Inpatient (sample)

IP claims data are for the federal fiscal year ending 09/30/2006.
The Case Mix Index (CMI) for LTAC hospitals reflects DRG changes implemented in FY04.
These reports are consistent with CMS Data Release policies.

 

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Patient Origin

Medicare Hospital Market Service Area file for calendar year ending 12/31/2006 / Definitions

ZIP Code of Residence Discharges Days of Care Charges Discharges Inc/(Dec) Market Share
40211 809 6,081 $22,301,087 -10% 48%
40203 630 4,451 $15,588,395 2% 36%
40210 521 3,748 $14,403,486 3% 44%
40212 462 3,361 $14,665,653 -7% 36%
40216 444 3,318 $14,815,842 -5% 13%
40214 440 3,251 $13,718,955 -1% 16%
40219 337 2,284 $9,240,708 -5% 16%
40215 279 2,096 $8,629,247 20% 17%
40272 273 1,964 $8,296,582 5% 10%
40218 247 1,779 $6,777,560 -13% 14%
All other ZIP Codes 8,591 60,412 $329,208,760    
Total 13,033 92,745 $457,646,275 -7%  

Trend Report

Definitions

Inpatient Utilization Statistics FY 2006 FY 2005 FY 2004 FY 2003 FY 2002
Case Mix Index 1.6286 1.6011 1.5880 1.5903 1.5553
Medical DRGs 63.24% 64.02% 65.13% 67.24% 66.99%
Surgical DRGs 36.44% 35.72% 34.52% 32.41% 32.54%
Routine Discharges to home 0 6,689 6,468 6,337 6,766
Discharges to other acute care hospitals 0 119 107 99 114
Discharges to Skilled Nursing Facilities (SNF) 0 3,164 2,746 2,235 2,223
Deaths 528 554 504 480 494
Other Discharges 12,008 2,840 3,003 2,583 2,110
Total Discharges 12,536 13,366 12,828 11,734 11,707
Psychiatric Discharges (DPU, included in Total) 375 421 421 453 580
Rehabilitation Discharges (DPU, included in Total) 326 457 563 502 478

Statistics for the Top 20 DRGs

Costs calculated per hospital's cost report for the period ending 08/31/2006. / Definitions

Twenty most frequent Diagnosis Related Groups Number Medicare Inpatients Average Length of Stay Average Charges Average Reimbursed Average Cost
462 - REHABILITATION 1,355 13.00 $25,366 $12,258 $13,698
127 - HEART FAILURE & SHOCK 585 5.33 $15,502 $4,408 $5,863
527 - PERCUTNEOUS CARDIOVASULAR PROC W DRUG ELUTING STENT W/O AMI 572 2.05 $30,161 $11,167 $8,727
209 - MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF LOWER EXTREMITY 414 3.83 $38,206 $8,234 $12,547
124 - CIRCULATORY DISORDERS EXCEPT AMI, W CARD CATH & COMPLEX DIAG 318 5.00 $23,587 $6,209 $7,108
109 - CORONARY BYPASS W/O PTCA OR CARDIAC CATH 315 8.57 $82,801 $19,060 $27,780
088 - CHRONIC OBSTRUCTIVE PULMONARY DISEASE 311 5.21 $15,016 $3,740 $5,543
089 - SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC 308 5.74 $16,649 $4,241 $6,140
416 - SEPTICEMIA AGE >17 243 8.10 $25,851 $7,103 $9,641
316 - RENAL FAILURE 243 6.79 $20,365 $5,717 $7,664
079 - RESPIRATORY INFECTIONS & INFLAMMATIONS AGE >17 W CC 237 8.90 $26,622 $7,286 $10,095
517 - PERC CARDIO PROC W NON-DRUG ELUTING STENT W/O AMI 232 2.82 $31,326 $9,662 $8,982
174 - G.I. HEMORRHAGE W CC 226 4.79 $16,191 $4,287 $6,099
014 - INTRACRANIAL HEMORRHAGE & STROKE W INFARCT 206 6.78 $25,669 $5,491 $8,774
144 - OTHER CIRCULATORY SYSTEM DIAGNOSES W CC 192 6.59 $21,855 $5,370 $7,952
182 - ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS AGE >17 W CC 183 4.37 $14,797 $3,371 $4,909
121 - CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE 182 7.02 $27,165 $7,235 $9,600
107 - CORONARY BYPASS W CARDIAC CATH 178 11.20 $101,610 $25,379 $33,136
105 - CARDIAC VALVE & OTH MAJOR CARDIOTHORACIC PROC W/O CARD CATH 175 12.13 $121,380 $29,212 $41,585
475 - RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT 174 13.80 $62,446 $17,530 $23,090
- All Other DRGs 7,024 6.79 $36,954 $10,017 $13,133
- T O T A L S 13,673 7.14 $34,759 $9,846 $12,600

