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Due: November 5, 2013 Team: Eikenberry, Gamble, Hinkle, Liu, Zhang Page 1 of 17 Team: Steven Eikenberry, Dale Gamble, Jessica Hinkle, Run Liu, Jinliang Zhang ACG5075 MBA Section 4993 Professor: Joost Impink Managerial Accounting, CASE #1 A. Explore the difference between the amounts charged (charges) and the cost (costs). You may treat the difference as a discount. Does the discount depend on the state the hospital operates in? Yes, the discount depends on the state the hospital operates in. A more detailed analysis is explored below. Example 1: In Chart 1 (Above), the average discounts for surgery procedure 460 (SPINAL FUSION EXCEPT CERVICAL W/O MCC) were compared by state with the national average of $67,790. Chart 1 indicates that average discounts can vary dramatically from one state to another for Procedure 460. For example, the average discount in California is approximately six times higher than those in Vermont or Hawaii. Next, each state’s average discount was statistically compared to the nationwide distribution of discounts to determine how well each state matched the national distribution. Note that the zvalues calculated for Table 1 (Below) depend on more than just the average discount for each state. The z values also depend on how many hospitals (n) reported data in that state. The more data points for that state, the less likely the calculated average discount could be a statistical anomaly. Utilizing the zvalue takes this concern into account and allows us to determine how probable it would be for a random sample of size n to have a state average this high above (or below) the national average. These probabilities are reflected in the column labeled ‘.05 α Test’ which reports whether the particular state has less than a 5% chance of matching the nationwide distribution, either on the ‘High’ or the ‘Low’ side. If there is a greater than 5% chance of matching the nationwide distribution, the state is listed as ‘In Range’. $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 MD VT HI RI ME DE MA MI NY OR ND IA ID AR WI UT MN CT NH MT AL KS WV NE OH MS KY NC VA SD AK OK MO GA WY National Average IN LA TN NM DC IL PA WA SC TX AZ FL NV NJ CO CA Chart 1: Average Discount For Procedure 460, by State
17

Case 1 Team Results

Jan 31, 2023

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Page 1: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 1 of 17  

Team:  Steven  Eikenberry,  Dale  Gamble,    Jessica  Hinkle,  Run  Liu,  Jinliang  Zhang  

ACG5075  MBA  Section  4993  Professor:  Joost  Impink    

Managerial  Accounting,  CASE  #1    

A.     Explore  the  difference  between  the  amounts  charged  (charges)  and  the  cost  (costs).  You  may  treat  the  difference  as  a  discount.  Does  the  discount  depend  on  the  state  the  hospital  operates  in?    

   Yes,  the  discount  depends  on  the  state  the  hospital  operates  in.  A  more  detailed  analysis  is  explored  below.  

Example  1:  

 In  Chart  1  (Above),  the  average  discounts  for  surgery  procedure  460  (SPINAL  FUSION  EXCEPT  CERVICAL  W/O  MCC)  were  compared  by  state  with  the  national  average  of  $67,790.  

 Chart  1  indicates  that  average  discounts  can  vary  dramatically  from  one  state  to  another  for  Procedure  460.    For  example,  the  average  discount  in  California  is  approximately  six  times  higher  than  those  in  Vermont  or  Hawaii.  

 Next,  each  state’s  average  discount  was  statistically  compared  to  the  nationwide  distribution  of  discounts  to  determine  how  well  each  state  matched  the  national  distribution.    Note  that  the  z-­‐values  calculated  for  Table  1  (Below)  depend  on  more  than  just  the  average  discount  for  each  state.    The  z-­‐values  also  depend  on  how  many  hospitals  (n)  reported  data  in  that  state.    The  more  data  points  for  that  state,  the  less  likely  the  calculated  average  discount  could  be  a  statistical  anomaly.      

 Utilizing  the  z-­‐value  takes  this  concern  into  account  and  allows  us  to  determine  how  probable  it  would  be  for  a  random  sample  of  size  n  to  have  a  state  average  this  high  above  (or  below)  the  national  average.    These  probabilities  are  reflected  in  the  column  labeled  ‘.05  α  Test’  which  reports  whether  the  particular  state  has  less  than  a  5%  chance  of  matching  the  nationwide  distribution,  either  on  the  ‘High’  or  the  ‘Low’  side.    If  there  is  a  greater  than  5%  chance  of  matching  the  nationwide  distribution,  the  state  is  listed  as  ‘In  Range’.        

