Percentile Lengths of Hospital Stay

$79 / year

This dataset consists of a table containing Medicare Prospective Payment System Selected Percentile Lengths of Stay; FY 2015 MedPAR Update – March 2016 Grouper V33 MS-DRGs.

Complexity

Section 1886(d) of the Social Security Act (the Act) sets forth a system of payment for the operating costs of acute care hospital inpatient stays under Medicare Part A (Hospital Insurance) based on prospectively set rates. This payment system is referred to as the inpatient prospective payment system (IPPS). Under the IPPS, each case is categorized into a diagnosis-related group (DRG). Each DRG has a payment weight assigned to it, based on the average resources used to treat Medicare patients in that DRG.

The base payment rate is divided into a labor-related and nonlabor share. The labor-related share is adjusted by the wage index applicable to the area where the hospital is located, and if the hospital is located in Alaska or Hawaii, the nonlabor share is adjusted by a cost of living adjustment factor. This base payment rate is multiplied by the DRG relative weight.

If the hospital treats a high-percentage of low-income patients, it receives a percentage add-on payment applied to the DRG-adjusted base payment rate. This add-on, known as the disproportionate share hospital (DSH) adjustment, provides for a percentage increase in Medicare payment for hospitals that qualify under either of two statutory formulas designed to identify hospitals that serve a disproportionate share of low-income patients. For qualifying hospitals, the amount of this adjustment may vary based on the outcome of the statutory calculation.

Also, if the hospital is an approved teaching hospital it receives a percentage add-on payment for each case paid through IPPS. This add-on known as the indirect medical education (IME) adjustment, varies depending on the ratio of residents-to-beds under the IPPS for operating costs, and according to the ratio of residents-to-average daily census under the IPPS for capital costs.

Finally, for particular cases that are unusually costly, known as outlier cases, the IPPS (Inpatient Prospective Payment System) payment is increased. This additional payment is designed to protect the hospital from large financial losses due to unusually expensive cases. Any outlier payment due is added to the DRG-adjusted base payment rate, plus any DSH or IME adjustments.

Date Created

2015

Last Modified

2016-03

Version

33 and 34

Update Frequency

Annual

Temporal Coverage

2016

Spatial Coverage

United States

Source

John Snow Labs => Centers for Medicare & Medicaid Services

Source License URL

John Snow Labs Standard License

Source License Requirements

N/A

Source Citation

N/A

Keywords

Medicare Hospital, DRG Codes, APR DRG, DRG Codes 2016, DRG Codes Version 33, DRG Codes List, Medicare DRG List, Medicare DRG, CMS DRG Codes

Other Titles

Percentile Lengths of Medicare Hospital Stay for MS-DRGs V33, Percentile Lengths of Hospital Stay for MS-DRGs V34 CMS Capital

Name Description Type Constraints
Version_NumberMS-DRGs Grouper version numberintegerenum : Array level : Nominal
Diagnosis_Related_Group_CodesMedicare Severity Diagnosis Related Group Codesstringrequired : 1
Number_of_Acute_DischargesNumber of Acute inpatient dischargesintegerrequired : 1 level : Ratio
Arithmetic_Mean_Length_of_Hospital_StayArithmetic Mean Length of Stay in Hospitalnumberrequired : 1 level : Ratio
Length_of_Stay_10_Percent10th Percentile of Length of Hospital Stayintegerrequired : 1 level : Ratio
Length_of_Stay_25_Percent25th Percentile of Length of Hospital Staynumberrequired : 1 level : Ratio
Length_of_Stay_50_Percent50th Percentile of Length of Hospital Staynumberrequired : 1 level : Ratio
Length_of_Stay_75_Percent75th Percentile of Length of Hospital Staynumberrequired : 1 level : Ratio
Length_of_Stay_90_Percent90th Percentile of Length of Hospital Staynumberrequired : 1 level : Ratio
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