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hospitals.html
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<header><h1>HHS on Github</h1>
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<section>
<h3>
HHS Datasets about <span itemprop="url" href="http://en.wikipedia.org/wiki/Hospital">Hospitals</span>
</h3>
<p>
This is a list of HHS Datasets that contain information about hospitals.<em>(<a href="https://github.com/HHS/hhs.github.io/issues">Help improve this content</a> by suggesting more datasets.)</em>
</p>
<table class="table table-striped">
<thead>
<tr>
<th>
Topic
</th>
<th>
Why you might be interested
</th>
<th>
Link to more info
</th>
</tr>
</thead>
<tbody>
<tr>
<td>Hospital costs</td>
<td>Hospitals submit quarterly cost/expense reports to Medicare (CMS) according to Medicare's accounting rules. Cost categories include labor/wages, capital costs, uncompensated care/bad debt, medical education, bed occupancy</td>
<td><a href="http://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/CostReports/Hospital-2010-form.html">Hospital 2552-10 Cost Report Data</td>
</tr>
<tr>
<td>Hospital payment adjusters</td>
<td>Medicare establishes standard payments, then adjusts payments to hospitals depending on specific characteristics of each hospital. Examples of characteristics captured by this dataset include: cost of living (COLA),
<link itemprop="url" href="http://en.wikipedia.org/wiki/Disproportionate_share_hospital" >
disproportionate share (DSH), sole community hospitals (SCH), small rural Medicare-dependent hospitals (MDHs). Learn more in the manual that describes payment processing <a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/clm104c03.pdf">here </td>
<td><a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/psf_text.html">Provider specific file</td>
</tr>
<tr>
<td>Hospital characteristics</td>
<td>Name, address, phone number, beds, staffing, ownership type, accreditation/certification, residency programs, medical school affiliation, Medicare/Medicaid participating provider. Service availability, direct/contracted service: laboratories, pharmacies, every department. Federally qualified health center (FQHC) indicator, CMS certification number, urban/rural indicator</td>
<td><a href="https://data.cms.gov/browse?tags=pos">Provider of Services File OTHER</a> <a href=https://docs.google.com/spreadsheet/pub?key=0AgjwE0iJzIMBdE4zQkdCT29mTEZPSWRCMjN4UjJBZFE&output=html>Public spreadsheet with variables</a></a></td>
</tr>
<tr>
<meta http://en.wikipedia.org/wiki/Category:Health_care>
<td>Hospital quality</td>
<td>Quality data for over 4,000 US hospitals. Indicators include satisfaction, readmissions, complications, death, timely and effective care, use of medical imaging.</td>
<td><a href="https://data.medicare.gov/data/hospital-compare"></a>Hospital Compare, <a href="https://data.medicare.gov/developers">API, </a><a href="http://www.healthdata.gov/cqld">Linked data</a></td>
</tr>
<tr>
<td>Master charge rates</td>
<td>Hospital level data for the top 100 most frequently billed Medicare discharges for more than 3,000 US hospitals. Includes both what is billed and what Medicare pays.</td>
<td><a href="http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html">Medicare Provider Charge Data: Inpatient, <a href="http://data.cms.gov/resource/97k6-zzx3.json">API</a></td>
</tr>
<tr>
<td>Hospital discharges</td>
<td>The Healthcare Cost and Utilization Project (HCUP) databases contain the largest collection of longitudinal hospital all payer claims data. Representative samples of encounter-level information on inpatient stays (including pediatrics), emergency department visits and ambulatory care (e.g., outpatient surgery) are available. Hospital identifiers are frequently suppressed</td>
<td><a href="https://www.hcup-us.ahrq.gov">HCUP home, </a><a href="https://www.hcup-us.ahrq.gov/db/nation/nis/NIS_Introduction_2011.jsp#app3">Example data elements</a></td>
