Skip to main content

Table of Contents

Data Source

Inpatient Data

Ambulatory Surgery (Outpatient) Data

Selecting cases to include in data reporting

Ambulatory (Outpatient) Surgery Center Facility Types

Healthcare-Associated Infections (HAIs) – General Overview

Healthcare-Associated Infections (HAIs) – Definitions

Risk Adjustment

All Patient Refined - Diagnosis Related Groups (APR-DRGs)

Enhanced Ambulatory Patient Groups (EAPGs)

Enhanced Ambulatory Patient Groups (EAPGs) – Explanation of Designation as Levels I-IV

Explanation of Results Pages

Hospital Performance Measures

Ambulatory (Outpatient) Surgery Center Performance Measures

Physicians

Why the Data May Differ From Provider to Provider

Methodology

Data Disclaimer

Data Source

Inpatient Data

The data collected for this website by the Florida Agency for Health Care Administration (AHCA) comes from information hospitals record primarily for billing purposes.  This type of record, referred to as "administrative data," consists of diagnoses and procedures along with information about the patient's age, gender, and discharge status.  Inpatient data consists of those patients admitted to a hospital who require at least one overnight stay.  The inpatient data reflects only the care provided to patients who were discharged from the hospital in a 12 month (1 year) time period.  Due to low volume, pediatric inpatient data represents 3 years of data.   When less than 30 patients in a facility had a specific procedure no data is included for charges and length of stay due to statistical significance, and an X is inserted.  When there are less than 5 patients, total hospitalizations (volume), charges, length of stay and readmissions are denoted by ‘Too few cases’.  This is to protect confidential patient information, as well as ensure the validity of the data.

Ambulatory Surgery (Outpatient) Data

The Ambulatory (Outpatient) Surgery data collected by the Florida Agency for Health Care Administration (AHCA) comes from information on outpatient facilities, including hospitals, freestanding ambulatory surgery centers and treatment centers record primarily for billing purposes. Ambulatory Surgery is an operative procedure, performed either in a hospital or in a freestanding facility, which does not require an overnight stay in a hospital.  This type of record, referred to as "outpatient administrative data," consists of diagnoses and procedures along with information about the patient's age, gender, and discharge status.    The ambulatory surgery data reflects only the care provided to patients on an outpatient basis in a 12 month (1 year) time period.   When there are less than 5 patients, total visits (volume) and charges are denoted by ‘Too few cases’.  When less than 30 patients in a facility had a specific procedure no data is included due to statistical significance, and (an X is inserted) as a further step to protect confidential patient information, as well as ensure the validity of the data.

Selecting cases to include in data reporting

All cases reported to the Agency for Health Care Administration (AHCA) for short-term acute care hospitals and ambulatory (outpatient) surgery centers were used in this analysis.  A small number of cases could not be categorized (not enough information to determine in which category they should be included), but these cases were negligible. 

Ambulatory (Outpatient) Surgery Center Facility Types

Freestanding Ambulatory Surgery Center (FASC)

A facility dedicated solely to the provision of surgery on an outpatient basis. FASCs are usually operated independently of a hospital.

Hospital Based Ambulatory Surgery Centers

The unit in a hospital that provides surgery on an outpatient basis.  The surgical procedure may be provided in the hospital's main operating rooms, or the hospital may have a separate location within the facility used explicitly for outpatient surgery.


Healthcare-Associated Infections (HAIs) – General Overview

What it is and why it’s important

The Healthcare-Associated Infections (HAI) measures are developed by Centers for Disease Control and Prevention (CDC) and collected through the National Healthcare Safety Network (NHSN). They provide information on infections that occur while the patient is in the hospital. These infections can be related to devices, such as central lines and urinary catheters, or spread from patient to patient after contact with an infected person or surface. Many Healthcare-Associated Infections can be prevented when the hospitals use CDC-recommended infection control steps.

For more information about the HAIs visit the CMS Hospital Compare website.


Healthcare-Associated Infections (HAIs) – Definitions

Central Line-Associated Bloodstream Infections (CLABSI)

A central line is a narrow tube inserted by a doctor into a large vein of a patient's neck or chest to give important medical treatment. When not put in correctly or kept clean, central lines can become an easy way for germs to enter the body and cause serious infections in the blood. These infections are called Central Line-Associated Bloodstream Infections (CLABSIs), and they can be deadly. CLABSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Catheter-Associated Urinary Tract Infections (CAUTI)

A catheter is a drainage tube that is inserted by a doctor into a patient’s urinary bladder through the urethra and is left in place to collect urine while a patient is immobile or incontinent. When not put in correctly or kept clean, or if left in place for long periods of time, catheters can become an easy way for germs to enter the body and cause serious infections in the urinary tract. These infections are called Catheter-Associated Urinary Tract Infections (CAUTIs), and they can cause additional illness or be deadly. CAUTIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Clostridium difficile Infections (C. diff.)