$0  $20,000  $40,000  $60,000  $80,000  $100,000  $120,000  $140,000  

MD   VT  

HI   RI  

ME   DE  

MA   MI  

NY  

OR  

ND   IA  

ID  

AR  

WI  

UT  

MN  

CT  

NH  

MT   AL  

KS  

WV   NE  

OH  

MS  

KY  

NC   VA  

SD  

AK  

OK  

MO   GA  

WY  

National  Average  

IN  

LA  

TN  

NM  

DC  

IL  

PA  

WA   SC  

TX  

AZ  

FL  

NV   NJ  

CO  

CA  

Chart  1:  Average  Discount  For  Procedure  460,  by  State  

Page 2: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 2 of 17  

Table  1:  Average  Discounts  and  Probabilities  of  Matching  National  Distribution  for          Procedure  460,  by  State  

State  

State  Average  Discount  

Sample  Size   Z-­‐Value   P-­‐Value   .05  α  Test  

AK   $64,894   3   -­‐0.111   0.46   In  Range  AL   $49,516   27   -­‐2.101   0.02   Low  AR   $44,078   16   -­‐2.098   0.02   Low  AZ   $80,770   23   1.377   0.92   In  Range  CA   $126,411   96   12.706   1.00   High  CO   $107,869   28   4.692   1.00   High  CT   $45,322   18   -­‐2.109   0.02   Low  DC   $73,002   4   0.231   0.59   In  Range  DE   $24,840   3   -­‐1.646   0.05   In  Range  FL   $88,429   91   4.356   1.00   High  GA   $67,527   45   -­‐0.039   0.48   In  Range  HI   $18,757   4   -­‐2.169   0.02   Low  IA   $42,586   17   -­‐2.299   0.01   Low  ID   $43,482   11   -­‐1.783   0.04   In  Range  IL   $73,695   55   0.969   0.83   In  Range  IN   $68,369   39   0.080   0.53   In  Range  KS   $49,650   16   -­‐1.605   0.05   In  Range  KY   $55,427   16   -­‐1.094   0.14   In  Range  LA   $69,594   27   0.207   0.58   In  Range  MA   $29,195   21   -­‐3.913   0.00   Low  MD   $2,385   27   -­‐7.518   0.00   Low  ME   $23,694   7   -­‐2.581   0.00   Low  MI   $37,934   41   -­‐4.229   0.00   Low  MN   $44,713   22   -­‐2.394   0.01   Low  MO   $66,622   30   -­‐0.141   0.44   In  Range  MS   $54,555   15   -­‐1.134   0.13   In  Range  MT   $49,474   9   -­‐1.216   0.11   In  Range  NC   $61,265   32   -­‐0.817   0.21   In  Range  ND   $40,751   3   -­‐1.036   0.15   In  Range  NE   $53,004   14   -­‐1.224   0.11   In  Range  NH   $49,456   7   -­‐1.073   0.14   In  Range  NJ   $95,408   31   3.402   1.00   High  NM   $71,097   9   0.219   0.59   In  Range  NV   $91,818   14   1.989   0.98   High  NY   $38,565   51   -­‐4.617   0.00   Low  OH   $54,241   53   -­‐2.182   0.01   Low  OK   $65,426   21   -­‐0.240   0.41   In  Range  OR   $40,518   19   -­‐2.630   0.00   Low  PA   $74,667   56   1.139   0.87   In  Range  RI   $19,509   7   -­‐2.826   0.00   Low  SC   $79,125   26   1.279   0.90   In  Range  SD   $63,024   10   -­‐0.333   0.37   In  Range  TN   $69,813   33   0.257   0.60   In  Range  TX   $79,442   119   2.812   1.00   High  UT   $44,552   11   -­‐1.705   0.04   In  Range  VA   $62,017   39   -­‐0.798   0.21   In  Range  VT   $17,322   4   -­‐2.233   0.01   Low  WA   $75,631   29   0.934   0.82   In  Range  WI   $44,254   23   -­‐2.497   0.01   Low  WV   $52,319   6   -­‐0.838   0.20   In  Range  WY   $67,571   4   -­‐0.010   0.50   In  Range  

Page 3: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 3 of 17  

Table  1  (previous  page)  shows  that  22  of  the  50  states  (51  if  including  DC)  have  less  than  a  5%  chance  of  matching  the  national  distribution,  six  on  the  high  side  and  sixteen  on  the  low  side.    The  six  high  states  are  highlighted  in  red.    

Similarly,  the  average  state  discounts  for  Procedure  470  (MAJOR  JOINT  REPLACEMENT  OR  REATTACHMENT  OF  LOWER  EXTREMITY  W/O  MCC)  were  found  to  vary  widely:  

 

     It  was  then  determined  that  28  of  the  50  states  have  less  than  a  5%  probability  of  matching  the  national  distribution.    Six  of  the  states  have  improbably  high  discounts,  and  twenty-­‐two  have  improbably  low  discounts.    Again,  the  six  high  states  are  highlighted  in  red  in  Table  2;  note  that  these  are  the  same  states  that  were  indicated  as  having  high  discounts  in  Table  1,  as  seen  on  the  following  page:                                

 

