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Profile Definitions and Methodology

Estimated Patient Volumes

HCRIS format

Patient volumes are estimated using data from a hospital's most recent Medicare Cost Report, Medicare inpatient claims data (MedPAR), and Medicare outpatient claims data (OPPS).  Estimates are rounded to the nearest hundred.

Inpatient Surgeries = MedicareSurgeries / (MedicareDischarges / TotalDischarges)
  where:

MedicareSurgeries =
number of Medicare inpatient claims for surgical DRGs (MedPAR)

MedicareDischarges =
total number of Medicare discharges per the hospital's most recent cost report (W/S S-3, part 1, line 14, column 13)

TotalDischarges =
total number of discharges (all payors) per the hospital's most recent cost report (W/S S-3, part 1, line 14, column 15)
 

Outpatient Surgeries = MedicareSurgeries / (MedicareDays / TotalDays)
  where:

MedicareSurgeries =
number of Medicare outpatient claims with revenue code 360 or 361 (OPPS)

MedicareDays =
total Medicare patient days per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 6)

TotalDays =
total patient days (all payors) per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 8)
 

Births = NurseryDays / AvgLOS
  where:

NurseryDays =
number of patient days for nursery per the hospital's most recent cost report (W/S S-3, part 1, line 13, column 3)

AvgLOS =
 national average length of stay for normal newborns (MS-DRG 795) and prematurity without major problems (MS-DRG 792) = 2.36*

*per AHRQ/HCUP statistics for year 2013 (most current available as of 8/11/2016).
 

Outpatient Visits = MedicareClaims / (MedicareDays / TotalDays)
  where:

MedicareClaims =
total number of Medicare outpatient claims (OPPS)

MedicareDays =
total Medicare patient days per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 6)

TotalDays =
total patient days (all payors) per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 8)
 

Emergency Room Visits (not admitted) = MedicareERClaims / (MedicareDays / TotalDays)
  where:

MedicareERClaims =
total number of Medicare outpatient claims with revenue code 45x (OPPS)

MedicareDays =
total Medicare patient days per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 6)

TotalDays =
total patient days (all payors) per the hospital's most recent cost report (W/S S-3, part 1, line 7, column 8)
 

Emergency Room Visits (admitted) = MedicareIPClaimsWithER / (MedicareDischarges / TotalDischarges)
  where:

MedicareIPClaimsWithER =
Number of Medicare inpatient claims with charges for emergency services (MedPAR)

MedicareDischarges =
total number of Medicare discharges per the hospital's most recent cost report (W/S S-3, part 1, line 14, column 13)

TotalDischarges =
total number of discharges (all payors) per the hospital's most recent cost report (W/S S-3, part 1, line 14, column 15)