Tools for More Accurate Inpatient Cost Estimates with HCUP ...

acute and long-term care units, operating room, radiology department, laboratories, varioustherapies, pharmacy, clinic, and all ancillary units.We then applied the cost-center specific and hospital-wide CCRs to qualified SID discharges foreach MS-DRG or CCS category. The relative cost of each MS-DRG (or CCS category) wascalculated as mean cost per case, in that MS-DRG (or CCS category) was divided by mean costacross all MS-DRGs (or CCS categories). The AF was the ratio of relative cost based on costcenterspecific CCRs to the relative cost based on the hospital-wide CCR. We only used aspecific MS-DRG or CCS category if it had a minimum of 10 hospitals with at least 30 caseseach. The remaining diagnostic categories were combined in the final results.ResultsWe defined 746 MS-DRG categories and 262 CCS categories. We calculated relative cost andAFs for 449 distinct MS-DRG categories and 227 distinct CCS categories. For the remaining297 MS-DRG and 35 CCS categories, we could only calculate a group AF.The resulting AFs ranged between 0.815 and 1.383 for MS-DRGs (0.864 and 1.396 for CCScategories). However, 87.5% of distinct AFs for MS-DRGs were between 0.90 and 1.10; 82.8%of distinct AFs were within this range for CCS categories. Both of the grouped AFs for the MS-DRG and CCS categories were in the range of 0.90 and 1.10. If we included the groupedcategories, 92.5% of AFs for MS-DRGs and 85.1% of AFs for CCS categories were between0.90 and 1.10, respectively.Cases with high AFs (above 1.0) tended to involve long stays for mental conditions andcomplications from deliveries. Cases with low AFs (below 1.0) included patients requiringextensive diagnostic services such as imaging, laboratory testing, drugs, and select surgeries.ConclusionIn general, department-specific CCRs are more accurate for deriving the cost of a hospital staythan hospital-wide CCRs. However, not all statewide data agencies ask hospitals to reportdetailed charges for every case, and not all hospitals have usable CMS accounting reports. It is2