</tr>
</tbody>
</table>
<h3>
Hospital payment adjusters
</h3>
<p>
This table describes the data elements in the Provider Specific File from the Medicare Claims Processing Manual, Chapter 3 - Inpatient Hospital Billing (Rev. 2367, 12-09-11), Addendum A - Provider Specific File (Rev. 817, Issued: 01-20-06, Effective: 04-01-06, Implementation: 04-03-06). Full text available
<a href="http://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/ProspMedicareFeeSvcPmtGen/Downloads/clm104c03.pdf">here.</a>
</p>
<table class="table table-striped">
<thead>
<tr>
<th>No.</th><th>Data element</th><th>Description</th><th>File position</th><th>Format</th>
</tr>
</thead>
<tbody>
<tr><td>1</td><td>National Provider Identifier (NPI)</td><td>Alpha-numeric 10 character NPI number.</td><td>1-10</td><td>X(10)</td></tr>
<tr><td>2</td><td>Provider Oscar No.</td><td>Alpha-numeric 6 character provider number. Cross check to provider type.</td><td>11-16</td><td>X(6)</td></tr>
<tr><td>3</td><td>Effective Date</td><td>Must be numeric, CCYYMMDD. This is the effective date of the provider's first PPS period, or for subsequent PPS periods, the effective date of a change to the PROV file. If a termination date is present for this record, the effective date must be equal to or less than the termination date. Year: Greater than 82, but not greater than current year. Month: 01-12 Day: 01-31</td><td>17-24</td><td>9(8)</td></tr>
<tr><td>4</td><td>Fiscal Year Beginning Date</td><td>Must be numeric, CCYYMMDD. Year: Greater than 81, but not greater than current year. Month: 01-12 Day: 01-31 Must be updated annually to show the current year for providers receiving a blended payment based on their FY begin date. Must be equal to or less than the effective date.</td><td>25-32</td><td>9(8)</td></tr>
<tr><td>5</td><td>Report Date</td><td>Must be numeric, CCYYMMDD. Date file created/run date of the PROV report for submittal to CMS CO.</td><td>33-40</td><td>9(8)</td></tr>
<tr><td>6</td><td>Termination Date</td><td>Must be numeric, CCYYMMDD. Termination Date in this context is the date on which the reporting FI ceased servicing the provider. Must be zeros or contain a termination date. Must be equal to or greater than the effective date. If the provider is terminated or transferred to another FI, a termination date is placed in the file to reflect the last date the provider was serviced by the outgoing FI. Likewise, if the provider identification number changes, the FI must place a termination date in the PROV file transmitted to CO for the old provider identification number.</td><td>41-48</td><td>9(8)</td></tr>
<tr><td>7</td><td>Waiver Indicator</td><td>Enter a “Y” or “N.”Y = waived (Provider is not under PPS). N = not waived (Provider is under PPS).</td><td>49</td><td>X(1)</td></tr>
<tr><td>8</td><td>Intermediary Number</td><td>Assigned intermediary number.</td><td>50-54</td><td>9(5)</td></tr>
<tr><td>9</td><td>Provider Type</td><td>This identifies providers that require special handling. Enter one of the following codes as appropriate. See sheet one.</td><td>55-56</td><td>X(2)</td></tr>
<tr><td>10</td><td>Current Census Division</td><td>Must be numeric (1-9). Enter the Census division to which the facility belongs for payment purposes. When a facility is reclassified for the standardized amount, FIs must change the census division to reflect the new standardized amount location. [See Sheet2!A1:A42] NOTE: When a facility is reclassified for purposes of the standard amount, the FI changes the census division to reflect the new standardized amount location.</td><td>57</td><td>9(1)</td></tr>
<tr><td>11</td><td>Change Code Wage Index Reclassification</td><td>Enter "Y" if hospital's wage index location has been reclassified for the year. Enter "N" if it has not been reclassified for the year. Adjust annually.</td><td>58</td><td>X(1)</td></tr>