Clostridium difficile (C. diff.) is a type of bacteria that causes inflammation of the colon. C. diff. infection can cause severe diarrhea, fever, appetite loss, nausea, and abdominal pain. Symptoms from C. diff. infections often take a few days to develop. Patients are tested for C. diff. infections if they show signs of illness while in the hospital. This measure compares the number of stool specimens that tested positive for C. diff. toxin four or more days after the patient entered the hospital to a national benchmark.

Methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) is a type of bacteria that is resistant to certain antibiotics. MRSA infections in the bloodstream can be acquired in hospital settings, and may cause severe or life-threatening symptoms. Symptoms from MRSA infections often take a few days to develop. Patients are tested for MRSA bloodstream infections if they show signs of illness while in the hospital. This measure compares the number of MRSA-positive blood specimens collected four or more days after the patient entered the hospital to a national benchmark.

Surgical Site Infections from colon surgery (SSI: Colon)

A surgical operative procedure is one that is performed on a patient in an operating room where a surgeon makes at least one incision through the skin or mucous membrane to give important medical treatment. When not conducted in a sterile environment and following sterile procedures, a surgical site can become an easy way for germs to enter the body and cause serious infections in a patient, which can affect the skin, tissues under the skin, organs, or implanted material. These infections are called Surgical Site Infections (SSIs), and they can be deadly. SSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).

Surgical Site Infections from abdominal hysterectomy (SSI: Hysterectomy)

A surgical operative procedure is one that is performed on a patient in an operating room where a surgeon makes at least one incision through the skin or mucous membrane to give important medical treatment. When not conducted in a sterile environment and following sterile procedures, a surgical site can become an easy way for germs to enter the body and cause serious infections in a patient, which can affect the skin, tissues under the skin, organs, or implanted material. These infections are called Surgical Site Infections (SSIs), and they can be deadly. SSIs are mostly preventable when healthcare providers use infection control steps recommended by the Centers for Disease Control and Prevention (CDC).


Risk Adjustment

In simpler terms, risk adjustment is a method to take a complex set of data and put it into terms where you can compare apples to apples.

Are the comparisons between facilities appropriate? What is risk adjustment?

Because of their expertise, some hospitals treat more high-risk patients, and some patients arrive at hospitals sicker than others and often sicker patients are transferred to specialty hospitals. That makes comparing hospitals for patients with the same condition but different health status difficult. To compensate for this fact, the data is risk adjusted to reflect the score the facility would have had if it had provided services to the average mix of sick, complicated patients utilizing 3M All Patient Refined-Diagnosis Related Groups (APR-DRGs). Ambulatory surgery is adjusted utilizing 3M Enhanced Ambulatory Patient Groups (EAPGs).

Risk adjusting the Average Length of Stay (ALOS) data:

A risk adjustment methodology was used that was developed by 3M Corporation.  For hospitals, this is called All Patient Refined Diagnostic Related Groups (APR-DRGs, www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml). This is a widely accepted industry standard tool for risk adjusting. This adjustment is done for each hospital and each medical condition or procedure category according to the severity of illness of the patients. This means that a hospital with more severely ill patients (as determined by the APR-DRG method) has had its actual length of stay, and a hospital with less severely ill patients has had its rates increased. This adjustment should allow comparisons between hospitals that reflect the differences in care delivered, rather than the differences in the patients.  For outpatient procedures, the data is risk adjusted by Enhanced Ambulatory Patient Groups (EAPGs).  See below for further information.

All Patient Refined - Diagnosis Related Groups (APR-DRGs)

APR-DRGs feature four severity of illness levels and four risk of mortality levels.  A different model, or set of logic, is used to assign each APR-DRG and subclass.  Subclasses are assigned according to sophisticated clinical logic that simultaneously evaluates multiple comorbidities (A concurrently existing but unrelated pathological or disease process), age, procedures, and principal diagnosis.  Patients with clinically similar characteristics and similar resource consumption are assigned to one descriptive subclass for both severity of illness and risk of mortality: minor, moderate, major, or extreme.  For more information please visit the 3M Health Information Systems website at: www.3m.com/us/healthcare/his/products/coding/refined_drg.jhtml

Enhanced Ambulatory Patient Groups (EAPGs)

Enhanced Ambulatory Patient Groups (EAPGs), also developed by 3M Health Information Systems (www.3m.com/us/healthcare/his/index.jhtml), are a patient classification system designed to explain the amount and type of resources used in an ambulatory visit. Patients in each EAPG have similar clinical characteristic and similar resource use and cost. Similar resource use means that the resources used are relatively constant across the patients within each EAPG. However, some variation in resource use will remain among the patients in each EAPG. In other words, the definition of the EAPG will not be so specific that every patient is identical, but the level of variation in resource use is known and predictable. Thus, while the precise resource use of a particular patient cannot be predicted by knowing the EAPG of the patient, the average pattern of resource use of a group of patients in an EAPG can be accurately predicted.

