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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
possible to form a more accurate estimate of cost by DRG by applying an adjustment to thehospital-wide CCR; the adjustment itself is derived by diagnostic group from hospitals in thestates with complete data. The adjustment by DRG can be applied to every relevant case inany hospital with a hospital-wide CCR.For the vast majority of DRGs (much more than is needed to get legislation through the U.S.Congress), the AF is between 0.90 and 1.10. The relatively small number of exceptions may beimportant in individual studies. We provide our latest estimates of AFs in Appendices as anoption to researchers concerned about the accuracy of cost estimation.3
Page 1 and 2: HCUP Methods Series
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5: EXECUTIVE SUMMARYBackgroundThe Agen
Page 9 and 10: Cluster #ClusterAbbreviationCMSCost
Page 11 and 12: • A case was considered invalid i
Page 13 and 14: • Appendicitis and other appendic
Page 15 and 16: UB-04 Revenue CodeCluster041x: Resp
Page 17 and 18: CHGnDescription13UB-04RevenueCodesC
Page 20 and 21: CHGn Revenue Codes DescriptionClust
Page 22 and 23: CHGn Description UB-92 Revenue Code
Page 24 and 25: CHGn Description UB-92 Revenue Code
Page 26 and 27: DRGDischargesRelativeCostBased onCo
Page 50 and 51: Appendix C: Cost Adjustment Factors
Page 52 and 53: DXCCS1DischargesRelative CostBased
Page 54 and 55: DXCCS1DischargesRelative CostBased
Page 56 and 57:
DXCCS1DischargesRelative CostBased
Page 58:
Appendix D: ErrataThis report, The
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