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
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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
Total hospital beds
Total inpatient days
Total discharges
Ownership status
Teaching status
Uncompensated care
Payer Mix
Location (zip code,
urban/rural)
Location
Worksheet S-3, Part I
Worksheet S-3, Part I
Worksheet S-3, Part I
Worksheet S-2 & RPT file
Worksheet S-2
Worksheet S-10
Worksheet S-3, Part I
Worksheet S-2
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Medicare Cost Reports
Example of Hospital Form 2552-10, Worksheet S-3, Part I
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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 freestanding and provider-based
» SNFs
» HHAs
» Hospices
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Facility Characteristics: Other Resources
 CMS “Compare” Databases
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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
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http://www.cms.gov/Medicare/Quality-Initiatives-Patient-AssessmentInstruments/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
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Total Margin
Revenues
Total Expenses
Average Daily Census
Bad Debt/Charity Care
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Financial Variable Locations
Variable
Location
Total Margin
Revenues
Worksheet G-3
Worksheet G-2
Expenses
Average Daily Census
Bad Debt
Worksheet G-2
Worksheet S-3
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 costeffectiveness analyses
 More to come in next segment
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Cost and Charge Variable Locations
Variable
Total cost
Total charges
Total Medicare costs
Location
Worksheet C, Part 1
Worksheet C, Part 1
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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Summary
 Cost reports are typically used to identify:
 Facility characteristics
 Financial health of a facility
 Calculate cost
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