<tr><td>12</td><td>Actual Geographic Location - MSA</td><td>Enter the appropriate code for the MSA 0040-9965, or the rural area, (blank)(blank) 2 digit numeric State code such as_ _36 for Ohio, where the facility is physically located.</td><td>59-62</td><td>X(4)</td></tr>
<tr><td>13</td><td>Wage Index Location - MSA</td><td>Enter the appropriate code for the MSA, 0040-9965, or the rural area, (blank)(blank) (2 digit numeric State code) such as_ _ 3 6 for Ohio, to which a hospital has been reclassified due to its prevailing wage rates. Leave blank or enter the actual location MSA (field 13), if not reclassified. Pricer will automatically default to the actual location MSA if this field is left blank</td><td>63-66</td><td>X(4)</td></tr>
<tr><td>14</td><td>Standardized Amount MSA Location</td><td>Enter the appropriate code for the MSA, 0040-9965, or the rural area, (blank)(blank) (2 digit numeric State code) such as_ _ 3 6 for Ohio, to which a hospital has been reclassified for standardized amount. Leave blank or enter the actual location MSA (field 13) if not reclassified. Pricer will automatically default to the actual location MSA if this field is left blank.</td><td>67-70</td><td>X(4)</td></tr>
<tr><td>15</td><td>Sole Community or Medicare Dependent Hospital – Base Year</td><td>Leave blank if not a sole community hospital (SCH) or a Medicare dependent hospital (MDH) effective with cost reporting periods that begin on or after April 1, 1990. If an SCH or an MDH, show the base year for the operating hospital specific rate, the higher of either 82 or 87. See §20.6. Must be completed for any SCH or MDH that operated in 82or 87, even if the hospital will be paid at the Federal rate</td><td>71-72</td><td>X(2)</td></tr>
<tr><td>16</td><td>Change Code for Lugar reclassification</td><td>Enter an "L" if the MSA has been reclassified for wage index purposes under §1886(d)(8)(B) of the Act. These are also known as Lugar reclassifications, and apply to ASC-approved services provided on an outpatient basis when a hospital qualifies for payment under an alternate wage index MSA. Leave blank for hospitals if there has not been a Lugar reclassification.</td><td>73</td><td>X(1)</td></tr>
<tr><td>17</td><td>Temporary Relief Indicator</td><td>Enter a “Y” if this provider qualifies for a payment update under the temporary relief provision, otherwise leave blank. IPPS: Effective October 1, 2004, code a "Y” if the provider is considered “low volume.”IPF PPS: Effective January 1, 2005, code a “Y” if the acute facility where the unit is located has an Emergency Department or if the freestanding psych facility has an Emergency Department. IRF PPS: Effective October 1, 2005, code a “Y” for IRFs located in the state and county in Table 2 of the Addendum of the August 15, 2005 Federal Register (70 FR47880). The table can also be found at the following website: www.cms.hhs.gov/InpatientRehabFacPPS/07_DataFiles.asp#TopOfPage</td><td>74</td><td>X(1)</td></tr>
<tr><td>18</td><td>Federal PPS Blend Indicator</td><td>HH PPS: Enter the code for the appropriate percentage payment to be made on HH PPS RAPs. Must be present for all HHA providers, effective on or after 10/01/2000 0 = Pay standard percentages1 = Pay zero percent IRF PPS: All IRFs are 100% Federal for cost reporting periods beginning on or after10/01/2002. LTCH PPS: Enter the appropriate code for the blend ratio between federal and facility rates. Effective for all LTCH providers with cost reporting periods beginning on or after 10/01/2002. Federal % Facility%1 20 802 40 603 60 404 80 205 100 00 IPF PPS: Enter the appropriate code for the blend ratio between federal and facilityrates. Effective for all IPF providers withcost reporting periods beginning on or after 1/1/2005. Federal % Facility% 1 25 752 50 503 75 254 100 00</td><td>75</td><td>X(1)</td></tr>