$0  

$10,000  

$20,000  

$30,000  

$40,000  

$50,000  

$60,000  

$70,000  

$80,000  

MD  

VT  

MA  

MT   ND   RI  

MI  

ME  

WV   HI  

MN  

DE  

NY   ID  

CT  

UT  

IA  

SD  

OR  

WI  

AR  

KY  

KS  

OH  

NC  

WY  

NE  

MO  

NH  

DC  

IN  

OK  

GA  

VA  

AK  

NM  

WA  

National  Average  

TN  

LA  

PA  

IL  

AL  

AZ  

MS   SC  

CO  

TX  

FL  

NV   NJ  

CA  

Chart  2:  Average  Discount  For  Procedure  470,  by  State    

Page 4: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 4 of 17  

Table  2:  Average  Discounts  and  Probabilities  of  Matching  National  Distribution  for          Procedure  470,  by  State  

State  

State  Average  Discount  

Sample  Size   Z-­‐Value   P-­‐Value   .05  α  Test  

AK   35945.62   7   -­‐0.170   0.43   In  Range  AL   40129.94   53   0.795   0.79   In  Range  AR   27045.70   28   -­‐2.292   0.01   Low  AZ   40190.03   49   0.782   0.78   In  Range  CA   68788.17   235   19.880   1.00   High  CO   45028.52   44   2.071   0.98   High  CT   24051.72   29   -­‐3.000   0.00   Low  DC   34465.29   6   -­‐0.308   0.38   In  Range  DE   22905.26   5   -­‐1.352   0.09   In  Range  FL   52867.21   151   7.828   1.00   High  GA   34965.45   81   -­‐0.944   0.17   In  Range  HI   21457.87   11   -­‐2.204   0.01   Low  IA   24277.00   33   -­‐3.147   0.00   Low  ID   23934.49   12   -­‐1.947   0.03   In  Range  IL   39576.49   110   0.904   0.82   In  Range  IN   34595.39   74   -­‐1.034   0.15   In  Range  KS   28498.44   44   -­‐2.473   0.01   Low  KY   27333.74   48   -­‐2.918   0.00   Low  LA   38727.72   62   0.402   0.66   In  Range  MA   17698.81   56   -­‐6.140   0.00   Low  MD   1317.38   43   -­‐9.832   0.00   Low  ME   20850.02   20   -­‐3.085   0.00   Low  MI   20665.65   89   -­‐6.580   0.00   Low  MN   22464.89   49   -­‐4.361   0.00   Low  MO   32181.24   63   -­‐1.748   0.04   In  Range  MS   40661.36   30   0.719   0.76   In  Range  MT   18229.52   12   -­‐2.766   0.00   Low  NC   29246.40   80   -­‐3.058   0.00   Low  ND   18703.99   6   -­‐1.908   0.03   In  Range  NE   30619.23   21   -­‐1.306   0.10   In  Range  NH   34311.62   13   -­‐0.476   0.32   In  Range  NJ   62802.39   60   8.124   1.00   High  NM   37329.20   23   -­‐0.033   0.49   In  Range  NV   60848.54   21   4.435   1.00   High  NY   23747.22   141   -­‐6.766   0.00   Low  OH   29003.33   126   -­‐3.951   0.00   Low  OK   34835.12   51   -­‐0.788   0.22   In  Range  OR   24957.31   31   -­‐2.893   0.00   Low  PA   38777.25   135   0.617   0.73   In  Range  RI   19375.31   10   -­‐2.375   0.01   Low  SC   43355.07   43   1.592   0.94   In  Range  SD   24519.72   15   -­‐2.083   0.02   Low  TN   38068.41   63   0.188   0.57   In  Range  TX   47996.88   224   6.513   1.00   High  UT   24081.10   27   -­‐2.889   0.00   Low  VA   35036.75   64   -­‐0.815   0.21   In  Range  VT   14809.95   6   -­‐2.303   0.01   Low  WA   37397.22   45   -­‐0.027   0.49   In  Range  WI   25123.71   63   -­‐4.070   0.00   Low  WV   21080.97   27   -­‐3.535   0.00   Low  WY   29776.63   11   -­‐1.061   0.14   In  Range  

Page 5: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 5 of 17  

As  noted  above,  the  same  six  states  (California,  Colorado,  Florida,  Nevada,  New  Jersey,  and  Texas)  have  improbably  high  discounts  for  both  Procedures  460  and  470.    In  statistical  terms,  this  means  the  same  states  had  high  ‘z-­‐values’  in  both  data  sets.    On  closer  inspection,  it  becomes  apparent  that  many  of  the  states  with  low  discounts  for  Procedure  460  also  have  low  discounts  for  Procedure  470.    We  can  use  statistics  to  determine  how  well  each  state’s  average  discount  for  Procedure  460  correlates  to  that  state’s  discount  for  Procedure  470.    Chart  3  shows  this  correlation:    

 

As  shown  in  Chart  3,  the  Coefficient  of  Determination  (R2)  between  discounts  for  Procedures  460  and  470  for  a  particular  state  is  0.8103;  this  means  that  over  80%  of  the  variation  in  the  Procedure  470  discount  can  be  attributed  to  the  variation  in  the  Procedure  460  discount  in  that  same  state.  

