Hospital costs for diagnostic groups

Information in this report is taken from the Medicare Provider Analysis and Review (MedPAR) file and from the Healthcare Cost Report Information System (HCRIS) dataset. The MedPAR file includes billing data for 100% of all Medicare fee-for-service claims (IPPS claims) for discharges during the twelve months ending September 30.  The HCRIS dataset contains the most recent version (i.e. as submitted, settled, reopened) of each hospital cost report filed with CMS (formerly HCFA) since federal FY 1996.

The MedPAR file is updated annually by CMS based on the federal fiscal year. Data used in this report are consistent with CMS cell size suppression policies. Only Base MS-DRGs with more than ten cases are reported. The federal fiscal year reported is indicated in the header of the report.

The HCRIS dataset is for the cost reporting period corresponding to the billing data being reported.

The Medicare Severity - Diagnosis Related Groups (MS-DRGs) provide up to three levels of severity for a particular condition. A "Base" MS-DRG combines all levels of severity into a single category. The MS-DRG numbers listed are the individual MS-DRGs that have been combined into a Base MS-DRG for reporting. Individual MS-DRGs within a Base MS-DRG are differentiated according to the presence of a complication (CC) or a major complication (MCC). The descriptors of these CC/MCCs are removed when describing the Base MS-DRG. Click on a Base MS-DRG to see the details for its component MS-DRGs.

Side-by-side statistics are reported in order to enable comparisons and benchmarking. The Hospital Statistics are for the hospital currently being reported. The Comparative Statistics are selected from a pull-down list at the top of the report (i.e. National Averages or Active List). National Averages are average statistics for all short term acute care hospitals nationwide. Active List are average statistics for all hospitals in the current Active List chosen. Each set of statistics includes:

Base MS-DRGs

The Medicare Severity - Diagnosis Related Groups (MS-DRGs) provide up to three levels of severity for a particular condition. A "Base" MS-DRG combines all levels of severity into a single category. The MS-DRG numbers listed are the individual MS-DRGs that have been combined into a Base MS-DRG for reporting. Individual MS-DRGs within a Base MS-DRG are differentiated according to the presence of a complication (CC) or a major complication (MCC). The descriptors of these CC/MCCs are removed when describing the Base MS-DRG.

Cases

"Cases" indicates the total number of IPPS claims (discharges) for the Base MS-DRG. IPPS claims are Medicare fee-for-service inpatient claims paid under the Inpatient Prospective Payment System.

CMI

The CMI is the average relative weight for all cases reported in a Base MS-DRG. MS-DRGs at lower severity levels have lower relative weights and MS-DRGs at higher severity levels have higher relative weights. The CMI provides an index of patient mix among levels of severity within a Base MS-DRG.

Average Charge

The Average Charge is calculated as total gross charges for the Base MS-DRG divided by its number of cases. Gross charges are amounts billed by the hospitals but are not necessarily the amounts paid by Medicare or other payers.

Average Cost

Costs are calculated for each patient on the basis of ratios of costs to charges for routine services and ancillary areas. The average reported for a Base MS-DRG is total allocated cost divided by its number of cases.