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

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PROJECT DESCRIPTIONData SourceThe data sources for this study were: (1) all states in the HCUP State Inpatient Databases (SID)for 2009 where hospitals reported detailed charges, (2) standard accounting reports publiclyreleased by CMS cost data for fiscal year 2009, and (3) HCUP Crosswalk data for hospitals in2009. The SID files were merged with Crosswalk data by DSHOSPID to obtain IDNUMBER,which was then used to merge the SID with CMS accounting reports. We only used 2009accounting reports that were available as of March 31, 2011 and complete with the necessaryschedules. The data passed several screens for credible cost and charge numbers. We onlyused the hospital reports that met these criteria for the study. Nationally, about 85% of HCUPhospitals had usable accounting data.Cost-Center ClustersBecause of the substantial variation in how hospitals report detailed charges, we combined anumber of the standard cost centers into clusters that could be adapted to all hospitals in thestudy. In previous research, AHRQ found that variations were most common between fourtypes of frequently used cost-center clusters: routine bed units, specialty care units (e.g.,intensive care units), labor and delivery services, and other ancillary services. The 2006 study(Song and Friedman, HCUP Methods Series report, 2008, #4) determined that variations aremost dependent on the relative use of routine bed unit services. We began with a moreextensive classification of cost-center clusters (see Table 1). These were based on both relatedservices and similar national CCRs of the component standard cost centers.Table 1: Cost-Center ClustersCMSCluster # Cluster DescriptionClusterAbbreviationCostCenter # CMS Cost Center Description1 Routine Bed Units RBU 252 Special Care Units SCU 26 ICU27 CCU28 Burn29 Surgical ICU4
Cluster #ClusterAbbreviationCMSCostCenter #Cluster Description30 Other Special care unit3 Subprovider SUB 31 Subprovider4 Nursery and lab/del NUR 33 Nursery39 Labor and delivery5 sub-acute & LTC LTC 34, 35, 36 SNF and other LTC units6operating room &related OR 37 OR38 recovery room55 SuppliesCMS Cost Center Description7 Radiology & related RAD 41 diagnostic Radiology42 therapeutic Radiology43 Radioisotope53 electrocardiology54 electroencenphalography8 Laboratory LAB 449 Therapies THER 48 IV49 Respiratory50 PT51 OT52 Speech path57 Renal dialysis10 Pharmacy DRUG 5611Clinic & related highCCR CLIN 60 clinic63 Other outpatient65 Ambulance66 DME – rent67 DME – sold68 Other reimbursable12 all other ancillary OANC 40 Anesthesiology & Acupuncture45 PBP Clinical Lab Service Program Only46 Whole Blood & Packed Red Blood Cells47 Blood Storing, Processing, & Transfusing58 ASC (Non-Distinct Part)59 Other Ancillary (specify)61 Emergency62 Observation Beds64 Home Program Dialysis13 all ancillary ANC All 31 centersFor each included hospital, we constructed a CCR for cost-center cluster in addition to thehospital-wide CCR. Table 2 indicates that the mean CCRs vary substantially by cluster.5
Page 1 and 2: HCUP Methods Series
Page 3 and 4: TABLE OF CONTENTSEXECUTIVE SUMMARY
Page 5 and 6: EXECUTIVE SUMMARYBackgroundThe Agen
Page 7: possible to form a more accurate es
Page 11 and 12: • A case was considered invalid i
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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
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Page 26 and 27: DRGDischargesRelativeCostBased onCo
Page 50 and 51: Appendix C: Cost Adjustment Factors
Page 52 and 53: DXCCS1DischargesRelative CostBased
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Appendix D: ErrataThis report, The
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