 Tables  1  and  2  respectively  indicate  that  22  of  the  states’  average  discounts  for  Procedure  460  and  28  of  the  states’  average  discounts  for  Procedure  470  do  not  match  the  national  average  distribution.    This  means  that  the  discounts  depend  heavily  on  the  state  in  which  the  hospital  operates.    Chart  3  further  indicates  that  the  states  are  at  least  80%  correlated  from  one  procedure  to  another;  states  that  have  high  discounts  for  one  procedure  are  likely  to  have  high  discounts  for  another,  and  states  with  low  discounts  for  one  procedure  are  likely  to  have  low  discounts  for  another.  

 This  correlation  increases  to  nearly  90%  when  comparing  the  probabilities  (as  represented  by  the  z-­‐values)  that  a  state  is  higher  or  lower  than  the  national  average  across  different  procedures,  as  shown  in  Chart  4,  located  on  the  following  page.  

                     

R²  =  0.81029  

$0  

$10,000  

$20,000  

$30,000  

$40,000  

$50,000  

$60,000  

$70,000  

$80,000  

$0   $20,000   $40,000   $60,000   $80,000   $100,000   $120,000   $140,000  

State  470  Discount  

State  460  Discount  

Chart  3:  Correlation  between  State  Discounts  for  Procedures  460  and  470  

Page 6: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 6 of 17  

   

Once  again,  the  discount  for  a  procedure  depends  on  the  state  in  which  the  hospital  operates.    

The  calculations  above  were  repeated  after  taking  outliers  into  account.    Outliers  were  determined  via  two  methods:  

In  the  first  method,  any  discount  found  to  be  greater  than  three  standard  deviations  from  the  population  mean  was  classified  as  an  outlier.    Assuming  a  normal  distribution,  this  would  theoretically  classify  only  0.3%  of  the  samples  as  outliers.    Instead,  18  of  1332  samples  (1.4%)  for  Procedure  460  and  38  of  2750  samples  (again  1.4%)  for  Procedure  470  were  calculated  as  outliers  with  this  approach.  

 A  second  approach  of  identifying  outliers  was  also  examined.    This  method  calculated  an  interquartile  range  (Q3-­‐Q1:  the  middle  50%  of  the  discount  population  falls  into  this  range),  and  classified  any  value  greater  than  1.5  times  the  interquartile  range  above  the  third  quartile  or  less  than  1.5  times  the  interquartile  range  below  the  first  quartile  as  an  outlier.    This  more  aggressive  approach  classified  54  of  1332  samples  (4.1%)  for  Procedure  460  and  113  of  2750  samples  (again  4.1%)  for  Procedure  470  as  outliers.    Since  this  second  method  had  greater  potential  to  disrupt  the  earlier  finding,  it  was  utilized  to  identify  and  exclude  the  outliers  from  the  calculations.    

    In  both  methods,  all  of  the  outliers  were  on  the  high  side.    

As  a  result,  for  Procedure  460,  21  of  the  50  states  (and  DC)  were  found  to  have  average  discounts  less  than  5%  probable  of  matching  the  national  average,  vs  22  states  previously.    It  should  be  noted  that  if  the  probability  were  increased  to  5.1%  the  result  would  have  been  22  states  again.  

R²  =  0.89248  

-­‐15  

-­‐10  

-­‐5  

0  

5  

10  

15  

20  

25  

-­‐10.000   -­‐5.000   0.000   5.000   10.000   15.000  

State  470  z-­‐Value  

State  460  z-­‐Value  

Chart  4:  Correlation  between  State  Discount  z-­‐Values  for  Procedures  460  and  470  

Page 7: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 7 of 17  

For  Procedure  470  the  number  of  “non-­‐conforming”  states  actually  increased  to  30  from  28.    The  six  high  states  were  unchanged,  but  removing  the  outliers  (all  of  which  were  on  the  high  side)  reduced  the  deviation  sufficiently  to  cause  more  of  the  low  states  to  fall  outside  the  now-­‐narrower  5%  threshold.    In  any  event,  the  conclusion  that  the  discounts  depend  on  the  state  in  which  the  hospital  operates  was  not  affected.    Similarly,  the  coefficient  of  determination  between  discounts  for  Procedures  460  and  470  reduced  almost  insignificantly  to  0.80  (see  Chart  5),  while  the  coefficient  of  determination  between  z-­‐values  for  the  discounts  decreased  slightly  to  0.86;  the  correlations  remain  very  strong:  

 

                                     

R²  =  0.8022  

$0  

$10,000  

$20,000  

$30,000  

$40,000  

$50,000  

$60,000  

$0   $20,000   $40,000   $60,000   $80,000   $100,000   $120,000  

State  470  Discount  

State  460  Discount  

Chart  5:  Correlation  between  State  Discounts  for  Procedures  460  and  470  (excluding  outliers)  

Page 8: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 8 of 17  

B.   Explore  the  costs  for  both  drgs.  What  is  the  distribution  of  the  average  cost  for  each  drg  over  the  hospitals?  Are  there  differences  between  states?  (You  may  ignore  the  amounts  charged  (charges)  in  this  and  following  questions.)  