Enhanced Ambulatory Patient Groups (EAPGs) – Explanation of Designation as Levels I - IV

EAPGs simplify ambulatory visits for analysis and reporting. This is achieved by identifying key diagnoses and procedures, both diagnostic and therapeutic, performed during an ambulatory visit. Once identified, these diagnoses and procedures are used to classify outpatient visits into categories, called EAPGs, that are both clinically and financial meaningful.

Once the EAPGs are assigned, a second step is taken that assigns a level of complexity to each respective EAPG. Levels I through IV may be assigned to each EAPG. The complexity of an EAPG is defined by the following criteria: clinical similarity within an EAPG, the type (e.g. incision vs excision) of procedures in a particular EAPG, the amount of resources needed for the procedures in an EAPG, and the likelihood that other ancillaries (e.g. diagnostic vs therapeutic procedures involving different types of surgical and other types of surgical pathology) will be performed for the procedure in that EAPG.

Levels of complexity are characterized as follows:

Level I – Short treatment time in the operating room. Few laboratory tests or radiology procedures ordered. Few expensive disposable devices used, if any.

Level II - Laboratory tests and radiology procedures typically ordered as part of procedure. Disposable devices may consume significant resources. Increased length of time in the operating room.

Level III - Laboratory tests and radiology procedures ordered as part of a procedure. Disposable devices consume significant resources. Longer stay in the operating room than levels I and II.

Level IV – Procedure of major complexity. Treatment and resources used are extensive. Thus, Level IV EAPGs are frequently performed in an inpatient setting, not in an outpatient setting.
 

Explanation of Results Pages

Hospital Performance Measures

Ranges for Charges

The range of charges is the set of charges specified by a maximum and minimum value that a hospital has billed for a particular condition or procedure.  Any charge that is between these two values is said to be within the range.  The hospital charge does not include physician fees nor does it reflect the actual cost or the amount paid for the care.  The amount that a patient pays depends on the type of insurance coverage, co-payments and/or deductibles, if a patient is uninsured, or whether that patient qualifies for discounts under the hospital’s discount or charity policies. 

The minimum value is represented by the 25th percentile and the maximum value is represented by the 75th percentile.  50 percent of the charges billed are between the 25th and 75th percentile.

Why are "charges" important?

In selecting a hospital, look at the ranges for charges for the hospital you are considering as compared to others.   Keep in mind that only large differences are significant, so do not be concerned with slight differences.  Use this measure to learn the typical charges for a condition or procedure.  Hospital charges can affect your costs so lower charges can possibly save you money.  NOTE:  If you need more specific pricing information, Florida law, upon written request, requires each licensed facility (not operated by the state) to provide a written good faith estimate of reasonably anticipated charges for the facility to treat the patient’s condition.  The estimate shall be provided within 7 business days after the receipt of the request.

Average Length of Stay

The average length of stay is the typical number of days a patient stayed in the hospital for a particular condition or procedure.  For a fair comparison between hospitals, the information has been risk adjusted (See Risk Adjustment) to take into account that some hospitals take care of patients who are sicker and require more treatment or resources than the "average" patient. 

Why is "length of stay" important?

Average length of stay provides an idea of how long you might expect to stay in the hospital as determined by your attending physician.  The average length of stay might show the efficiency of care provided by a hospital.  Typically, a shorter average length of stay decreases the chance of getting an in-hospital infection or experiencing a complication, and can be an indicator of improved outcomes.  However, if a length of stay is too short, it could result in a readmission.  To learn the typical length of stay for a particular condition or procedure look at the average length of stay for the state as whole and compare it to the hospital you are considering.  Keep in mind that only large differences are significant, so do not be concerned with slight differences. 

Readmission Rate

The Readmission Rate is based on the percentage of patients who were readmitted to the same hospital or another short term acute care hospital for the same or related condition within 15 days of the initial discharge. 

This rate is assigned to the hospital that first admitted the patient regardless of where the patient is readmitted. 

Since sicker patients are more likely to be readmitted, the readmission rate is adjusted for the severity of patients’ illness.1  A rate that is “lower than expected” indicates the hospital had fewer readmissions compared to other hospitals with similar patients.  A rate that is “higher than expected” indicates the hospital had more readmissions compared to other hospitals with similar patients.

