Table 2.
Professional Fee Ratios by Major Diagnostic Category and Payer Type, 2016–2020
| MDC Code | MDC Description | PFR Inpatient admissionsa | PFR Emergency department treat and release visitsa | ||
|---|---|---|---|---|---|
| Commercial | Medicaid | Commercial | Medicaid | ||
| 1 | Diseases and disorders of the nervous system | 1.171 | 1.151 | 1.261 | 1.430 |
| 2 | Diseases and disorders of the eye | 1.176 | 1.189 | 1.351 | 1.454 |
| 3 | Diseases and disorders of the ear, nose, mouth and throat | 1.189 | 1.161 | 1.326 | 1.496 |
| 4 | Diseases and disorders of the respiratory system | 1.131 | 1.124 | 1.268 | 1.378 |
| 5 | Diseases and disorders of the circulatory system | 1.138 | 1.121 | 1.240 | 1.332 |
| 6 | Diseases and disorders of the digestive system | 1.172 | 1.142 | 1.246 | 1.413 |
| 7 | Diseases and disorders of the hepatobiliary system and pancreas | 1.182 | 1.150 | 1.204 | 1.333 |
| 8 | Diseases and disorders of the musculoskeletal system and connective tissue | 1.208 | 1.153 | 1.313 | 1.366 |
| 9 | Diseases and disorders of the skin, subcutaneous tissue and breast | 1.234 | 1.137 | 1.367 | 1.447 |
| 10 | Endocrine, nutritional and metabolic diseases and disorders | 1.195 | 1.142 | 1.233 | 1.299 |
| 11 | Diseases and disorders of the kidney and urinary tract | 1.154 | 1.123 | 1.254 | 1.389 |
| 12 | Diseases and disorders of the male reproductive system | 1.280 | 1.168 | 1.279 | 1.424 |
| 13 | Diseases and disorders of the female reproductive system | 1.233 | 1.162 | 1.262 | 1.443 |
| 14 | Pregnancy, childbirth and the puerperium | 1.485 | 1.391 | 1.219 | 1.484 |
| 15 | Newborns and other neonates with conditions originating in perinatal period | 1.200 | 1.172 | 1.270 | 1.484 |
| 16 | Diseases and disorders of blood, blood forming organs and immunologic disorders | 1.131 | 1.117 | 1.223 | 1.307 |
| 17 | Myeloproliferative diseases and disorders, poorly differentiated neoplasms | 1.095 | 1.090 | 1.102 | 1.241 |
| 18 | Infectious and parasitic diseases, systemic or unspecified sites | 1.123 | 1.117 | 1.287 | 1.470 |
| 19 | Mental diseases and disorders | 1.128 | 1.132 | 1.285 | 1.393 |
| 20 | Alcohol or drug use or induced organic mental disorders | 1.062 | 1.112 | 1.218 | 1.350 |
| 21 | Injuries, poisonings and toxic effects of drugs | 1.143 | 1.165 | 1.299 | 1.413 |
| 22 | Burns | 1.118 | 1.147 | 1.322 | 1.393 |
| 23 | Factors influencing health status and other contacts with health services | 1.134 | 1.128 | 1.258 | 1.373 |
| 24 | Multiple significant trauma | 1.143 | 1.170 | NA | NA |
| 25 | Human immunodeficiency virus infections | 1.134 | 1.101 | 1.113 | 1.245 |
Data source: 2016–2020 Merative™ MarketScan® databases.
a
Counts for admissions and visits analyzed to produce these estimates and 95% confidence intervals reported in SDC1. MDC indicates Major Diagnostic Category; NA Not assessed (observations n<100); PFR Professional Fee Ratio.