 The  distribution  for  both  procedures  is  right  skewed.  Most  states  are  near  the  average,  but  in  both  cases  there  are  several  states  far  above  the  average.  This  can  be  seen  in  the  histograms  that  follow.  The  average  cost  of  each  procedure  across  all  states  and  hospitals  is  highlighted  in  yellow.  Outliers  were  included  in  this  analysis.  Please  see  below:    DRG  460  State  Costs  

 

     Bin   Frequency        22000   1        24000   2        26000   13        28000   14        30000   10        32000   4        34000   3        More   4                      DRG  470  State  Costs  

 

Bin   Frequency        12000   1        13000   8        14000   19        15000   9        16000   5        17000   2        18000   2        More   5      

     

460  Statistics  Mean   27995.48079  Standard  Deviation   3623.656395  Skewness   1.02148753  Range   17333.0717  Minimum   21268.3718  Maximum   38601.4435  

 

  470  Statistics  Mean   14572.47531  Standard  Deviation   2075.497573  Skewness   1.466339835  Range   9451.739479  Minimum   11709.20188  Maximum   21160.94136  

 

 

         

DRG  ID   Number  of  Procedures   Total  Cost  of  All  Procedures   Average  Cost  of  Procedure  460   65997    $1,804,860,128      $27,348    470   427207    $6,119,519,851      $14,324    

Page 9: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 9 of 17  

  Steps  taken  in  the  calculation  of  the  above  responses:  1. Calculate  the  total  cost  of  each  procedure  for  each  hospital  using  sum  product      2. Use  a  pivot  table  to  group  hospitals  by  state  and  aggregate  the  total  costs  and  number  of  procedures  (Pivot  worksheet:  in  Appendix)  

3. Use  these  aggregated  numbers  to  get  a  state  average  (Columns  D  &  G  in  Pivot  Work  sheet)  4. Create  histograms  for  each  5. Run  descriptive  statistics  on  each  

 

    Additionally,  the  comparison  chart  above  demonstrates  that  with  exception  of  rare  outliers,  there  are  

no  obvious  differences  in  the  cost  of  the  drgs  by  state.                                                      

0  

10000  

20000  

30000  

40000  

50000  

AK  

AR  

CA  

CT  

DE  

GA  

IA  

IL  

KS  

LA  

MD   MI  

MO  

MT   ND  

NH  

NM  

NY  

OK  

PA  

SC  

TN  

UT  

VT  

WI  

WY  

Cost  of  drgs  by  states  

average_cost_460   average_cost_470  

Page 10: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 10 of 17  

C.     In  addition  to  B):  Does  the  degree  of  specialization  impact  the  costs?  Use  the  number  of  unique  drgs  for  each  hospital  as  a  proxy  of  specialization.  

 The  degree  of  specialization  has  little  impact  on  costs.  For  both  DRG460  and  DRG  470,  the  correlation  is  less  than  .1  between  these  data  sets  and  the  coefficient  of  determination  is  less  than  1%.  (this  means  less  than  1%  of  the  price  variance  is  explained  by  the  number  of  unique  DRGs).    Outliers  here  were  again  included  and  even  they  could  not  create  a  correlation:    

   

460:  Correlation  b/w  DRG  &  Cost      

  470:  Correlation  b/w  DRG  &  cost  0.071341497     0.084372197  

 

   Steps  taken  in  the  calculation  of  the  above  response:  

1. Find  the  average  price  for  both  460  &  470  for  each  hospital  using  a  V  lookup  from  the  data  on  Question  B  spreadsheet  

2. We  have  more  info  on  hospital  specialization  than  for  cost  of  460  &  470,  so  eliminate  hospitals  with  no  data  before  running  a  correlation  (this  is  where  columns  F&G  have  N/As  …  correlation  data  sets  are  J&K  columns  and  N&O  columns  (In  Appendix)  

3. Run  correlations  between  J&K  and  N&O  ,  answers  in  yellow  above  4. Create  scatter  plots  between  #Unique  DRGs  and  average  cost  5. Add  R  squared  to  each  scatterplot  to  find  the  coefficient  of  determination  

 

R²  =  0.0051  

0  20000  40000  60000  80000  100000  120000  140000  

0   20   40   60   80   100   120  

Avg  Price  

Unique  DRGs  

460  Price  vs.  Unique  DRGs  

R²  =  0.00712  

0  

10000  

20000  

30000  

40000  

50000  

0   20   40   60   80   100   120  

Avg  Price  

Unique  DRGs  

470  Price  vs.  Unique  #  DRGs  

Page 11: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 11 of 17  

D.     Do  you  believe  there  are  economies  of  scale  (positive  or  negative)  for  drgs  460  and  470  for  Shands  and  FRMC?  

