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 (IPPS claims) for discharges during the
twelve months ending September 30. The report is
based on the most recent periods available and is consistent with
CMS
Data Release policies.
Please note that a new
MS-DRG
patient classification system was introduced
in FY 2008.
The new
MS-DRGs
replace prior
DRG
definitions and
MS-DRGs
are not compatible
with the prior DRGs.
The twenty base
MS-DRGs
with the highest numbers of discharges are ranked by volume and
the remaining
MS-DRGs
are summarized:
- 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.
- Base
MS-DRG
Description
- 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.
- IPPS Cases
- total number of IPPS claims for the Base
MS-DRG.
IPPS claims are Medicare fee-for-service inpatient claims paid
under the Inpatient Prospective Payment System.
- ALOS
- The Average Length of Stay is calculated as total patient days for the Base
MS-DRG
divided by its number of
discharges.
- Average
Charges - The Average Charge is calculated as total gross charges
for the Base MS-DRG
divided by its number of
discharges. 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 for the
Base MS-DRG.
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 for a Base
MS-DRG
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.
Click here for cost allocation methodology. The
average reported for a Base
MS-DRG
is total allocated cost divided by its number of discharges.
- Case Mix Index
(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.
- CC/MCC Rate -
measures the incidence of CCs or
MCCs within Base
MS-DRGs
that are effected by the presence of either or both types of
complications (i.e. complications or major complications). The
numerator is the number of cases in
MS-DRGs
effected defined by the presence of a
CC or
MCC. The denominator
is the total number of cases in the Base
MS-DRG.
(Some
MS-DRGs
may not be effected by the presence of
CCs or
MCCs
and consequently will not have rates calculated.)
- MCC Rate -
measures the incidence of MCCs within Base
MS-DRGs
that are effected by the presence of a major complication. The
numerator is the number of cases in an
MS-DRGs
defined by the presence of an
MCC. The denominator is the total
number of cases in its Base
MS-DRG.
(Some
MS-DRGs
may not be effected by the presence an
MCC
and consequently will not have a rate calculated.)
A brief
description of the Medicare Prospective Payment System is provided to explain
the system,
MS-DRGs,
the case mix index, etc.