Medicare provider analysis and review

Medicare Provider

Benchmark Assignment: Case 2-33

Using data from Case Study 2-33, create a 1,050- to 1,400-word report answering questions one through five on p. 121.

· 1 The top 20 MS-DRGs by number of discharges

· 2. The top 10 MS-DRGs by patient days

· 3. The highest 5 MS-DRGs by ALOS

· 4. What state is the most efficient, based on ALOS?

· 5. What state is the most efficient, based on cost-of-stay average charge?

Include the following:

o Analyze how MEDPAR could be used to affect decision-making to improve financial performance,health outcomes, and operational efficiency in a hospital.

o Analyze the additional data needed to conduct a thorough analysis of financial performance, health outcomes, and operational efficiency in a hospital.

o What you need and why

o Choose one of the additional data types described in the previous bullet, and evaluate how that data type will affect your overall analysis.

o Evaluate a data source for the additional data type you have identified above. Address its currency,value, and relevance.

Include a minimum of 3 peer-reviewed, scholarly, or similar references.

Format your references according to APA guidelines.

CASE 2-33: Medicare Provider Analysis and Review (MEDPAR) Data Analysis
Based on the data in Tables 2-18 and 2-19 , identify/answer the following:

· 1. The top 20 MS-DRGs by number of discharges

· 2. The top 10 MS-DRGs by patient days

· 3. The highest 5 MS-DRGs by ALOS

· 4. What state is the most efficient, based on ALOS?

· 5. What state is the most efficient, based on cost-of-stay average charge?

· 6. How can MEDPAR be used by a hospital?

Table 2-18: Medicare Provider Analysis and Review (MEDPAR) Data 2010 by Diagnosis-Related Group Short Stay Inpatient by State

