statistic used to track health care-associated infection prevention progress over time. The SIR for a facility or state is adjusted to account for factors that might cause infection rates to be higher or lower, such as hospital size, the type of patients a hospital serves, and surgery and patient characteristics.
The nurse staffing measure represents nursing care hours per patient day, which refers to the number of nursing care hours relative to the patient workload. This measure was developed by the American Nurses Association for the National Database of Nursing Quality Indicators.
Many studies have shown adequate nurse staffing helps achieve improvements in patient care including:
- Improvements in patient satisfaction and health-related quality of life
- Reduction/decrease in:
- Medical and medication errors
- Number of preventable events such as patient falls, pressure ulcers, central line infections, healthcare-associated infections (HAIs), and other complications related to hospitalizations
- Patient mortality, hospital readmissions, and length of stay
- Patient care costs through avoidance of unplanned readmissions
- Nurse fatigue, thus promoting nursing safety, nurse retention, and job satisfaction, which all contribute to safer patient care.
There is no national standard established for optimal nurse staffing level. This is due to varying factors playing key roles. These factors include intensity of patient's needs, the number of admissions, discharges and transfers during a shift, level of experience of nursing staff, layout of the unit, and availability of resources (ancillary staff, technology etc.). Consumers can get a sense of staffing levels at Vermont hospitals by reading the reports in this section.
Reports below cover reporting period of April 2016 - March 2017.
What are “nursing care hours”?
Nursing Care Hours Per Patient Day refers to the number of hours of nursing care provided on a hospital unit, compared to the number of patients on that unit during a 24-hour period. This measure was developed by the American Nurses Association for the National Database of Nursing Quality Indicators. “Nursing care hours” are the number of hours worked by nursing staff that have direct patient care responsibilities for more than 50% of their shift.
- RN nursing care hours include hours worked by registered nurses (RNs).
- Total nursing care hours include hours worked by registered nurses (RNs), licensed practical and vocational nurses, licensed nurse’s aides, and mental health technicians.
What are “patient days”?
“Patient days” are the daily average of the number of patients on the unit, as counted at least once during each shift for 24 hours.
Should the results of this measure be compared among hospitals?
There are some very important reasons why hospitals should not be compared to each other for this measure, including:
- There are no published national averages or standards with which to compare the Vermont results. In the future, data will be comparable over time for each individual hospital as more months of data become available.
- The measure does not account for hospital differences in physical layout, frequency of admissions and discharges, or other factors that might impact nurse staffing needs.
- The results are not adjusted to account for factors that might require more nursing care hours (e.g., age of patients, severity of patient illnesses).
Brattleboro Memorial Hospital - Medical/Surgical Unit, Special Care Unit
Central Vermont Medical Center - Medical/Surgical Unit, Women and Children’s Unit, Intensive Care Unit, Psychiatric Unit
Copley Hospital - Medical/Surgical Unit, Special Care Unit
The University of Vermont Medical Center - Medical/Surgical Unit, Intensive Care Unit, Inpatient Psychiatric Unit, Neonatal Intensive Care Unit, Inpatient Rehabilitation Unit, Mother-Baby Unit
Gifford Medical Center - Medical/Surgical Unit
Grace Cottage Hospital - Medical/Surgical Unit
Mt. Ascutney Hospital - Medical/Surgical Unit
North Country Hospital - Medical/Surgical Unit, Intensive Care Unit
Northeastern Vermont Regional Hospital - Medical/Surgical Unit, Intensive Care Unit, Birthing Center Unit
Northwestern Medical Center - Medical/Surgical Unit, Intensive Care Unit
Porter Medical Center - Medical/Surgical Combined Unit
Rutland Regional Medical Center - Medical/Surgical Unit (5th floor), Progressive Care Unit, Surgical Care Unit, Intensive Care Unit, Psychiatric Inpatient Services and Intensive Care Unit
Southwestern Vermont Medical Center - Medical/Surgical Unit, Intensive Care Unit
Springfield Hospital - Inpatient Care Unit, Psychiatric Unit (Windham Center)
VPSSIS is designed to improve patient safety, eliminate adverse events and support quality improvement efforts by Vermont hospitals.
Vermont Hospital websites
Find additional hospital-specific information, including community health needs assessment, strategic plan, and annual progress report, hospital governance, discount and free care policies, and hospital complaint process. In place of community health needs assessment reports, psychiatric hospitals include quality improvement projects they have undertaken to make patient care safer and more effective.
Useful resources are listed here.
- Hospital Compare has information about the quality of care at over 4,000 Medicare-certified hospitals across the country. You can use Hospital Compare to find hospitals and compare the quality of their care.
- The Leap Frog Group is a national nonprofit organization driving a movement for giant leaps forward in the quality and safety of American health care.
- Agency for Healthcare Research and Quality page lists quality indicators and their resources.
- MONAHRQ lists other states’ health care websites generated using MONAHRQ.
- A Guide to Choosing a Hospital - a publication by Medicare.gov.
- 2017 Hospital Report Card Reporting Manual (revised 3/6)
- Nurse Staffing Data Collection Template/FTE-based (for April 2018-March 2019)
- Nurse Staffing Data Collection Template/Hour-based (for April 2018-March 2019)
- 2018 Hospital Report Card Reporting Manual for Community Hospitals (revised 3/26/2018)
- 2018 Hospital Report Card Reporting Manual for Psychiatric Hospitals (revised 3/26/2018)
- Financial Reporting Template for VPCH
- Financial Reporting Template for Brattleboro Retreat