FY 2002 Prospective Payment System Payment Impact File (May 2001 Update):

This file contains data used to estimate FY 2002 payments under Medicare's prospective payment systems (PPS) for hospitals' operating and capital costs.  The data are taken from various sources, including the Provider Specific File, the PPS-XV and PPS-XVI cost report Minimum Data Sets, and prior years= impact files.  The data set is abstracted from an internal file used for the impact analysis of the changes to PPS published in the Federal Register.  This file is available for release after the PPS Proposed and Final Rules are published in the Federal Register, which generally occurs during April (Proposed) and August (Final).

	FY 2002 PPS PAYMENT IMPACT FILE

File Pos. | | Format | | Title | | Description
1 | | $6. | | Provider Number | | Six character provider number, first two digits identify the State^1
8 | | $40. | | Hospital Name | | From cost reports
49 | | 4. | | Average Daily Census (ADC) | | From cost reports
54 | | 4. | | Number of Beds | | From cost reports
59 | | 8.2 | | Medicare Discharges | | From 2000 MEDPAR file (adjusted for transfer cases)^2,3
68 | | 6.4 | | Case-Mix Index | | Version 19 GROUPER (adjusted for transfer cases)^4
75 | | 6.4 | | Operating Cost of Living Adjustment | | Applied to providers in Alaska and Hawaii for operating PPS
82 | | 6.4 | | Capital Cost of Living Adjustment | | Applied to providers in Alaska and Hawaii for capital PPS
89 | | 9.7 | | Capital Outlier Percentage | | Estimated capital outlier payments as a percentage of Federal capital PPS payments
99 | | 7.5 | | Capital Cost-to-Charge Ratio | | From Provider Specific File, ratio of Medicare capital costs to Medicare covered charges
107 | | 9.7 | | Disproportionate Share (DSH) Patient Percentage | | As determined from cost report and Social Security Administration (SSA) data

117 | | 9.7 | | Capital DSH Adjustment Factor | | Applied to Federal PPS payments

127 | | 9.7 | | Operating DSH Adjustment Factor | | Applied to operating PPS payments

137

8.2

Hospital-Specific Rate

Higher of 1982 or 1987 hospital-specific rates, updated through FY 2000 (Data for Sole Community Hospitals and Medicare-Dependent Small, Rural Hospitals) or blended rate of 1982 or 1987 (50%) and the greater of the 1996 hospital specific rates or the current federal rate (50%)(Data for Sole Community Hospitals).
.

146 | | $4. | | Pre-Reclassification Metropolitan Statistical Area (MSA) | | MSA where hospital is actually located, prior to any reclassification decisions by the Medicare Geographic Classification Review Board (MGCRB).  Rural areas designated by two digit SSA State codes. ^4
151 | | $4. | | Post-Reclassification FY 2002 MSA (Wage Index) | | MSA used for wage index assignment after reclassification by the MGCRB.
156 | | $4. | | Post-Reclassification FY 2002 MSA (Standardized Payment Amount) | | MSA used for standardized amount assignment after reclassification by the MGCRB.
161 | | 7.5 | | Operating Cost-to-Charge Ratio | | From Provider Specific File, ratio of Medicare operating costs to Medicare covered charges
169 | | 9.7 | | Operating Outlier Percentage | | Estimated operating outlier payments as a percentage of operating PPS payments
179 | | 2. | | Provider Type | | 0 =	Short term PPS hospital

| | | | | | 7 =	Rural Referral Center

8 =	Indian hospital

14 = 	Medicare-Dependent, Small Rural Hospital

| | | | | | 16 =	Sole Community Hospital

17 =	Sole Community Hospital and Rural Referral Center

21 =	Essential Access Community Hospital

22 =	Essential Access Community Hospital/Rural Referral Center

182 | | 7.5 | | Resident-to-ADC ratio | | Used to calculate the indirect medical education (IME) adjustment for capital PPS payments

