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.

Medical Service categories are based on groupings of patient MS-DRGs.  Click on any Medical Service in the report to see the statistics for individual MS-DRGs that are combined to define the category.

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. Each set of statistics includes:

Medical Service

Medical Service categories are based on groupings of patient MS-DRGs. (Definitions of these categories are provided on the Inpatient report.)

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 Payment

The Average Payment is the amount paid to the hospital. This amount does not include any capital pass-thru amount or organ acquisition amount. It includes payments by Medicare (i.e. base MS-DRG payment, outlier payment, disproportionate share adjustment (DSH), indirect medical expense adjustments (IME), adjustments for certain transfers, etc.) It also includes amounts paid by or on behalf of the patient (e.g. deductibles or coinsurance) and amounts paid by third party insurers. The average reported is the total payment divided by its number of discharges.

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.