<tr><td>19</td><td>State Code</td><td>Enter the 2-digit state where the provider is located. Enter only the first (lowest) code for a given state. For example, effective October 1, 2005, Florida has the following State Codes: 10, 68 and 69. FIs shall enter a “10” for Florida’s state code. List of valid state codes is located in Pub.100-07, Chapter 2, Section 2779A1.</td><td>76-77</td><td>9(2)</td></tr>
<tr><td>20</td><td>Filler</td><td>Blank</td><td>78-80</td><td>X(3)</td></tr>
<tr><td>21</td><td>Case Mix Adjusted Cost Per Discharge/ PPS Facility Specific Rate</td><td>For PPS hospitals and waiver state non excluded hospitals, enter the base year cost per discharge divided by the case mix index. Enter zero for new providers. See§20.1 for sole community and Medicare dependent hospitals on or after 04/01/90. For inpatient PPS hospitals, verify if figure is greater than $10,000. For LTCH, verify if figure is greater than $35,000.</td><td>81-87</td><td>9(5)V9(2)</td></tr>
<tr><td>22</td><td>Cost of Living Adjustment (COLA)</td><td>Enter the COLA. All hospitals except Alaska and Hawaii use 1.000.</td><td>88-91</td><td>9V9(3)</td></tr>
<tr><td>23</td><td>Intern/Beds Ratio</td><td>Enter the provider's intern/resident to bed ratio. Calculate this by dividing the provider's full time equivalent residents by the number of available beds (as calculated in positions 97-101). Do not include residents in anesthesiology who are employed to replace anesthetists or those assigned to PPS excluded units. Base the count upon the average number of full-time equivalent residents assigned to the hospital during the fiscal year. Correct cases where there is reason to believe that the count is substantially in error for a particular facility. The FI is responsible for reviewing hospital records and making necessary changes in the count at the end of the cost reporting period. Enter zero for non-teaching hospitals. IPF PPS: Enter the ratio of residents/interns to the hospital’s average daily census.</td><td>92-96</td><td>9V9(4)</td></tr>
<tr><td>24</td><td>Bed Size</td><td>Enter the number of adult hospital beds and pediatric beds available for lodging inpatient. Must be greater than zero. (Seethe Provider Reimbursement Manual,§2405.3G.)</td><td>97-101</td><td>9(5)</td></tr>
<tr><td>25</td><td>Operating Cost to Charge Ratio</td><td>Derived from the latest settled cost report and corresponding charge data from the billing file. Compute this amount by dividing the Medicare operating costs by Medicare covered charges. Obtain Medicare operating costs from the Medicare cost report form CMS-2552-1996 (replaced by 2552-2010), Supplemental Worksheet D-1, Part II, Line 53. Obtain Medicare covered charges from the FI billing file, i.e., PS&R record. For hospitals for which the FI is unable to compute a reasonable cost-to-charge ratio, they use the appropriate urban or rural statewide average cost-to-charge ratio calculated annually by CMS and published in the Federal Register. These average ratios are used to calculate cost outlier payments for those hospitals where you compute cost-to-charge ratios that are not within the limits published in the Federal Register. For LTCH and IRF PPS, a combined operating and capital cost-to-charge ratio is entered here. See below for a discussion of the use of more recent data for determining CCRs.</td><td>102-105</td><td>9V9(3)</td></tr>
<tr><td>26</td><td>Case Mix Index</td><td>The case mix index is used to compute positions 81-87 (field 21). Zero-fill for all others. In most cases, this is the case mix index that has been calculated and published by CMS for each hospital (based on 1981 cost and billing data) reflecting the relative cost of that hospital's mix of cases compared to the national average mix.</td><td>106-110</td><td>9V9(4)</td></tr>
<tr><td>27</td><td>Supplemental Security Income Ratio</td><td>Enter the SSI ratio used to determine if the hospital qualifies for a disproportionate share adjustment and to determine the size of the capital and operating DSH adjustments.</td><td>111-114</td><td>V9(4)</td></tr>
