This section summarizes adjustments in Medicare rulemaking that effect
hospital Medicare revenue. Unless otherwise indicated, all information in this
section is based on hospital data contained in the CMS Impact File. This file
corresponds to the Final Rule and Correction Notice and contains data elements
by provider used in calculating rates and impacts for a federal fiscal
- Wage Index
- The wage index indicates the relative hospital wage level in a geographic
area (i.e. a Core-Based Statistical Area) compared to the national average
hospital wage level. A hospital may sometimes be reclassified to a different
labor market. The wage index is updated annually and is used in determining
payment (i.e. the labor portion of the standardized amounts).
- DSH Adjustment
- The estimated Operating Disproportionate Share Hospital (DSH) adjustment.
It reflects a 75% reduction to the DSH adjustment required under Section 3333
of the Affordable Care Act
- Capital DSH Adjustment
- The Capital Disproportionate Share (DSH) adjustment.
- Uncompensated Care per Claim
- The Uncompensated Care per Claim Amount is based on a hospital's assigned
Uncompensated Care Payment amount divided by a 3 year claims average. The per
Claim Amount is used in the determination of outliers and used in to determine
if a sole community hospital (SCH) is paid on a hospital specific rate or
federal rate on a per claim basis.
- Operating IME Adjustment
- The Indirect Medical Education (IME) adjustment factor for Operating IPPS.
- Capital IME Adjustment
- The Indirect Medical Education (IME) adjustment factor for Capital IPPS.
- HAC Adjustment
- Payment adjustments related to the Hospital-Acquired Conditions (HAC)
Reduction Program are obtained from Hospital Compare, a website created through
the efforts of CMS along with the Hospital Quality Alliance (HQA). CMS reduces
Medicare payments for IPPS hospitals based on the frequency of HACs, a group of
reasonably preventable conditions that patients did not have upon admission to
a hospital, but which developed during the hospital stay.
- Quality Reduction
- "Yes" indicates a hospital that was found not to have submitted quality
data in the form and manner based in the prior year update of the Provider
Specific File (PSF), and therefore was modeled as receiving a reduction to the
percentage increase in the current market basket index.
- EHR Reduction
- "Yes" indicates a hospital that was found not to be a meaningful electronic
health record (EHR) user for the applicable EHR reporting period and did not
receive an exception based on a subsequent update of the Provider Specific File
(PSF), and therefore was modeled as receiving a reduction to the percentage
increase in the market basket index.