The State Grade
One letter for how a state treats the people who pay for its hospitals. Six cost drivers, graded one by one, weighted into a single letter.
The formula
Grade = the weighted average of the driver points, read against the letter cutoffs.
Each of the six cost drivers gets a letter grade for the state. Each letter is worth points: A is 4, down to F at 0.
Each driver has a fixed weight. The weighted average of the points is the state’s number, and the cutoffs turn it back into a letter.
| Letter | Points |
|---|---|
| A | 4 |
| B | 3 |
| C | 2 |
| D | 1 |
| F | 0 |
| Grade | Weighted average |
|---|---|
| A | 3.5 or higher |
| B | 2.5 to 3.49 |
| C | 1.5 to 2.49 |
| D | 0.5 to 1.49 |
| F | below 0.5 |
The six drivers and their weights
I.Physician-owned hospitals
5%II.Price transparency
12.5%III.Certificate of need
30%IV.Hospital subsidies
27.5%V.CMS favoritism
12.5%VI.Stark and Anti-Kickback
12.5%The weights add to 100.
Provisional grades
A driver that has not been graded drops out. The remaining weights are scaled back up to 100 and the average is taken over the graded drivers only.
Until all six drivers are graded, the grade box says “provisional” and shows how many drivers are in. A provisional grade can move either way when the missing drivers come in.
Worked on the published dossiers
Calculated live from the dossier dataNorth Carolina: Dprovisional, four of six drivers
| Driver | Grade | Points | Weight | Points × weight |
|---|---|---|---|---|
| I. Physician-owned hospitals | F | 0 | 5% | 0.0 |
| II. Prices without teeth | — | 12.5% | — | |
| III. Still a permit to compete | D | 1 | 30% | 30.0 |
| IV. $1.1 billion a year in tax breaks | F | 0 | 27.5% | 0.0 |
| V. Urban hospitals, rural rules | D | 1 | 12.5% | 12.5 |
| VI. No room to build rivals | — | 12.5% | — | |
| Weighted average: 42.5 ÷ 75 graded weight | 0.57 → D | |||
How each driver is graded
RubricsA rubric is the written test that turns a state’s facts into a letter for one driver. Each rubric is published here when it is finished, and the dossier data cites it.
- I. Physician-owned hospitals
Current driver grades are editorial grades, marked provisional on the dossier.
- II. Price transparency
Current driver grades are editorial grades, marked provisional on the dossier.
- III. Certificate of need
Current driver grades are editorial grades, marked provisional on the dossier.
- IV. Hospital subsidies
Current driver grades are editorial grades, marked provisional on the dossier.
- V. CMS favoritism
Current driver grades are editorial grades, marked provisional on the dossier.
- VI. Stark and Anti-Kickback
Current driver grades are editorial grades, marked provisional on the dossier.