Others titles
- Geographic Indices IPPS Provider Index Data
- Geographic Index Repricing of Fee For Service Medicare Claims
- Repricing of Medicare Fee For Service Insurance Geographic Index
Keywords
- Geographic Indices IPPS Provider Index
- Medicare Payment Adjustments
- Medicare Service Payment Rates
- Medicare Payment Structure
- Medicare Fee for Service
- FFS Insurance
- Medicare Spending for Beneficiaries
- Fee for Service Reimbursement
- Aged Cost Contracts
Geographic Indices IPPS Provider Index
The dataset has information on the Medicare payment adjustments of geographic indices for Inpatient Prospective Payment System (IPPS) by provider number for the fiscal years 2017-2023. The Medicare System adjusts fee for service payment rates for hospitals and practitioners according to the geographic location in which providers practice, recognizing that certain costs beyond the providers’ control vary between metropolitan and nonmetropolitan areas and also differ by region.
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Description
Geographic adjustments are intended to ensure that the Medicare Program does not overpay hospitals and practitioners in certain areas and underpay in other as a result of geographic difference in price for resources such as clinical and administrative staff salaries and benefits, office or hospital space (rent), malpractice insurance (premiums), and other resources that are part of the cost of providing care. The fundamental rationale for geographic adjustment is to create a payment structure that adjusts payments for the input price difference, such as employee compensation, that providers face when they provide care. As a result, Medicare’s Inpatient Prospective Payment System (IPPS), other Institutional Prospective Payment Systems (PPSs), and the Medicare Physician Fee Schedule (PFS, or fee schedule), all employ geographic adjustments factors (GAFs). The two geographic adjustments applied to Medicare payments for care provided by hospitals and practitioners are the hospital wage index (HWI) and three geographic practice cost indexes (GPCI). The index compares difference in price or quantity for a group of goods and services relative to an average value derived from a standard baseline geographic area or time period.
GPCIs helps to standardize the differences in resource costs incurred across geographic areas when those costs are compared with the national average costs for the physician work, practice expense and malpractice insurance components of the fee schedule. Specifically, the three adjustments are provided for the following: 1) Physician work reflects the time, skill, effort, judgement, and stress associated with providing one service relative to other services according to the Healthcare Common Procedure Coding System (HCPCS) codes. On average, as of 2011, work accounted for 52.5 % of the geographic adjustment factor within the fee schedule. 2) Practice expense considers certain price for maintaining a clinical practice, including salaries and benefits for administrative and clinical employees, rent, equipment, and supplies. Practice expense (PE) associated with supplies and equipment are not adjusted geographically because they are purchased in a national market in which prices are similar across the country. On average as of 2011, the PE GPCI accounted for 43.7 % of the geographic adjustment. 3) Professional liability insurance (PLI) represents payment for professional liability malpractice expenses and on average, account for 3.9 % of the geographic adjustment.
About this Dataset
Data Info
Date Created | 2016-04-04 |
---|---|
Last Modified | 2023-03-16 |
Version | 2023-03-16 |
Update Frequency |
Annual |
Temporal Coverage |
2017-2023 |
Spatial Coverage |
United States |
Source | John Snow Labs; Centers for Medicare and Medicaid Services; |
Source License URL | |
Source License Requirements |
N/A |
Source Citation |
N/A |
Keywords | Geographic Indices IPPS Provider Index, Medicare Payment Adjustments, Medicare Service Payment Rates, Medicare Payment Structure, Medicare Fee for Service, FFS Insurance, Medicare Spending for Beneficiaries, Fee for Service Reimbursement, Aged Cost Contracts |
Other Titles | Geographic Indices IPPS Provider Index Data, Geographic Index Repricing of Fee For Service Medicare Claims, Repricing of Medicare Fee For Service Insurance Geographic Index |
Data Fields
Name | Description | Type | Constraints |
---|---|---|---|
Provider_Number | Provider identification number | integer | level : Nominal |
Core_Based_Statistical_Area_2023 | Core Based Statistical Area (CBSA) is a U.S. geographic area defined by the Office of Management and Budget (OMB) that consists of one or more counties (or equivalents) anchored by an urban center of at least 10,000 people plus adjacent counties that are socioeconomically tied to the urban center by commuting | integer | level : Nominal |
County_FIPS_Code | The 5 digits county Federal Information Processing Standard (FIPS) code | string | - |
State_Abbreviation | The abbreviated name of the state | string | - |
County | Name of County | string | - |
IPPS_Provider_2017 | Inpatient prospective payment system by provider and fiscal year 2017 | number | level : Ratio |
IPPS_Provider_2018 | Inpatient prospective payment system by provider and fiscal year 2018 | number | level : Ratio |
IPPS_Provider_2019 | Inpatient prospective payment system by provider and fiscal year 2019 | number | level : Ratio |
IPPS_Provider_2020 | Inpatient prospective payment system by provider and fiscal year 2020 | number | level : Ratio |
IPPS_Provider_2021 | Inpatient prospective payment system by provider and fiscal year 2021 | number | level : Ratio |
IPPS_Provider_2022 | Inpatient prospective payment system by provider and fiscal year 2022 | number | level : Ratio |
IPPS_Provider_2023 | Inpatient prospective payment system by provider and fiscal year 2023 | number | level : Ratio |
Data Preview
Provider Number | Core Based Statistical Area 2024 | County FIPS Code | State Abbreviation | County | IPPS Provider 2018 | IPPS Provider 2019 | IPPS Provider 2020 | IPPS Provider 2021 | IPPS Provider 2022 | IPPS Provider 2023 | IPPS Provider 2024 |
10108 | 33860.0 | 1000 | AL | AUTAUGA | 0.7249 | 0.7459 | 0.8008 | 0.8032 | 0.7864 | 0.8012 | 0.8259 |
10100 | 19300.0 | 1010 | AL | BALDWIN | 0.7816 | 0.7287 | 0.8312 | 0.8216 | 0.8146 | 0.7877 | 0.8089 |
10129 | 19300.0 | 1010 | AL | BALDWIN | 0.7816 | 0.7287 | 0.7999 | 0.7891 | 0.7892 | 0.7877 | 0.8089 |
10083 | 19300.0 | 1010 | AL | BALDWIN | 0.8184 | 0.803 | 0.8312 | 0.8216 | 0.8146 | 0.8176 | 0.8089 |
10069 | 1020 | AL | BARBOUR | 0.6848 | 0.6704 | 0.7543 | 0.757 | 0.7461 | 0.7489 | 0.7894 | |
10058 | 13820.0 | 1030 | AL | BIBB | 0.813 | 0.8036 | 0.8127 | 0.828 | 0.8221 | 0.8167 | 0.8173 |
10110 | 1050 | AL | BULLOCK | 0.6848 | 0.6704 | 0.7543 | 0.757 | 0.7461 | 0.7489 | 0.7894 | |
10047 | 1060 | AL | BUTLER | 0.7024 | 0.688 | 0.7693 | 0.772 | 0.761 | 0.7657 | 0.8062 | |
10150 | 1060 | AL | BUTLER | 0.7249 | 0.7459 | 0.8008 | 0.8032 | 0.7864 | 0.8012 | 0.8259 | |
10146 | 11500.0 | 1070 | AL | CALHOUN | 0.6959 | 0.7542 | 0.8147 | 0.7946 | 0.7801 | 0.7565 | 0.7894 |