FAQ

How can VerifyMICare help me make smart decisions when it comes to my personal healthcare?

Being an informed patient eases your healthcare experiences and allows you to focus on what’s most important – your health. When making healthcare decisions, you should use ALL available tools at your disposal – and VerifyMICare is one of those tools. VerifyMICare can assist you in choosing a hospital, but it should not be the sole factor in making healthcare decisions. You should always talk to your doctors or other healthcare professionals and your family about the treatment options that are best for you.

What information is available through VerifyMICare?

Medicare inpatient procedures (if provided) for the selected hospital.

What price information is available through Comparing Hospitals?

Medicare inpatient charge and payment data for acute care hospitals in Michigan.

What should I do if I have concerns about my hospital’s information

You should begin by discussing any concerns you might have with your doctor, nurse or other healthcare provider and/or contacting the hospital in question.

Where does VerifyMICare get its quality data?

The quality information links to a public website created by the federal Centers for Medicare & Medicaid Services (CMS) and the Hospital Quality Alliance. Hospitals voluntarily submit medical data to Hospital Compare for all adult patients for such categories as heart attacks, heart failure, pneumonia and surgery. CMS does not require certain critical access hospitals to report their process measures, but some critical access hospitals in Michigan choose to participate anyway. Other critical access hospitals voluntarily submit their data directly to the MHA.

Why do charges and payments vary between hospitals for the same procedure or service?

Healthcare pricing is complicated for all providers, including hospitals, physicians, therapists and more. There are a number of factors that can impact hospital pricing, including:

  • The severity of illnesses, injuries and conditions being treated. Some hospitals, such as teaching and children’s hospitals, treat a higher proportion of very sick patients compared to other hospitals.
  • The payer mix, which refers to how patients’ healthcare is paid for. Hospitals with a higher percentage of patients using government programs like Medicare and Medicaid are paid at rates less than the actual cost of providing care. As a result, these hospitals often have to recover a greater percentage of their operations costs from privately insured and self-pay patients.
  • The level of technology in use. Hospitals with new technology may have higher charges than those with older equipment; however, new equipment often improves patient outcomes. It can also lead to outpatient versus inpatient care and shorter hospital stays, which allows patients to return home, recover and assume daily activities sooner.
  • Staff and benefit costs, which tend to vary greatly by geographic region and are usually higher in metropolitan areas. Shortages of nurses and other medical staff may increase hospital costs and impact hospital charges.
  • The number of services and procedures available at a given hospital. Some hospitals offer a full range of services, including highly specialized care. Other hospitals may stabilize patients and then transfer them to another facility for specialized care.
  • Community service and social mission, which often vary by community and can include burn centers, trauma care, obstetrics, high risk nurseries, poison control centers, medical education, services for low-income individuals, organ transplants and others.
  • Emergency department use. ERs provide lifesaving care in emergency situations, but they are one of the most expensive departments to staff and operate in a hospital. ERs are open 24 hours a day, seven days a week, 365 days a year and treat all patients regardless of their ability to pay. Some patients seek treatment at the ER when they lack insurance or are unable to locate a provider who accepts their insurance. Hospitals have charity care policies that provide assistance to patients in need.
Why do charges vary between hospitals for the same procedure or service?

Healthcare pricing is complicated for all providers, including hospitals, physicians, therapists and more. There are a number of factors that can impact hospital pricing, including:

  • The severity of illnesses, injuries and conditions being treated. Some hospitals, such as teaching and children’s hospitals, treat a higher proportion of very sick patients compared to other hospitals.
  • The payer mix, which refers to how patients’ healthcare is paid for. Hospitals with a higher percentage of patients using government programs like Medicare and Medicaid are paid at rates less than the actual cost of providing care. As a result, these hospitals often have to recover a greater percentage of their operations costs from privately insured and self-pay patients.
  • The level of technology in use. Hospitals with new technology may have higher charges than those with older equipment; however, new equipment often improves patient outcomes. It can also lead to outpatient versus inpatient care and shorter hospital stays, which allows patients to return home, recover and assume daily activities sooner.
  • Staff and benefit costs, which tend to vary greatly by geographic region and are usually higher in metropolitan areas. Shortages of nurses and other medical staff may increase hospital costs and impact hospital charges.
  • The number of services and procedures available at a given hospital. Some hospitals offer a full range of services, including highly specialized care. Other hospitals may stabilize patients and then transfer them to another facility for specialized care.
  • Community service and social mission, which often vary by community and can include burn centers, trauma care, obstetrics, high risk nurseries, poison control centers, medical education, services for low-income individuals, organ transplants and others.
  • Emergency department use. ERs provide lifesaving care in emergency situations, but they are one of the most expensive departments to staff and operate in a hospital. ERs are open 24 hours a day, seven days a week, 365 days a year and treat all patients regardless of their ability to pay. Some patients seek treatment at the ER when they lack insurance or are unable to locate a provider who accepts their insurance. Hospitals have charity care policies that provide assistance to patients in need.
Why do some hospitals show partial or no data for the quality and price information?

There are a number of reasons why data may not be available.

  • The federal government requires a minimum of 11 Medicare patients for any inpatient or outpatient procedure before the data can be displayed. This is done, in part, to protect the identity of the patient. If a hospital does not meet this requirement for a specific procedure or service, their information cannot be displayed.
  • Some hospitals may not perform a specific procedure. This can happen in smaller hospitals or hospitals that specialize in a particular type of care, like psychiatric care or rehabilitation services.
  • Critical Access Hospitals (CAHs) payments are calculated based on a percentage of reasonable cost and are not available.
Why do you use Medicare information?

Medicare patients generally represent a significant portion of hospital patients. While charges and payments for non-Medicare patients vary depending on healthcare needs, insurance coverage and other factors, Medicare charges and payments can serve as a useful guide for consumers seeking information about specific services or procedures.

Why is there a difference between what hospitals charge and the payments they receive?

Hospitals are required by federal regulations to charge all patients the same amount for the same service, with some limited exceptions. There are three main reasons why the amount hospitals accept as payment in full differs from the actual cost of a procedure or service.

  1. Insurance companies negotiate discounts with hospitals on behalf of the patients they represent.
  2. Programs like Medicare and Medicaid typically pay hospitals much less than the billed charge. These payments are determined by government agencies. Hospitals do not have any ability to negotiate these rates.
  3. Hospitals typically have policies that allow individuals with no insurance or low incomes to receive reduced charge or free care.