<tr><td>28</td><td>Medicaid Ratio</td><td>Enter the Medicaid ratio used to determine if the hospital qualifies for a disproportionate share adjustment and to determine the size of the capital and operating DSH adjustments.</td><td>115-118</td><td>V9(4)</td></tr>
<tr><td>29</td><td>Provider PPS Period</td><td>This field is obsolete as of 4/1/91. Leave Blank for periods on or after 4/1/91.</td><td>119</td><td>X(1)</td></tr>
<tr><td>30</td><td>Special Provider Update Factor</td><td>Zero-fill for all hospitals after FY91. [This Field is obsolete as of FY92.]</td><td>120-125</td><td>9V9(5)</td></tr>
<tr><td>31</td><td>Operating DSH</td><td>Disproportionate share adjustment Percentage. Pricer calculates the Operating DSH effective 10/1/91 and bypasses this field. Zero-fill for all hospitals 10/1/91 and later.</td><td>126-129</td><td>V9(4)</td></tr>
<tr><td>32</td><td>Fiscal Year End</td><td>This field is no longer used. If present, must be CCYYMMDD.</td><td>130-137</td><td>9(8)</td></tr>
<tr><td>33</td><td>Special Payment Indicator</td><td>Enter the code that indicates the type of special payment provision that applies. Blank = not applicable Y = reclassified1 = special wage index indicator 2 = both special wage index indicator and reclassified</td><td>138</td><td>X(1)</td></tr>
<tr><td>34</td><td>Hospital Quality Indicator</td><td>Enter code to indicate that hospital meets criteria to receive higher payment per MMA quality standards. Blank = hospital does not meet criteria 1 = hospital quality standards have been met</td><td>139</td><td>X(1)</td></tr>
<tr><td>35</td><td>Actual Geographic Location Core - Based Statistical Area (CBSA)</td><td>Enter the appropriate code for the CBSA00001-89999, or the rural area, (blank(blank) (blank) 2 digit numeric State code such as _ _ _ 36 for Ohio, where the facility is physically located.</td><td>140-144</td><td>X(5)</td></tr>
<tr><td>36</td><td>Wage Index Location CBSA</td><td>Enter the appropriate code for the CBSA, 00001-89999, or the rural area, (blank)(blank) (blank) (2 digit numeric State code) such as _ _ _ 3 6 for Ohio, to which a hospital has been reclassified due to its prevailing wage rates. Leave blank or enter the actual location CBSA (field35), if not reclassified. Pricer will automatically default to the actual location CBSA if this field is left blank.</td><td>145-149</td><td>X(5)</td></tr>
<tr><td>37</td><td>Standardized Amount Location CBSA</td><td>Enter the appropriate code for the CBSA, 00001-89999 or the rural area, (blank)(blank)(blank) (2 digit numeric State code)</td><td>150-154</td><td>X(5)</td></tr>
<tr><td>38</td><td>Special Wage Index</td><td>Enter the special wage index that certain providers may be assigned. Enter zeroes unless the Special Payment Indicator field equals a “1” or “2.”</td><td>155-160</td><td>9(2)V9(4)</td></tr>
<tr><td>39</td><td>Pass Through Amount for Capital</td><td>Per diem amount based on the interim payments to the hospital. Must be zero if location 185 = A, B, or C (See the Provider Reimbursement Manual, §2405.2). Used for PPS hospitals prior to their cost reporting period beginning in FY 92, new hospitals during their first 2 years of operation FY 92 or later, and non-PPS hospitals or units. Zero-fill if this does not apply.</td><td>161-166</td><td>9(4)V9(2)</td></tr>
<tr><td>40</td><td>Pass Through Amount for Direct Medical Education</td><td>Per diem amount based on the interim payments to the hospital (See the Provider, Reimbursement Manual, §2405.2.). Zero fill if this does not apply.</td><td>167-172</td><td>9(4)V9(2)</td></tr>
<tr><td>41</td><td>Pass Through Amount for Organ Acquisition</td><td>Per diem amount based on the interim payments to the hospital. Include standard acquisition amounts for kidney, heart, lung, pancreas, intestine and liver transplants. Do not include acquisition costs for bone marrow transplants. (See the Provider Reimbursement Manual, §2405.2.) Zero fill if this does not apply.</td><td>173-178</td><td>9(4)V9(2)</td></tr>