 There  is  no  evidence  in  the  data  to  suggest  that  Shands  and  FRMC  will  observe  economies  of  scale  (or  diseconomies  of  scale)  as  the  result  of  their  joint  venture  initiative.    

To  determine  if  there  are  economies  of  scale  for  Procedures  460  or  470,  it  is  necessary  to  correlate  the  costs  of  the  procedures  with  the  number  of  patients  at  each  hospital  on  which  those  procedures  are  performed.    Charts  6  and  7  plot  the  costs  against  the  number  of  discharges  (which  serves  as  a  measure  of  the  number  of  patients  treated,  presumably  with  a  small  error  for  patients  that  died  during  treatment)  for  Procedures  460  and  470,  respectively.      

 

   

   

R²  =  0.00506  

$0  

$20,000  

$40,000  

$60,000  

$80,000  

$100,000  

$120,000  

$140,000  

0   50   100   150   200   250   300   350   400  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  6:  Cost  of  Procedure  460  vs  #  of  Patients  Treated  

R²  =  0.00487  

$0  $5,000  $10,000  $15,000  $20,000  $25,000  $30,000  $35,000  $40,000  $45,000  

0   500   1000   1500   2000   2500   3000   3500   4000  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  7:  Cost  of  Procedure  470  vs  #  of  Patients  Treated  

Page 12: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 12 of 17  

The  coefficient  of  determination  is  very  low  for  both  procedures,  only  half  of  one  percent,  which  indicates  that  increasing  the  number  of  procedures  performed  has  no  discernible  effect  on  cost.    Hence,  there  are  no  economies  of  scale  for  either  procedure.  

 To  discern  the  influence  of  outliers  on  the  data,  the  interquartile  range  procedure  described  in  Section  A  was  again  utilized  to  identify  and  remove  outlying  data  points.    Outliers  were  removed  both  for  the  cost  of  treatment,  and  for  the  number  of  patients  treated.    Charts  8  and  9  show  that  the  results  are  unchanged:  there  is  no  evidence  of  a  correlation  between  cost  of  treatment  and  number  of  procedures  performed.    If  anything,  the  correlation  decreased  with  the  removal  of  the  outliers.  

 

   

   

R²  =  5E-­‐05  

$0  $5,000  $10,000  $15,000  $20,000  $25,000  $30,000  $35,000  $40,000  $45,000  

0   20   40   60   80   100   120   140  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  8:  Cost  of  Procedure  460  vs  #  of  Patients  Treated  (Outliers  Removed)  

R²  =  0.00025  

$0  

$5,000  

$10,000  

$15,000  

$20,000  

$25,000  

0   50   100   150   200   250   300   350   400   450   500  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  9:  Cost  of  Procedure  470  vs  #  of  Patients  Treated  (Outliers  Removed)  

Page 13: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 13 of 17  

Finally,  given  the  earlier  findings  that  discounts  and  costs  depend  heavily  on  the  states  in  which  the  hospitals  are  located,  the  costs  and  patient  counts  for  just  the  Florida  hospitals  were  analyzed.    Charts  10  and  11  show  that  while  the  Coefficient  of  Determination  did  increase,  the  resulting  correlation  was  still  insignificant  at  2%  and  1%  respectively  for  Procedures  460  and  470.  

 

   

   In  conclusion,  there  is  no  evidence  in  the  data  to  suggest  that  Shands  and  FRMC  will  observe  economies  of  scale  (or  diseconomies  of  scale)  as  the  result  of  their  joint  venture  initiative.    

R²  =  0.01997  

$0  

$10,000  

$20,000  

$30,000  

$40,000  

$50,000  

$60,000  

0   50   100   150   200   250   300  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  10:  Florida  Cost  of  Procedure  460  vs  #  of  Patients  Treated  

R²  =  0.01102  

$0  

$5,000  

$10,000  

$15,000  

$20,000  

$25,000  

$30,000  

0   100   200   300   400   500   600   700   800  

Cost  of  Treatment  

#  Patients  Treated  (Discharges)  

Chart  11:  Florida  Cost  of  Procedure  470  vs  #  of  Patients  Treated    

Page 14: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 14 of 17  

E.   Shortly  address  challenges  that  Shands  and  FRMC  need  to  be  manage  in  case  they  go  ahead  and  form  the  joint  venture.  Address  issues  like  profit/cost  sharing,  difference  in  goals  (profit  vs  educational),  compensation,  et  cetera.    

 The  main  challenge  facing  Shands  is  the  difference  in  missions.  Shands  is  a  nonprofit  

organization,  while  FRMC  is  profit-­‐seeking.    Therefore  FRMC  will  be  more  naturally  inclined  to  reduce  costs  &  revenue.    As  a  manager  of  FRMC,  the  joint  venture  would  be  a  hard  sell  for  me  (based  on  no  knowledge  of  economies  of  scale)  because  I  can  perform  both  DRGs  at  a  lower  cost  than  can  Shands.    However,  460  is  a  more  expensive  operation  so  if  I  only  perform  470,  my  costs  will  be  minimized.  Depending  on  my  contribution  margin  on  470  though,  I  may  be  less  profitable  even  though  my  costs  are  lower.  

