| Charge Model |
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The variables included in the Charge Model are as follows:
Tab: Indexes (Days) This tab contains data on a per diem basis. These indices are severity and geographically adjusted. # of Cases – This is the number of cases included in the Index. The cases used are from the Hospital Efficiency Model with a few exceptions – cases with non-Medicare primary payer, HMO, Kaiser or Group Health or zero charges, reimbursements or days were excluded. Charges – This is the Index for the Charge/Day weighted against the U.S. average Charge/Day. Reimb – This is the Index for the Reimbursement/Day weighted against the U.S. Average Reimbursement/Day. Cost – This is the Index for the Cost/Day weighted against the U.S. Average Cost/Day. The costs were derived using the cost to charge ratios from CMS. Where there was no cost to charge ratio available, (1-Discount) was used. Tab: Indexes (Adm) This tab contains data on a per admission basis. These indices are severity and geographically adjusted. # of Cases – This is the number of cases included in the Index. The cases used are from the Hospital Efficiency Model with a few exceptions – cases with non-Medicare primary payer, HMO, Kaiser or Group Health or zero charges, reimbursements or days were excluded. Charges – This is the Index for the Charge/Day weighted against the U.S. Average Charge/Admit. Reimb – This is the Index for Reimbursement/Admit weighted against the U.S. Average Reimbursement/Admit. Cost – This is the Index for the Cost/Admit weighted against the U.S. Average Cost/Admit. The costs were derived using the cost to charge ratios from CMS. Where there was no cost to charge ratios available, (1-Discount) was used. Tab: $ (Days) This tab contains data on a per diem basis. These per diems are severity adjusted – but not geographically adjusted. # of Cases – This is the number of cases included in the per diems. The cases used are from the Hospital Efficiency Model with a few exceptions – cases with non-Medicare primary payer, HMO, Kaiser or Group Health or zero charges, reimbursements or days were excluded. Charges – Average Charge/Day Reimb – Average Reimbursement/Day Cost – Average Cost/Day Tab: $ (Adm) This tab contains data on a per admit basis. These dollars are severity adjusted – but not geographically adjusted. # of Cases – This is the number of cases included in the per admit dollars. The cases used are from the Hospital Efficiency Model with a few exceptions – cases with non-Medicare primary payer, HMO, Kaiser or Group Health or zero charges, reimbursements or days were excluded. Charges – Average Charge/Admit Reimb – Average Reimbursement/Admit Cost – Average Cost/Admit Tab: Geo Index This tab contains the data used to geographically adjust the Indexes. For now, this data is only shown at the MSA and Hospital levels. Operating – Operating Wage Index Capital – Capital Wage Index Geo Adj – This is the geographical adjustment applied to the Indices. It is 71% Operating Wage and 29% Capital Wage. Tab: Cost to Chrg Ratio This tab contains the cost to charge ratios used to derive the cost fields. These ratios came from CMS’s Provider Specific File. For now, this data is only shown at the Hospital Level. Operating – Operating Cost to Charge Ratio – This is the ratio of Medicare operating costs to Medicare covered charges. Capital – Capital Cost to Charge Ratio – This is the ratio of Medicare Capital Costs to Medicare Covered Charges. Total – This is the sum of the Operating and Capital Cost to charge ratios. If there were no cost to charge ratios available, (1-Discount) was used. Discount – Medicare discount (represents the discount percentage implied by the Medicare Reimbursement vs. Charges). Tab: Add Ons ($) This tab contains additional amounts that Medicare pays above their DRG payments. Net Reimb – This is the Reimbursement/Day less IME/Day, Disprop. Share/Day and Outlier/Day. The net Reimbursement/Day is geographically adjusted. IME – Indirect Medical Education/Day – This is the additional amount paid to teaching hospitals. Capital – Capital/Day (included in the Net Reimbursement). This is the reimbursement for depreciation, rent, certain interest and real estate taxes for hospital building and equipment subject to the PPS. Disprop Share – Disproportionate Share/Day. This is the amount paid over the DRG for the disproportionate share hospitals. Outlier – Outlier Payments/Day. This is the amount paid over the DRG allowance. Tab: Add Ons (%) This tab contains the percentages of Net Reimbursements. Net Reimb – This is the Reimbursement/Day less IME/Day, Disprop. Share/Day and Outlier/Day. The net Reimbursement/Day is geographically adjusted. IME – Indirect Medical Education percent of the Net Reimbursement. Capital – Capital percent of the Net Reimbursement. Disprop Share – Disproportionate Share percent of the Net Reimbursement. Outlier – Outlier payments percent of the Net Reimbursement. |