The Medicare program's emphasis on care coordination took a new turn this month when its hospital value-based purchasing program added a new measure — Medicare spending per beneficiary, or MSPB — to the formula that determines how much each hospital is paid.

The measure is noteworthy because, for the first time, it holds hospitals accountable for the costs of some outpatient and post-acute care, even if the providers are not affiliated with the hospital.

Baseline measures, reported as efficiency scores, already are posted on Medicare's Hospital Compare website. A score of 1 indicates the hospital performs at the average efficiency of all hospitals nationally; a score higher than 1 indicates the hospital is more costly than average and a score below 1 shows greater efficiency than the average.

Scores are calculated using hundreds of data points in MSPB reports available on The reports detail each hospital's spending for three phases of care — the three days before admission, the inpatient stay and the 30-day period after discharge — for each major diagnostic category, such as circulatory system or digestive system.

The reports compare a hospital's spending levels in each category with state and national averages. Further, they reveal the spending in each phase by type of claim — outpatient, inpatient, skilled nursing, durable medical equipment and others. Hospitals can see how their service lines stack up to their peers in efficiency, and highlight areas that might be dragging down the hospital's overall performance.

Nancy Foster, the American Hospital Association's vice president of quality and patient safety policy, says the reports may be most useful in helping hospitals to understand the costs of post-acute care for the patients they discharge.