Centers for Medicare & Medicaid Services

100% MEDPAR Inpatient Hospital Fiscal Year 2010

Short Stay Inpatient by State

State

Total Charges

Covered Charges

Medicare Reimbursement

Total Days

Number of Discharges

Avg Tot Days

ALABAMA

$10,147,574,758

$10,038,072,172

$1,871,880,274

1,510,549

282,003

5.4

ALASKA

$577,259,995

$566,639,626

$178,507,545

63,829

12,412

5.1

ARIZONA

$12,131,537,372

$12,004,545,106

$1,890,455,415

1,259,379

268,233

4.7

ARKANSAS

$4,650,893,942

$4,617,340,101

$1,198,753,807

859,328

163,926

5.2

CALIFORNIA

$76,320,204,015

$75,110,250,884

$11,191,656,553

5,991,233

1,159,833

5.2

COLORADO

$6,904,049,450

$6,859,514,264

$1,117,218,735

682,982

145,861

4.7

CONNECTICUT

$6,139,247,809

$6,046,063,110

$1,797,610,980

1,018,530

179,172

5.7

DELAWARE

$1,196,604,851

$1,188,116,227

$444,808,903

244,161

43,237

5.6

DISTRICT OF CO

$1,801,374,695

$1,758,124,064

$535,615,255

244,515

38,178

6.4

FLORIDA

$52,617,494,107

$52,293,923,852

$7,587,899,229

5,830,082

1,099,252

5.3

GEORGIA

$12,774,675,044

$12,670,647,571

$2,971,580,228

1,993,096

366,794

5.4

HAWAII

$1,155,327,643

$1,128,511,837

$303,609,640

210,869

32,879

6.4

IDAHO

$1,070,859,131

$1,068,209,787

$282,670,824

172,290

39,761

4.3

ILLINOIS

$23,220,247,028

$22,986,364,994

$5,506,557,400

3,167,766

616,325

5.1

INDIANA

$10,046,158,605

$9,974,718,544

$2,644,144,815

1,667,772

322,776

5.2

IOWA

$3,500,727,854

$3,471,430,275

$987,181,870

620,740

124,562

5

KANSAS

$4,298,673,428

$4,272,076,840

$967,292,484

596,333

118,347

5

KENTUCKY

$7,569,184,626

$7,505,177,124

$2,044,026,403

1,379,637

264,888

5.2

LOUISIANA

$8,235,304,586

$8,133,823,924

$1,647,692,129

1,279,408

231,488

5.5

MAINE

$1,447,797,039

$1,434,223,961

$533,523,616

304,584

61,257

5

MARYLAND

$3,946,237,184

$3,883,076,774

$3,223,158,908

1,367,904

276,931

4.9

MASSACHUSETTS

$9,139,634,478

$9,036,823,618

$3,389,376,309

1,843,260

357,214

5.2

MICHIGAN

$15,619,449,714

$15,466,296,055

$4,996,125,348

2,958,671

555,665

5.3

MINNESOTA

$6,935,040,451

$6,873,436,755

$1,829,860,224

952,088

205,607

4.6

MISSISSIPPI

$5,382,816,252

$5,340,100,260

$1,317,180,432

957,191

169,249

5.7

MISSOURI

$11,736,910,838

$11,455,708,404

$2,690,755,303

1,782,840

344,361

5.2

MONTANA

$865,186,366

$858,204,690

$266,045,718

158,962

34,071

4.7

NEBRASKA

$2,758,111,247

$2,737,944,914

$670,223,142

380,521

74,966

5.1

NEVADA

$6,179,609,713

$6,115,884,991

$775,757,239

522,179

98,868

5.3

NEW HAMPSHIRE

$1,476,037,830

$1,467,436,682

$460,132,445

252,953

47,692

5.3

NEW JERSEY

$28,489,630,729

$28,080,939,035

$4,101,798,474

2,516,729

425,674

5.9

NEW MEXICO

$2,050,325,541

$2,036,148,735

$484,642,557

304,839

63,606

4.8

NEW YORK

$36,991,790,908

$36,109,494,617

$9,804,172,781

6,583,804

983,092

6.7

NORTH CAROLINA

$13,298,007,382

$13,194,616,158

$4,018,966,039

2,479,974

465,217

5.3

NORTH DAKOTA

$724,008,854

$716,854,958

$266,956,934

148,920

30,999

4.8

OHIO

$21,264,776,632

$20,950,208,271

$4,548,391,978

3,306,485

647,345

5.1

OKLAHOMA

$6,358,089,969

$6,288,927,901

$1,464,254,308

992,113

192,253

5.2

OREGON

$3,968,392,976

$3,947,051,190

$858,307,627

594,065

128,713

4.6

PENNSYLVANIA

$37,410,926,656

$36,256,231,748

$5,280,683,810

4,378,798

787,788

5.6

PUERTO RICO

$603,859,499

$598,657,220

$177,973,749

432,535

63,620

6.8

RHODE ISLAND

$1,756,908,758

$1,729,754,707

$405,756,528

313,857

55,596

5.6

SOUTH CAROLINA

$8,807,688,270

$8,737,287,659

$1,858,440,523

1,228,448

218,321

5.6

SOUTH DAKOTA

$1,167,580,116

$1,155,116,775

$335,715,909

181,462

36,146

5

TENNESSEE

$12,746,772,706

$12,679,779,976

$2,742,276,783

2,041,124

383,981

5.3

TEXAS

$42,875,387,649

$41,971,787,681

$7,851,225,314

5,031,311

928,834

5.4

UTAH

$1,901,227,466

$1,883,723,968

$463,159,245

277,474

62,834

4.4

VERMONT

$420,145,959

$416,954,353

$217,601,470

93,556

17,870

5.2

VIRGIN ISLANDS

$39,504,740

$38,982,645

$18,577,125

15,343

1,957

7.8

VIRGINIA

$10,757,693,488

$10,689,967,199

$2,651,053,226

1,724,897

326,211

5.3

WASHINGTON

$8,468,518,610

$8,424,232,175

$1,933,437,855

1,009,585

217,781

4.6

WEST VIRGINIA

$2,628,845,839

$2,610,209,963

$819,069,756

648,423

118,769

5.5

WISCONSIN

$6,857,942,766

$6,804,514,268

$1,750,294,339

1,074,539

219,821

4.9

WYOMING

$418,561,455

$413,241,167

$150,892,761

65,075

14,116

4.6

UNKNOWN

$26,501,628

$25,960,389

$11,968,865

17,531

2,325

7.5

TOTAL LINE

$559,877,318,647

$552,123,330,164

$117,536,919,129

75,734,539

14,128,677

5.4

Courtesy of the Centers for Medicare and Medicaid Services.

Table 2-19: Medicare Provider Analysis and Review (MEDPAR) Inpatient National Data by Short Stay Inpatient Diagnosis-Related Groups (DRGs)

Centers for Medicare & Medicaid Services

100% MEDPAR Inpatient Hospital National Data for Fiscal Year 2010

Short Stay Inpatient Diagnosis Related Groups

Blank cells represent ten or less discharges in order to conform to CMS guidelines, zero means no discharges, therefore, sum of columns will not equal total

