Geographic Indices IPPS Provider Index

$179 / year

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 2010-2018. 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.

Complexity

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.

Date Created

2016-04-04

Last Modified

2018-02-01

Version

2018-02-01

Update Frequency

Annual

Temporal Coverage

2010-2018

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

NameDescriptionTypeConstraints
Provider_NumberProvider identification numberintegerlevel : Nominal
Core_Based_Statistical_Area_2018Core 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 commutingintegerlevel : Nominal
County_FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
State_AbbreviationThe abbreviated name of the statestring-
CountyName of Countystring-
IPPS_Provider_2010_AInpatient prospective payment system by provider, "A" and "B" designation indicate that there was a mid-year change in the index due to change in claims processor during the yearnumberlevel : Ratio
IPPS_Provider_2010_BInpatient prospective payment system by provider, "A" and "B" designation indicate that there was a mid-year change in the index due to change in claims processor during the yearnumberlevel : Ratio
IPPS_Provider_2011Inpatient prospective payment system by provider and fiscal year 2011numberlevel : Ratio
IPPS_Provider_2012Inpatient prospective payment system by provider and fiscal year 2012numberlevel : Ratio
IPPS_Provider_2013Inpatient prospective payment system by provider and fiscal year 2013numberlevel : Ratio
IPPS_Provider_2014Inpatient prospective payment system by provider and fiscal year 2014numberlevel : Ratio
IPPS_Provider_2015Inpatient prospective payment system by provider and fiscal year 2015numberlevel : Ratio
IPPS_Provider_2016Inpatient prospective payment system by provider and fiscal year 2016numberlevel : Ratio
IPPS_Provider_2017Inpatient prospective payment system by provider and fiscal year 2017numberlevel : Ratio
IPPS_Provider_2018Inpatient prospective payment system by provider and fiscal year 2018numberlevel : Ratio
Provider_NumberCore_Based_Statistical_Area_2018County_FIPS_CodeState_AbbreviationCountyIPPS_Provider_2010_AIPPS_Provider_2010_BIPPS_Provider_2011IPPS_Provider_2012IPPS_Provider_2013IPPS_Provider_2014IPPS_Provider_2015IPPS_Provider_2016IPPS_Provider_2017IPPS_Provider_2018
5076805400CAOrange
67006345310TXCollin0.9657
10032210370FLLevy0.95880.8853
25016625750MSWashington1.4448
67002145130TXBexar0.89130.8913
67009445795TXMilam0.94360.9764
11023411080GABerrien0.74960.7439
23027823450MILenawee0.94080.9267
23017523450MILenawee0.94080.9267
23011323450MILenawee0.94080.9267