Geographic Indices Physician GPCI

$179 / year

The dataset has information on the Medicare payment adjustments of Geographic Practice Cost Indices (GPCI) for calendar 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. 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. 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.

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.

A Medicare carrier, or Medicare Administrative Contractor (MAC), serves as the primary point of contact for Medicare providers, oversees the administration and processing of both Medicare part A and part B policies, also acts as the provider’s chief source for coverage, billing, and enrollment questions. In addition, Medicare carriers also handle claims appeals, identify billing errors, and answer any beneficiary inquiries. Medicare carriers vary by state and work with their area’s assigned providers to ensure they meet enrollment requirements.

The current Physician Fee Schedule (PFS) locality structure was developed and implemented in 1997. There are currently 89 total PFS localities; 34 localities are statewide areas.

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 Physician GPCI, Geographic Indices IPPS Wage Index, Geographic Indices IPPS Provider Index, Medicare Payment Adjustments, Medicare Service Payment Rates, Medicare Payment Structure, Medicare Fee for Service, Medicare Spending for Beneficiaries, Fee for Service Reimbursement, Aged Cost Contracts

Other Titles

Geographic Indices Physician GPCI Data, Geographic Index Repricing of Fee For Service Medicare Claims, Repricing of Medicare Fee For Service Insurance Geographic Index

NameDescriptionTypeConstraints
County_FIPS_CodeThe 5 digits county Federal Information Processing Standard (FIPS) codestring-
StateThe full name of the statestring-
State_AbbreviationThe abbreviated name of the statestring-
CountyName of Countystring-
Carrier_2018The 2018 carrier numberstring-
Locality_2018The 2018 locality numberstring-
GPCI_Work_2010The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2010numberlevel : Ratio
GPCI_Work_2011The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2011numberlevel : Ratio
GPCI_Work_2012The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2012numberlevel : Ratio
GPCI_Work_2013The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2013numberlevel : Ratio
GPCI_Work_2014The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2014numberlevel : Ratio
GPCI_Work_2015The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2015numberlevel : Ratio
GPCI_Work_2016The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2016numberlevel : Ratio
GPCI_Work_2017The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2017numberlevel : Ratio
GPCI_Work_2018The GPCI physician work is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2018numberlevel : Ratio
GPCI_Practice_Expense_2010The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2010numberlevel : Ratio
GPCI_Practice_Expense_2011The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2011numberlevel : Ratio
GPCI_Practice_Expense_2012The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2012numberlevel : Ratio
GPCI_Practice_Expense_2013The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2013numberlevel : Ratio
GPCI_Practice_Expense_2014The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2014numberlevel : Ratio
GPCI_Practice_Expense_2015The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2015numberlevel : Ratio
GPCI_Practice_Expense_2016The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2016numberlevel : Ratio
GPCI_Practice_Expense_2017The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2017numberlevel : Ratio
GPCI_Practice_Expense_2018The GPCI practice expense is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2018numberlevel : Ratio
GPCI_Malpractice_Insurance_2010The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2010numberlevel : Ratio
GPCI_Malpractice_Insurance_2011The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2011numberlevel : Ratio
GPCI_Malpractice_Insurance_2012The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2012numberlevel : Ratio
GPCI_Malpractice_Insurance_2013The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2013numberlevel : Ratio
GPCI_Malpractice_Insurance_2014The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2014numberlevel : Ratio
GPCI_Malpractice_Insurance_2015The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2015numberlevel : Ratio
GPCI_Malpractice_Insurance_2016The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2016numberlevel : Ratio
GPCI_Malpractice_Insurance_2017The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2017numberlevel : Ratio
GPCI_Malpractice_Insurance_2018The GPCI malpractice insurance is the GPCIs adjust payments for geographic variation in the costs of providing services, for the calendar year 2018numberlevel : Ratio
County_FIPS_CodeStateState_AbbreviationCountyCarrier_2018Locality_2018GPCI_Work_2010GPCI_Work_2011GPCI_Work_2012GPCI_Work_2013GPCI_Work_2014GPCI_Work_2015GPCI_Work_2016GPCI_Work_2017GPCI_Work_2018GPCI_Practice_Expense_2010GPCI_Practice_Expense_2011GPCI_Practice_Expense_2012GPCI_Practice_Expense_2013GPCI_Practice_Expense_2014GPCI_Practice_Expense_2015GPCI_Practice_Expense_2016GPCI_Practice_Expense_2017GPCI_Practice_Expense_2018GPCI_Malpractice_Insurance_2010GPCI_Malpractice_Insurance_2011GPCI_Malpractice_Insurance_2012GPCI_Malpractice_Insurance_2013GPCI_Malpractice_Insurance_2014GPCI_Malpractice_Insurance_2015GPCI_Malpractice_Insurance_2016GPCI_Malpractice_Insurance_2017GPCI_Malpractice_Insurance_2018
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