Search for Other DRGs and Prior Year Statistics

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(Only DRGs representing more than 10 patients are reported.)
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Statistics by Medical Service

Costs calculated per hospital's cost report for the period ending 08/31/2006. / Definitions

  Number Medicare Inpatients Average Length of Stay Average Charges Average Cost Medicare CMI CMI Adjusted Avg. Cost
Cardiology 1,820 4.67 $12,614 $5,658 0.9904 $5,713
Cardiovascular Surgery 985 5.05 $43,391 $20,074 3.4940 $5,745
Gynecology 76 2.79 $9,292 $4,106 0.9007 $4,558
Medicine 2,467 6.60 $14,372 $6,942 1.1131 $6,236
Neurology 775 5.34 $13,774 $6,013 1.0914 $5,510
Neurosurgery 92 8.16 $37,793 $16,814 3.0816 $5,456
Oncology 221 7.56 $21,279 $9,193 1.6695 $5,506
Orthopedic Surgery 1,807 4.35 $22,646 $11,576 2.0127 $5,751
Orthopedics 307 4.12 $10,292 $4,431 0.8450 $5,244
Psychiatry 302 8.31 $9,405 $5,972 0.6270 $9,524
Pulmonology 1,497 6.06 $13,786 $6,642 1.3142 $5,054
Surgery 919 10.05 $31,831 $15,018 3.2423 $4,632
Surgery for Malignancy 194 4.24 $16,395 $7,343 1.5960 $4,601
Urology 691 5.02 $13,403 $6,063 1.1667 $5,197
Vascular Surgery 372 3.86 $21,695 $9,732 1.8945 $5,137
TOTAL 12,536 5.76 $18,994 $9,001 1.6286 $5,527

Projected Impact of FY2009 IPPS Regulations

Projected Impact of FY2009 Proposed IPPS Regulations Projections are based on FY2007 Medicare fee-for-service hospital claims data as billed on or before 12/31/2007. Calculations are per FY2009 proposed regulations and include all components of reimbursement. LTACH relative weights are used for long term hospitals. / Distinct part units are excluded.

Definitions

  FY 2008 CMI FY 2009 CMI Percentage
Change
Cardiology 1.0264 1.0311 0.5%
Cardiovascular Surgery 3.3715 3.3327 -1.2%
Gynecology 0.9361 0.9497 1.5%
Medicine 1.1887 1.2011 1.0%
Neurology 1.1339 1.1393 0.5%
Neurosurgery 3.0109 3.1731 5.4%
Oncology 1.4680 1.4734 0.4%
Orthopedic Surgery 2.0945 2.1714 3.7%
Orthopedics 0.9047 0.9391 3.8%
Psychiatry 0.7056 0.7712 9.3%
Pulmonology 1.3324 1.3431 0.8%
Surgery 3.4042 3.4070 0.1%
Surgery for Malignancy 1.6988 1.6970 -0.1%
Urology 1.1982 1.2031 0.4%
Vascular Surgery 1.8238 1.8216 -0.1%
TOTAL 1.6873 1.7048 1.0%
Projected IPPS Reimbursement $91,989,560 $69,245,928 -24.7%