Hospital cost information with MS-DRG and revenue center specificity

[ph-jdeng]

Seeking to compare the average costs of medical/surgical supplies for each MS-DRG across hospitals and against reimbursement amounts. The goal is to identify potential cost management opportunities.

Requesting hospital cost information for for-profit use with the following fields:

• hospital name, zip code/city
• average total cost per patient per MS-DRG assignment (or total cost per MS-DRG AND total number of patients/discharges per MS-DRG)
• average cost per patient per MS-DRG per revenue center (e.g. medical/surgical supplies, OR, etc.)

Likely source was de-identified CMS Cost Reports, but ResDAC indicates that the reports do not contain DRG-identifiable information. Unclear if MedPAR or Limited Data Sets contain desired cost information.

Limitations of uncertainty in how overhead costs are assigned to revenue centers. Ideally, we would know that hospitals are systematically assigning overhead. (no insight)

[betshsu]

@ph-jdeng A couple of questions:

• Can you let us know which CMS datasets you requested assistance for from ResDAC or other CMS sources (I see you mentioned Cost Reports)?
• Have you identified a specific dataset within the Limited Datasets that appears like it might have the data of interest, but isn't sufficiently well documented to determine?
• Finally, have you reviewed the MedPAR data dictionary to determine if it has any of the information of interest? https://www.cms.gov/Research-Statistics-Data-and-Systems/Files-for-Order/IdentifiableDataFiles/MedicareProviderAnalysisandReviewFile.html

[loranstefani]

This is an interesting request. I can tell you from working with the datasets that I use (all LDS datasets put out by CMS), you can't do this right now. The Cost Report gives medical/surgical supplies by department, but not by claim, or by MS-DRG. Then the data sets that do give data at the claim/MS-DRG level don't report supplies costs. You can get Medical/Surgical Supply Charge Amount from MedPAR, but my understanding is that the charge amount is what's charged to the patient/payer, not what it actually costed. Hope that helps; will be watching this one!

[betshsu]

@loranstefani Thanks -- that's very useful, as I'm not nearly as familiar with the multitude of CMS datasets as you are

[ph-jdeng]

@loranstefani thanks for clarifying some the constraints of the various datasets.

@betshsu A couple different correspondents from ResDAC have directed us to the cost reports, Inpatient LDS, and MedPAR datasets, but none have been able to speak to how cost information is collected or compiled. As loranstefani mentioned, MedPAR seems to only contain charge information with no mentions of cost data in the data dictionary. Neither does the Inpatient LDS data dictionary contain references to detailed cost information.

[betshsu]

@ph-jdeng Thanks for this. We can try approaching CMS program owners to clarify how cost information is collected or complied, but we would need to identify the specific dataset of interest as there are a multitude of program owners for all possible datasets you mentioned. It would be helpful if you could identify:

• The dataset that appears to be the most relevant to the information you are looking for (even if it does not contain the information you are looking for)
• The specific policy type questions you have around the data in question
• If you have any other data specifications (other than those you mentioned in your initial entry).

[ph-jdeng]

I think the cost reports would be the most pertinent dataset even though it does not contain claim- or DRG-level information. Here are some specific questions we have:

• Are hospitals calculating costs at the DRG- and revenue center-level or are they calculating a cost-charge ratio for a revenue center at the hospital-level and applying that across the board for all DRGs?
• Is there a standardized process for arriving at cost per revenue center (e.g. a policy that specifies what to include as Medical Surgical Supplies) that all hospitals must follow?
• Are there indicators for how comparable the costs are that individual hospitals share in cost reports? (e.g. a policy that states hospitals only include 10% overhead)

[betshsu]

@ph-jdeng Thanks -- we'll see if we can get an internal contact for the Cost Reports data and determine how to best proceed with CMS

[dportnoy]

@ph-jdeng Still working on it. Ball is in our court.