 Profit  sharing  is  the  next  largest  challenge.  Will  each  hospital  simply  cease  doing  one  of  the  

procedures  and  absorb  all  costs  and  profits  for  the  one  they  continue  to  do?    Or,  for  instance,  will  FRMC  be  sharing  some  profits    with  Shands  since  Shands  would  be  agreeing  to  take  on  the  more  costly  procedure.    As  mentioned  in  the  paragraph  above,  if  FRMC’s  contribution  margin  is  such  that  they  make  less  by  only  performing  470,  they  will  surely  want  to  share  some  of  Shands’  460  profit,  since  FRMC  is  a  profit  seeker.  

 Yet  another  key  difficulty  faced  by  a  Shands/FRMC  joint  venture  would  be  legal  approval  

from  both  entities.    To  reduce  potential  lawsuit  liabilities,  each  hospital  doubtless  follows  strict  protocols  for  many  aspects  of  their  operations.    These  protocols  would  cover  admitting  procedures,  surgery  confirmation  procedures  (eg,  confirming  the  left  knee  rather  than  the  right  knee  is  to  be  replaced),  patient  discharge  routines,  medical  record  retention,  billing,  and  many  more.    The  lawyers  for  each  hospital  would  either  need  to  approve  the  use  of  each  of  the  other  hospital’s  protocols,  or  endeavor  to  merge  the  two  sets  of  protocols  into  a  unified  whole.  

                                                     

Page 15: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 15 of 17  

APPENDIX    PIVOT  TABLE  referenced  in  Question  B:    Column  Labels                      

460       470        

Sum  of  Total  Cost  Sum  of  #  of  Procedures   Sum  of  Total  Cost  

Sum  of  #  of  Procedures  

 Total  Sum  of  Total  Cost  

 Total  Sum  of  #  of  Procedures  

35752133   1681   98486097   8411   134238230   10092  4458458   118   13712290   648   18170748   766  35167961   1215   127188724   8943   162356685   10158  17771815   786   65498938   5441   83270753   6227  127779960   3926   510999866   29731   638779826   33657  41071795   1459   100406568   6991   141478363   8450  19919525   637   90347739.01   5324   110267264   5961  

9674754.999   362   26829251   1817   36504005.99   2179  8469353   252   15948547   1013   24417900   1265  

139564435   5754   383482177   29985   523046612   35739  61920757   2354   149663056   11250   211583813   13604  3312341   99   13588146   734   16900487   833  14131163   542   32631457   2365   46762620   2907  68252116   2321   298222570   20095   366474686   22416  49325741   1741   150670552   11499   199996293   13240  15544266   643   84594728   6599   100138994   7242  21166458   905   77952494   6188   99118952   7093  23483348   902   99609309.01   7469   123092657   8371  27456445   1079   70669146.99   5415   98125592   6494  7294069   272   34729438   2499   42023507   2771  49873065   1292   177512630   8854   227385695   10146  31927641   1016   158148214   9781   190075855   10797  81497328   3021   243509706   16847   325007034   19868  31172021   1089   141259814   9442   172431835   10531  14788567   601   58850400   4598   73638967   5199  46668427   1810   137916069   10731   184584496   12541  9916807   389   26691919   1987   36608726   2376  15478185   615   59238512   4349   74716697   4964  22161623   804   36828170   2605   58989793   3409  7016262   243   31806675   2177   38822937   2420  24319463   832   150861798   10018   175181261   10850  7532685   272   31677870   2114   39210555   2386  68709233   2175   331005861   19371   399715094   21546  70264727   2648   214425540   15820   284690267   18468  3368289   137   28987053   2093   32355342.01   2230  66182959   2540   212983942   16062   279166901   18602  28729344   1143   87552301   7020   116281645   8163  23156967   825   64931343   4236   88088310   5061  64310631   2431   228609650   16712   292920281   19143  7074726   237   18814342   1206   25889068   1443  41238626   1536   102232876   7489   143471502   9025  

Page 16: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 16 of 17  

13017176   512   36482007   2721   49499183   3233  51255764   2044   132692730   10063   183948494   12107  127697591   4943   385337836   27546   513035427   32489  16226092   583   50078498   3579   66304590   4162  3848101   113   13054492   719   16902593   832  57539838   2110   164402518   12410   221942356   14520  40362249   1307   143073902   9231   183436151   10538  6311293   243   34368416   2739   40679709   2982  23087562   805   125518283   9099   148605845   9904  5888728   169   12214044   622   18102772   791  12721264   464   33221346   2549   45942610   3013  

1804860128   65997   6119519851   427207   7924379979   493204      PIVOT  WORK  SHEET  referenced  in  Question  B:    