<tr><td>42</td><td>Total Pass Through Amount, Including Miscellaneous</td><td>Per diem amount based on the interim payments to the hospital (See the Provider Reimbursement Manual §2405.2.) Must beat least equal to the three pass through amounts listed above. The following are included in total pass through amount in addition to the above pass through amounts. Certified Registered Nurse Anesthetists (CRNAs) are paid as part of Miscellaneous Pass Through for rural hospitals that perform fewer than 500 surgeries per year, and Nursing and Allied Health Professional Education when conducted by a provider in an approved program. Do not include amounts paid for Indirect Medical Education, Hemophilia Clotting Factors, or DSH adjustments. Zero-fill if this does not apply.</td><td>179-184</td><td>9(4)V9(2)</td></tr>
<tr><td>43</td><td>Capital PPS Payment Code</td><td>Enter the code to indicate the type of capital payment methodology for hospitals: A = Hold Harmless – cost payment for old capital B = Hold Harmless – 100% Federal rate C = Fully prospective blended rate</td><td>185</td><td>X(1)</td></tr>
<tr><td>44</td><td>Hospital Specific Capital Rate</td><td>Must be present unless:· A "Y" is entered in the Capital Indirect Medical Education Ratio field; or· A“08” is entered in the Provider Type field; or· A termination date is present in Termination Date field. Enter the hospital's allowable adjusted base year inpatient capital costs per discharge. This field is not used as of 10/1/02.</td><td>186-191</td><td>9(4)V9(2)</td></tr>
<tr><td>45</td><td>Old Capital Hold Harmless Rate</td><td>Enter the hospital's allowable inpatient "old" capital costs per discharge incurred for assets acquired before December 31,1990, for capital PPS. Update annually.</td><td>192-197</td><td>9(4)V9(2)</td></tr>
<tr><td>46</td><td>New Capital-Hold Harmless Ratio</td><td>Enter the ratio of the hospital's allowable inpatient costs for new capital to the hospital's total allowable inpatient capital costs. Update annually.</td><td>198-202</td><td>9V9(4)</td></tr>
<tr><td>47</td><td>Capital Cost-to-Charge Ratio</td><td>Derived from the latest cost report and corresponding charge data from the billing file. For hospitals for which the FI is unable to compute a reasonable cost-to charge ratio, it uses the appropriate statewide average cost-to-charge ratio calculated annually by CMS and published in the "Federal Register." A provider may submit evidence to justify a capital cost-to charge ratio that lies outside a 3 standard deviation band. The FI uses the hospital's ratio rather than the statewide average if it agrees the hospital's rate is justified. See below for a detailed description of the methodology to be used to determine the CCR for Acute Care Hospital Inpatient and LTCH Prospective Payment Systems.</td><td>203-206</td><td>9V9(3)</td></tr>
<tr><td>48</td><td>New Hospital</td><td>Enter "Y" for the first 2 years that a new hospital is in operation. Leave blank if hospital is not within first 2 years of operation.</td><td>207</td><td>X(1)</td></tr>
<tr><td>49</td><td>Capital Indirect Medical Education Ratio</td><td>This is for IPPS hospitals and IRFs only. Enter the ratio of residents/interns to the hospital's average daily census. Calculate by dividing the hospital's full-time equivalent total of residents during the fiscal year by the hospital's total inpatient days. (See §20.4.1 for inpatient acute hospital and §§140.2.4.3 and 140.2.4.5.1for IRFs.) Zero-fill for a non-teaching hospital.</td><td>208-212</td><td>9V9(4)</td></tr>
<tr><td>50</td><td>Capital Exception Payment Rate</td><td>The per discharge exception payment to which a hospital is entitled. (See §20.4.7above.)</td><td>213-218</td><td>9(4)V9(2)</td></tr>
<tr><td>51</td><td>Filler</td><td>Blank</td><td>219-240</td><td>X(22)</td></tr>
</tbody>
</table>
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