Profile Definitions and Methodology

All information in this report is taken from the Medicare Provider Analysis and Review (MedPAR) file which is updated annually by CMS based on the federal fiscal year.  The file includes billing data for 100% of all Medicare fee-for-service claims for discharges during the twelve months ending September 30.  The report is based on the most recent period available and is consistent with CMS Data Release policies.

Medical service categories are based on groupings of patient MS-DRGs.  Click on any medical service in the report to see the MS-DRGs that are combined to define the category:

• Number of Medicare Discharges - total number of claims for the MS-DRG.
• Average Length of Stay - total patient day divided by the number of discharges.
• Average Charges - total gross charges divided by the 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. Click here for cost allocation methodology.  The average reported for a MS-DRG is total allocated cost divided by the number of discharges.
• Medicare CMI - the Medicare case mix index (CMI) is based on the Medicare Hospital Inpatient Prospective Payment System for the corresponding federal fiscal year.  The CMI for long term acute care (LTAC) hospitals reflects DRG changes implemented by CMS in FY04.
• CMI Adjusted Avg. Cost. - the case mix adjusted average cost is the average cost divided by the case mix index.

A brief description of the Medicare Prospective Payment System is provided to explain the system, MS-DRGs, the case mix index, etc.