Drg

Total Charges

Covered Charges

Medicare Reimbursement

Total Days

Number of Discharges

Avg Tot Days

1

$1,117,985,829

$1,090,743,161

$286,358,414

56,582

1,528

37

2

$140,502,546

$140,205,825

$32,065,545

6,165

340

18.1

3

$11,615,298,430

$11,376,271,614

$2,730,104,797

932,325

25,937

35.9

4

$6,883,608,321

$6,772,437,052

$1,644,116,325

700,736

26,334

26.6

5

$536,660,556

$523,614,813

$105,731,995

25,975

1,264

20.5

6

$81,182,083

$78,643,466

$12,279,994

3,048

354

8.6

7

$262,789,035

$255,603,053

$45,062,614

11,773

604

19.5

8

$175,972,939

$168,897,085

$22,564,644

6,887

574

12

9

$567,469,241

$552,460,131

$143,027,966

56,323

2,741

20.5

10

$30,143,942

$29,339,199

$4,450,723

1,444

147

9.8

11

$295,466,194

$291,834,258

$69,624,418

32,296

2,130

15.2

12

$220,515,688

$217,391,636

$49,339,587

24,976

2,495

10

13

$68,341,801

$67,433,386

$13,652,721

8,189

1,247

6.6

20

$368,647,928

$361,900,643

$82,162,628

24,660

1,470

16.8

21

$107,157,847

$106,458,732

$22,749,702

8,204

575

14.3

22

$20,739,902

$20,659,675

$4,041,955

1,365

177

7.7

23

$882,403,654

$870,985,336

$188,705,591

70,583

6,053

11.7

24

$211,292,564

$209,850,830

$41,041,146

16,299

2,212

7.4

25

$2,056,624,169

$2,041,667,831

$462,265,665

183,111

16,773

10.9

26

$1,037,741,879

$1,031,428,875

$215,109,592

92,916

13,338

7

27

$938,564,429

$931,288,046

$178,589,497

58,276

15,651

3.7

28

$360,938,746

$358,080,879

$77,931,794

32,524

2,481

13.1

29

$318,517,999

$316,380,961

$68,427,214

26,899

4,397

6.1

30

$184,224,557

$182,526,420

$36,746,483

13,956

4,341

3.2

31

$173,582,626

$171,584,124

$44,375,603

19,300

1,577

12.2

32

$156,840,627

$155,387,108

$33,741,779

16,172

3,121

5.2

33

$141,216,554

$140,686,167

$27,489,347

10,181

3,915

2.6

34

$118,484,660

$112,734,822

$22,045,991

8,889

1,246

7.1

35

$156,693,536

$153,558,341

$29,191,285

8,195

2,758

3

36

$318,194,476

$313,455,607

$57,042,777

11,487

7,291

1.6

37

$558,705,110

$541,710,113

$110,947,634

56,225

7,049

8

38

$663,459,914

$650,504,718

$113,810,384

54,956

16,362

3.4

39

$1,467,780,661

$1,445,653,303

$225,954,554

88,434

53,289

1.7

40

$675,720,893

$664,811,989

$159,007,555

81,513

7,032

11.6

41

$430,266,157

$426,250,341

$88,988,681

50,934

8,080

6.3

42

$196,761,257

$193,527,177

$37,239,920

14,329

4,321

3.3

52

$64,478,116

$64,288,652

$13,713,327

9,749

1,591

6.1

53

$13,912,886

$13,704,326

$2,374,719

2,002

593

3.4

54

$439,551,450

$436,952,029

$98,859,323

68,392

11,313

6

55

$400,739,058

$397,030,153

$76,306,161

63,288

14,148

4.5

56

$673,144,943

$661,893,296

$172,953,789

152,636

18,259

8.4

57

$1,762,289,022

$1,698,820,233

$479,004,212

594,899

74,367

8

58

$45,473,713

$45,059,972

$10,761,922

7,957

1,189

6.7

59

$95,925,712

$94,490,314

$18,579,888

17,903

3,637

4.9

60

$86,275,941

$85,352,841

$14,830,908

15,766

4,158

3.8

61

$303,534,322

$301,979,724

$62,785,937

30,852

3,938

7.8

62

$292,681,977

$290,401,883

$52,904,980

29,706

5,496

5.4

63

$93,631,735

$92,948,688

$15,017,877

7,915

2,091

3.8

64

$4,165,859,831

$4,130,693,605

$887,553,425

610,353

91,703

6.7

65

$3,739,821,756

$3,715,714,395

$709,881,578

597,729

130,125

4.6

66

$1,874,477,204

$1,861,269,708

$302,910,888

268,945

85,258

3.2

67

$91,666,056

$90,527,880

$17,218,443

12,986

2,490

5.2

68

$278,442,031

$274,768,848

$44,341,378

35,650

11,356

3.1

69

$2,270,920,888

$2,204,521,964

$351,122,407

