Hospital costs for diagnostic groups

Categorical Costs for a Base MS-DRG

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.

MedPAR claims data includes categorical room and ancillary charges. The HCRIS dataset of hospital cost report data can be used to determine the cost to charge ratio for each of these categories. The available categories are restricted to the categories captured on Medicare claims and corresponding Medicare cost reports.

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. The report is divided into two categorical sections. The first section details Inpatient Routine Service Cost Centers and the second section details Ancillary Service Cost Centers as reported by CMS in the MedPAR file of claims data. Each set of statistics includes:

Total Charges
Total gross charges for the category are reported. Gross charges are amounts billed by the hospitals but are not necessarily the amounts paid by Medicare or other payers.
Total Cost
Costs for the category are allocated for each patient on the basis of ratios of costs to charges for routine services and ancillary areas. (More information regarding this methodology is provided in Definitions for the Inpatient report.)
Cost / Day
The Cost per Day for Routine Services is calculated as total gross charges for the category divided by the number of patient days in the category. (Cost per Day for Ancillary Service categories cannot be calculated.)
Cost / Case
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 the category is its total allocated cost divided by its number of cases.