 Column  Labels  

           

460      

470      

Row  Labels   Sum  of  Total  Cost  Sum  of  #  of  Procedures  

Statewide  Average  Cost   Sum  of  Total  Cost  

Sum  of  #  of  Procedures  

Statewide  Average  Cost  

10000-­‐19999   35752133   1681   21268.3718   98486097   8411   11709.20188  20000-­‐29999   4458458   118   37783.54237   13712290   648   21160.94136  30000-­‐39999   35167961   1215   28944.82387   127188724   8943   14222.15409  40000-­‐49999   17771815   786   22610.45165   65498938   5441   12038.03308  50000-­‐59999   127779960   3926   32547.11156   510999866   29731   17187.44294  60000-­‐69999   41071795   1459   28150.6477   100406568   6991   14362.26119  70000-­‐79999   19919525   637   31270.83987   90347739.01   5324   16969.89839  80000-­‐89999   9674754.999   362   26725.84254   26829251   1817   14765.68574  90000-­‐99999   8469353   252   33608.54365   15948547   1013   15743.87661  100000-­‐109999   139564435   5754   24255.20247   383482177   29985   12789.1338  110000-­‐119999   61920757   2354   26304.48471   149663056   11250   13303.38276  120000-­‐129999   3312341   99   33457.9899   13588146   734   18512.46049  130000-­‐139999   14131163   542   26072.25646   32631457   2365   13797.65624  140000-­‐149999   68252116   2321   29406.34037   298222570   20095   14840.63548  150000-­‐159999   49325741   1741   28331.84434   150670552   11499   13102.92652  160000-­‐169999   15544266   643   24174.5972   84594728   6599   12819.32535  170000-­‐179999   21166458   905   23388.35138   77952494   6188   12597.3649  180000-­‐189999   23483348   902   26034.75388   99609309.01   7469   13336.36484  190000-­‐199999   27456445   1079   25446.19555   70669146.99   5415   13050.62733  200000-­‐209999   7294069   272   26816.43015   34729438   2499   13897.33414  210000-­‐219999   49873065   1292   38601.4435   177512630   8854   20048.86266  220000-­‐229999   31927641   1016   31424.8435   158148214   9781   16168.92076  230000-­‐239999   81497328   3021   26976.93744   243509706   16847   14454.18804  240000-­‐249999   31172021   1089   28624.44536   141259814   9442   14960.79369  250000-­‐259999   14788567   601   24606.60067   58850400   4598   12799.13006  260000-­‐269999   46668427   1810   25783.66133   137916069   10731   12852.11714  270000-­‐279999   9916807   389   25493.07712   26691919   1987   13433.27579  280000-­‐289999   15478185   615   25167.78049   59238512   4349   13621.18004  290000-­‐299999   22161623   804   27564.20771   36828170   2605   14137.49328  

Page 17: Case 1 Team Results

Due:  November  5,  2013    

Team: Eikenberry,  Gamble,  Hinkle,  Liu,  Zhang                                                          Page 17 of 17  

300000-­‐309999   7016262   243   28873.50617   31806675   2177   14610.32384  310000-­‐319999   24319463   832   29230.1238   150861798   10018   15059.07347  320000-­‐329999   7532685   272   27693.69485   31677870   2114   14984.80132  330000-­‐339999   68709233   2175   31590.45195   331005861   19371   17087.70125  340000-­‐349999   70264727   2648   26535.01775   214425540   15820   13554.07965  350000-­‐359999   3368289   137   24586.0511   28987053   2093   13849.52365  360000-­‐369999   66182959   2540   26056.28307   212983942   16062   13260.11344  370000-­‐379999   28729344   1143   25135.03412   87552301   7020   12471.83775  380000-­‐389999   23156967   825   28069.05091   64931343   4236   15328.4568  390000-­‐399999   64310631   2431   26454.39366   228609650   16712   13679.37111  410000-­‐419999   7074726   237   29851.16456   18814342   1206   15600.61526  420000-­‐429999   41238626   1536   26848.0638   102232876   7489   13651.0717  430000-­‐439999   13017176   512   25424.17188   36482007   2721   13407.57332  440000-­‐449999   51255764   2044   25076.20548   132692730   10063   13186.19994  450000-­‐459999   140418855   5407   25969.82708   418559182   30095   13907.93095  460000-­‐469999   16226092   583   27832.06175   50078498   3579   13992.31573  470000-­‐479999   3848101   113   34053.99115   13054492   719   18156.45619  490000-­‐499999   57539838   2110   27270.0654   164402518   12410   13247.58405  500000-­‐509999   40362249   1307   30881.59832   143073902   9231   15499.28523  510000-­‐519999   6311293   243   25972.39918   34368416   2739   12547.79701  520000-­‐529999   23087562   805   28680.20124   125518283   9099   13794.73382  530000-­‐539999   5888728   169   34844.54438   12214044   622   19636.72669