305,759

114,296

2.7

70

$721,068,555

$716,136,757

$172,440,683

122,776

18,332

6.7

71

$360,513,934

$357,002,930

$79,997,297

72,164

14,273

5.1

72

$125,914,525

$122,942,941

$21,696,240

19,651

6,428

3.1

73

$459,906,672

$443,526,776

$104,529,023

79,799

14,916

5.3

74

$767,701,926

$751,178,923

$139,159,755

131,995

34,430

3.8

75

$81,220,873

$80,530,175

$15,665,469

11,834

1,730

6.8

76

$19,995,516

$19,939,781

$3,020,745

3,175

847

3.7

77

$98,962,837

$98,245,725

$22,289,287

14,426

2,392

6

78

$61,771,373

$61,499,474

$11,552,504

9,803

2,460

4

79

$20,579,935

$20,411,125

$3,250,367

3,063

1,048

2.9

80

$81,719,854

$80,803,237

$17,445,095

13,545

2,761

4.9

81

$123,771,316

$122,160,079

$23,030,351

22,293

6,505

3.4

82

$192,610,201

$189,635,866

$43,276,897

20,564

3,449

6

83

$116,508,233

$115,635,333

$23,117,464

14,834

3,161

4.7

84

$79,371,849

$78,724,245

$13,896,808

8,702

3,234

2.7

85

$602,495,271

$599,433,741

$135,603,700

81,601

11,637

7

86

$512,097,684

$508,595,175

$107,049,762

76,144

17,309

4.4

87

$353,029,120

$350,741,571

$63,635,135

48,146

16,995

2.8

88

$52,123,005

$51,653,662

$10,009,231

6,832

1,307

5.2

89

$92,022,041

$90,873,741

$15,145,663

12,051

3,487

3.5

90

$64,244,798

$63,194,789

$9,033,489

6,732

3,010

2.2

91

$546,743,309

$538,741,266

$120,226,771

82,538

14,241

5.8

92

$482,576,545

$474,718,229

$95,977,558

84,169

21,007

4

93

$287,305,154

$281,420,478

$47,719,708

43,392

15,681

2.8

94

$162,878,697

$161,386,841

$37,494,905

21,515

1,870

11.5

95

$80,816,719

$80,329,493

$15,291,728

9,744

1,286

7.6

96

$32,833,801

$32,704,454

$5,623,946

3,575

630

5.7

97

$139,767,442

$138,923,630

$30,010,680

18,748

1,701

11

98

$54,244,525

$53,637,349

$11,631,965

8,493

1,167

7.3

99

$19,197,976

$18,867,079

$3,382,557

3,067

580

5.3

100

$1,042,382,685

$1,029,639,675

$229,736,675

155,295

27,234

5.7

101

$1,309,231,621

$1,298,479,928

$249,514,325

210,895

64,450

3.3

102

$53,845,199

$53,078,191

$10,322,064

8,551

1,968

4.3

103

$287,876,714

$282,667,679

$43,453,447

44,864

15,676

2.9

113

$44,199,886

$43,975,117

$9,550,671

4,552

820

5.6

114

$13,314,633

$13,070,519

$2,309,893

1,299

481

2.7

115

$36,741,207

$36,210,753

$7,273,100

4,581

1,066

4.3

116

$22,334,037

$22,037,584

$4,550,527

2,669

645

4.1

117

$13,963,838

$13,760,670

$2,403,393

1,479

693

2.1

121

$24,204,277

$23,997,958

$5,499,582

4,948

943

5.2

122

$9,316,207

$9,290,432

$1,826,740

2,154

583

3.7

123

$78,974,117

$78,357,268

$11,813,644

9,683

3,672

2.6

124

$40,154,874

$39,906,521

$9,538,965

6,865

1,434

4.8

125

$89,190,669

$88,156,933

$15,697,255

15,463

4,978

3.1

129

$127,372,855

$125,980,332

$26,296,324

10,442

1,960

5.3

130

$50,086,953

$49,558,605

$9,128,562

3,905

1,371

2.8

131

$97,402,936

$95,473,068

$19,287,298

8,575

1,494

5.7

132

$34,484,428

$33,752,352

$6,152,445

2,546

948

2.7

133

$136,459,949

$134,346,800

$26,368,075

15,338

2,820

5.4

134

$79,903,514

$77,408,087

$12,894,042

6,678

3,137

2.1

135

$29,926,811

$29,723,602

$5,977,225

3,343

531

6.3

136

$13,630,402

$13,451,629

$2,139,710

1,080

452

2.4

137

$44,325,989

$43,357,312

$9,800,096

6,243

1,257

5

138

$20,483,067

$19,788,568

$3,372,745

2,219

937

2.4

139

$41,975,662

$41,413,561

$6,239,919

2,798

1,614

1.7

146

$51,784,219

$51,281,702

$13,176,019

8,459

1,036

8.2

147

$48,481,198

$47,428,742

$10,285,854

8,539

1,524

5