190 | | $1. | | Reclassification Status | | Indicates hospitals reclassified by the MGCRB
| | | | | | N =	Not reclassified

| | | | | | R = 	Reclassified for the standardized payment amount

| | | | | | W = 	Reclassified for the wage index
| | | | | | B =	Reclassified for the standardized payment amount and the wage index
| | | | | | L =	Reclassified under Section 1886(d)(8) of the Social Security Act
192 | | 2. | | Census Division | | Based on pre-reclassification MSA assignment
| | | | | | 1 =	New England
| | | | | | 2 =	Middle Atlantic

| | | | | | 3 =	South Atlantic |
| | | | | | 4 =	East North Central
| | | | | | 5 =	East South Central
| | | | | | 6 =	West North Central
| | | | | | 7 =	West South Central
| | | | | | 8 =	Mountain
| | | | | | 9 =	Pacific
| | | | | | 40 = Puerto Rico
195 | | 6.4 | | Resident-to-Bed Ratio | | Used to determine IME factor for operating PPS payments
202 | | 9.7 | | Capital IME Adjustment | | Based on resident-to-ADC ratio
212 | | 9.7 | | Operating IME Adjustment | | Based on resident-to-bed ratio
222 | | $6. | | Pre-Reclassification Urban/Rural Location | | Urban/rural designations based on geographic location prior to reclassification by the MGCRB
| | | | | | LURBAN = Large urban area
| | | | | | OURBAN  = Other urban area
| | | | | | RURAL  = Rural area
229 | | $6. | | Post-Reclassification Urban/Rural Location | | Urban/rural designations after reclassification by the MGCRB (see pre-reclass urban/rural location for key)
236 | | 6.4 | | Medicare Utilization Rate | | Medicare days as a percentage of total inpatient days. (Data not available for all hospitals)
243 | | 9.7 | | Capital Wage Index | | Used to determine geographic adjustment factor

253 | | 9.7 | | Operating Wage Index | | Applied to labor-share of standardized amount
263 | | 9.7 | | Puerto Rico Capital Wage Index | | Used to adjust the Puerto Rico capital rate.

273

283	

292

9.7

8.2

8.2

Puerto Rico Operating Wage Index 

Sole Community Hospitals Cost/Case for FY1996	

Old Hospital Specific Rate

Used to adjust the labor portion of the Puerto Rico operating standardized amount.

Cost per Case for Sole Community Hospitals FY 1996

82 or 87 Hospital Specific Rate updated to FY 2000(Data for Sole Community Hospitals).

Notes:

^1 SSA State Codes:

 01    ALABAMA
 02    ALASKA
 03    ARIZONA
 04    ARKANSAS
 05    CALIFORNIA
 06    COLORADO
 07    CONNECTICUT
 08    DELAWARE
 09    DISTRICT OF COLUMBIA
 10    FLORIDA
 11    GEORGIA
 12    HAWAII
 13    IDAHO
 14    ILLINOIS
 15    INDIANA
 16    IOWA
 17    KANSAS
 18    KENTUCKY
 19    LOUISIANA
 20    MAINE
 21    MARYLAND
 22    MASSACHUSETTS
 23    MICHIGAN
 24    MINNESOTA
 25    MISSISSIPPI
 26    MISSOURI
 27    MONTANA
 28    NEBRASKA
 29    NEVADA
 30    NEW HAMPSHIRE
 31    NEW JERSEY
 32    NEW MEXICO
 33    NEW YORK
 34    NORTH CAROLINA
 35    NORTH DAKOTA
 36    OHIO
 37    OKLAHOMA
38    OREGON
 39    PENNSYLVANIA
 40    PUERTO RICO
 41    RHODE ISLAND
 42    SOUTH CAROLINA
 43    SOUTH DAKOTA
 44    TENNESSEE
 45    TEXAS
 46    UTAH
 47    VERMONT
 49    VIRGINIA
 50    WASHINGTON
 51    WEST VIRGINIA
 52    WISCONSIN
 53    WYOMING 

^2 Medicare discharges are adjusted to account for the less-than-full (per diem) payment hospitals receive for cases transferred to another PPS hospital prior to reaching the geometric mean length of stay for the DRG.  The adjustment is calculated by accounting for transfers in proportion to the total per diem payment relative to the full DRG amount, calculated as:

1 X (Length of stay prior to transfer plus one day ) Geometric Mean LOS),

where the result cannot exceed 1.

^3 In addition to transfers from one PPS hospital to another, Medicare discharges are adjusted to account for the implementation of section 4407 of the Balanced Budget Act, which requires Medicare to pay as transfers discharges from 10 DRGs to postacute care.  In the case of seven of these DRGs (14, 113, 236, 263, 264, 429, and 483), transfers to postacute care are paid using the same methodology as transfers from one PPS hospital to another.  For three DRGs (209, 210, and 211), payment is equal to half of what the case would get under the PPS to PPS transfer methodology, and half of what the case would be paid if it were paid as a normal discharge.

^4 The case-mix index is also adjusted to account for transfers occurring before the geometric mean length of stay.  This adjustment is calculated as:

Sum of (DRG Relative Weight X (Transfer Payment Amount ) Full DRG Payment Amount)).
Transfer adjusted number of Medicare discharges.

6