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