Why is this important? 

Readmissions are costly and may indicate an opportunity to improve quality of care.  Readmissions may reflect health care challenges such as:

  • poor coordination between the inpatient and outpatient healthcare team,
  • the patient not being able to get the prescription drugs or treatment needed following hospitalization,
  • the patient may have had an underlying health condition that was not treated,
  • the patient may have developed a complication after discharge,
  • the medical care following discharge may not have been adequate,
  • the patient may not have had an adequate support system after discharge
  • the patient may not have followed the doctor’s instructions following discharge.

Patients can reduce their chances of being readmitted by being engaged and informed about health care decisions.  For example:

When you are being discharged from the hospital…

  • ask your doctor to explain the treatment plan you will use at home and get a written copy.
  • Inform your doctor of all the medications including prescriptions and over the counter medicines that you take at home.
  • Schedule your follow-up doctor’s appointments before you leave the hospital and make sure you have a transportation plan.
  • Get your doctor’s name and phone number for regular working hours and who to contact in case of an emergency after hours.
  • Ask for information about your medicines in terms you can understand—both when your medicines are prescribed and when you receive them.
  • Ask about potential side effects of each medication and what to do if a side effect occurs.
  • Make sure that any new medications the hospital doctor prescribes is covered by your insurance plan. If you do not have insurance, work with hospital staff to find out about low cost or no cost ways of paying for your medications and doctor visits.
  • Learn about your condition and ask what symptoms might signal a change in health and for which you should contact your doctor.
  • Request printed information to help you manage your health and any symptoms
  • Make sure your doctor or nurse has answered your most important questions.

1  Severity adjusted readmission benchmarks calculated using 3M APR DRGs. Readmission rates computed using 3M Potentially Preventable Readmissions (PPR) software.

Source: Institute for Healthcare Improvement, University of Colorado Health Sciences Center

Total Hospitalizations

Total hospitalizations is the total number of patients treated at that hospital for a particular condition or procedure, or if one is not selected, then the total number of hospitalizations at the facility. 

Why is a hospital's "total hospitalizations" important?

While volume of hospitalizations is not a direct measure of quality of care, it is useful in seeing how much experience a hospital has for a given procedure or condition.  Generally, the higher the volume the better.  If you have a condition that is not very common or involves complex procedures, you should consider the volume of similar cases your hospital handles, or find a facility with more experience with treating your condition.

Ambulatory (Outpatient) Surgery Center Performance Measures

Outpatient Range of Charges

The range of charges is the set of charges specified by a maximum and minimum value that a hospital has billed for particular condition or procedure.  Any charge that is between these two values is said to be within the range.  The charge does not include physician fees nor does it reflect the actual cost or the amount paid for the care.  The amount that a patient pays depends on the type of insurance coverage, co-payments and/or deductibles. 

The minimum value is represented by the 25th percentile and the maximum value is represented by the 75th percentile.  50 percent of the charges billed are between the 25th and 75th percentile.

Why are "charges" important?

In selecting a facility, look at the ranges for charges for the facility you are considering as compared to others.   Keep in mind that only large differences are significant, so do not be concerned with slight differences.  Use this measure to learn the typical charges for a condition or procedure.  Facility charges can affect your costs so lower charges can possibly save you money.  NOTE:  If you need more specific pricing information, Florida law, upon written request, requires each licensed facility (not operated by the state) to provide a written good faith estimate of reasonably anticipated charges for the facility to treat the patient’s condition.  The estimate shall be provided within 7 business days after the receipt of the request.

Total Visits

Total visits are the count of ambulatory (outpatient) procedures a facility performs within each procedure category, or if you do not choose a category then the total number at the facility.  This data includes all ages.

Why is an ambulatory surgery center's "total visits" important?

Total visits or volume is an indication of the experience a facility has with a condition or procedure. Generally, the higher the volume the better.  In addition, many ambulatory surgery centers specialize in a certain area which may explain their higher volume.

Physicians

Physician Volume

Why is physician volume important?

There is no consensus about the minimum procedure volume for the procedures listed. It is best to consider the surgical volume listed on this website as just one component of the information you should gather to make the best decision for your care. You should also consult with your primary care physician and your health insurance provider whenever choosing a surgeon or hospital. See Data Disclaimer.

IMPORTANT: The physician volume methodology varies from the Compare Hospitals facility level information thus the totals are not comparable.



We Appreciate Your Feedback!
1. Did you find this information useful?
         Yes
         No
2. Would you recommend this website to family and friends?
         Yes
         No