Post on 09-Sep-2020
Identification of Specific Variables: Part 2
Faith Asper, MHS
Director, ResDAC Assistance Desk
Objectives
Review common types of research
Review the worksheets that contain these
variables
Review helpful resources
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Research Areas Using Cost Reports
Facility Characteristics
Financial Health of Facilities
Calculating Costs
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Facility Characteristics
Selected facility characteristics variables are used
in prospective payment.
Article compared cost report data to AHA data and
concluded that cost report data was optimal for
facility characteristics.
“Identifying and Measuring Hospital
Characteristics Using the SEER-Medicare Data and
Other Claims-Based Sources” Schrag D, et al. Medical Care
Suppl Vol 40, No 8, Suppl pp IV-96-IV-103, Aug 2002.
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Facility Characteristics
Number of beds
Number of days
Number of discharges
Ownership status
Teaching Hospital
Uncompensated or Charity care
Payer Mix
Geographic location
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Facility Variable Locations
Variable Location
Total hospital beds Worksheet S-3, Part I
Total inpatient days Worksheet S-3, Part I
Total discharges Worksheet S-3, Part I
Ownership status Worksheet S-2 & RPT file
Teaching status Worksheet S-2
Uncompensated care Worksheet S-10
Payer Mix Worksheet S-3, Part I
Location (zip code,
urban/rural)
Worksheet S-2
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Medicare Cost Reports
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Example of Hospital Form 2552-10, Worksheet S-3, Part I
Facility Characteristics: Other Resources
Provider of Services File
˗ Source is the OSCAR database (Survey and
Certification)
˗ Collected at different points in time depending on the
facility type
˗ May be better source for facilities that can be free-
standing and provider-based
» SNFs
» HHAs
» Hospices
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Facility Characteristics: Other Resources
CMS “Compare” Databases
˗ Hospital Compare
˗ Nursing Home Compare
˗ Home Health Compare
˗ Dialysis Compare
Current compare database can be downloaded
here
˗ https://www.medicare.gov/download/downloaddb.asp
Archived copies can be found at ˗ http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-
Instruments/HospitalQualityInits/HospitalCompare.html
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Facility Characteristics: Other Resources
American Hospital Associate Survey
˗ Includes all Hospitals
˗ Includes wide range of descriptive and financial
characteristics
˗ Some survey information comes from the cost reports
˗ Survey is not audited
˗ Costly
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Financial Health of Facilities
Total Margin
Revenues
Total Expenses
Average Daily Census
Bad Debt/Charity Care
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Financial Variable Locations
Variable Location
Total Margin Worksheet G-3
Revenues Worksheet G-2
Expenses Worksheet G-2
Average Daily Census Worksheet S-3
Bad Debt Worksheet S-10
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Medicare Cost Reports
Example of Hospital Form 2552-10, Worksheet G-3
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Financial Variables
Article that outlines formulas for calculating
financial indicators.
Flex Monitoring Team Briefing Paper #7: “Financial
Indicators for Critical Access Hospitals” May 2005.
(Table 3)
“Sources of Financial Data on Medicare Providers”
MedPAC June 2004.
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Calculating Cost
Calculating Costs
˗ Use Cost-to-Charge Ratios (CCR) to adjust facility
charges to cost
» Total
» Departmental
» Medicare
˗ Use it in economic evaluations, such as cost-
effectiveness analyses
More to come in next segment
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Cost and Charge Variable Locations
Variable Location
Total cost Worksheet C, Part 1
Total charges Worksheet C, Part 1
Total Medicare costs Worksheet D
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Medicare Cost Reports
Example of Hospital Form 2552-10, Worksheet C, Part 1
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Calculating Cost Other Resources
Survey information ˗ Medicare Current Beneficiary Survey
˗ Medical Expenditure Panel Survey (MEPS)
˗ Healthcare Cost and Utilization Project (HCUP) » Survey information may be able to better capture the cost to the
beneficiary
» Survey information may be subject to recall bias
Provider accounting data ˗ Difficult to obtain
˗ Time consuming if dealing with national study
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Cost reports are typically used to identify:
Facility characteristics
Financial health of a facility
Calculate cost
Summary
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