title: Estimating True Resource Costs of Outpatient Care for Medicare Beneficiaries: Standardized Costs versus Medicare Payments and Charges.
abstract: OBJECTIVE
  To compare standardized estimates of the true resource costs of outpatient health care to the allowable and billed charges for that care among Medicare Fee for Service (FFS) beneficiaries.
  
  
  METHODS
  Medicare Carrier and Outpatient Standard Analytic (SAF) files linked to participant data in the Study of Osteoporotic Fractures from 2004 through 2010. Participants were 3,435 female Medicare Fee for Service enrollees age 80 and older recruited in one rural and three metropolitan areas of the United States.
  
  
  METHODS
  We estimated standardized costs for Carrier and OP-SAF claims using Medicare payment weights, and compared them to allowable and billed charges for those claims. We used semilog linear regression to estimate the associations of age, race, bone mineral density, prior fracture, and geriatric depression scale score with allowable charges, billed charges, and standardized costs.
  
  
  RESULTS
  Estimated associations of patient characteristics with standardized costs were not statistically different than the associations with allowable charges (chi-squared [χ(2)]: 8.6, p = .13) but were different from associations with billed charges (χ(2): 25.5, p < .001).
  
  
  CONCLUSIONS
  Allowable charges for outpatient utilization in the Carrier file and OP-SAF may be good surrogates for standardized costs that reflect patient medical and surgical acuity.
authors.affiliation: Health Research Center, Park Nicollet Institute for Research and Education, Minneapolis, MN.
authors.forename: John T
authors.identifier: http://orcid.org/0000-0002-9329-0750
authors.initials: JT
authors.lastname: Schousboe
authors.affiliation: NORC, University of Chicago, Bethesda, MD.
authors.forename: Misti L
authors.initials: ML
authors.lastname: Paudel
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VAMC, Minneapolis, MN.
authors.forename: Brent C
authors.initials: BC
authors.lastname: Taylor
authors.affiliation: Chronic Disease Research Group, Minneapolis Medical Research Foundation, Minneapolis, MN.
authors.forename: Allyson M
authors.initials: AM
authors.lastname: Kats
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
authors.forename: Beth A
authors.initials: BA
authors.lastname: Virnig
authors.affiliation: Center for Chronic Disease Outcomes Research, Minneapolis VAMC, Minneapolis, MN.
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.affiliation: Division of Health Policy and Management, University of Minnesota, Minneapolis, MN.
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Dowd
mesh_terms: D000367:Age Factors; D000368:Aged; D000553:Ambulatory Care / Q000191:economics*; D015519:Bone Density; D003863:Depression / Q000191:economics / Q000453:epidemiology; D018588:Fee-for-Service Plans / Q000191:economics; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000191:economics*; D006278:Medicare / Q000191:economics*; D058866:Osteoporotic Fractures / Q000191:economics / Q000453:epidemiology; D044469:Racial Groups; D014481:United States
keywords: Carrier file; Medicare payment; Outpatient costs; health care costs; outpatient SAF file