[Federal Register: August 1, 2000 (Volume 65, Number 148)]
[Rules and Regulations]
[Page 47154-47203]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr01au00-15]
[[pp. 47154-47203]] Medicare Program; Changes to the Hospital Inpatient Prospective
Payment Systems and Fiscal Year 2001 Rates
[[Continued from page 47153]]
[[Page 47153]]
4920 \1\ Memphis, TN-AR-MS......................... 0.8723 0.9107
Crittenden, AR
DeSoto, MS
Fayette, TN
Shelby, TN
Tipton, TN
4940 \2\ Merced, CA................................ 0.9861 0.9905
Merced, CA
5000 \1\ Miami, FL................................. 1.0059 1.0040
Dade, FL
5015 \1\ Middlesex-Somerset-Hunterdon, NJ.......... 1.0333 1.0227
Hunterdon, NJ
Middlesex, NJ
Somerset, NJ
5080 \1\ Milwaukee-Waukesha, WI.................... 0.9767 0.9840
Milwaukee, WI
Ozaukee, WI
Washington, WI
Waukesha, WI
5120 \1\ Minneapolis-St. Paul, MN-WI............... 1.1017 1.0686
Anoka, MN
Carver, MN
Chisago, MN
Dakota, MN
Hennepin, MN
Isanti, MN
Ramsey, MN
Scott, MN
Sherburne, MN
Washington, MN
Wright, MN
Pierce, WI
St. Croix, WI
5140 Missoula, MT.................................. 0.9332 0.9538
Missoula, MT
5160 Mobile, AL.................................... 0.8163 0.8702
Baldwin, AL
Mobile, AL
5170 Modesto, CA................................... 1.0396 1.0270
Stanislaus, CA
5190 \1\ Monmouth-Ocean, NJ........................ 1.1283 1.0862
Monmouth, NJ
Ocean, NJ
5200 Monroe, LA.................................... 0.8396 0.8872
Ouachita, LA
5240 Montgomery, AL................................ 0.7653 0.8326
Autauga, AL
Elmore, AL
Montgomery, AL
5280 Muncie, IN.................................... 1.0969 1.0654
Delaware, IN
5330 Myrtle Beach, SC.............................. 0.8440 0.8903
Horry, SC
5345 Naples, FL.................................... 0.9661 0.9767
Collier, FL
5360 \1\ Nashville, TN............................. 0.9490 0.9648
Cheatham, TN
Davidson, TN
Dickson, TN
Robertson, TN
Rutherford, TN
Sumner, TN
Williamson, TN
Wilson, TN
5380 \1\ Nassau-Suffolk, NY........................ 1.3932 1.2549
Nassau, NY
Suffolk, NY
5483 \1\ New Haven-Bridgeport-Stamford-Waterbury- 1.2034 1.1352
Danbury, CT........................................
Fairfield, CT
New Haven, CT
5523 New London-Norwich, CT........................ 1.2063 1.1371
New London, CT
5560 \1\ New Orleans, LA........................... 0.9295 0.9512
Jefferson, LA
Orleans, LA
Plaquemines, LA
St. Bernard, LA
St. Charles, LA
St. James, LA
St. John The Baptist, LA
St. Tammany, LA
5600 \1\ New York, NY.............................. 1.4651 1.2989
Bronx, NY
Kings, NY
New York, NY
Putnam, NY
Queens, NY
Richmond, NY
Rockland, NY
Westchester, NY
5640 \1\ Newark, NJ................................ 1.0757 1.0512
Essex, NJ
Morris, NJ
Sussex, NJ
Union, NJ
Warren, NJ
5660 Newburgh, NY-PA............................... 1.0847 1.0573
Orange, NY
Pike, PA
5720 \1\ Norfolk-Virginia Beach-Newport News, VA-NC 0.8422 0.8890
Currituck, NC
Chesapeake City, VA
Gloucester, VA
Hampton City, VA
Isle of Wight, VA
James City, VA
Mathews, VA
Newport News City, VA
Norfolk City, VA
Poquoson City, VA
Portsmouth City, VA
Suffolk City, VA
Virginia Beach City, VA
Williamsburg City, VA
York, VA
5775 \1\ Oakland, CA............................... 1.4983 1.3190
Alameda, CA
Contra Costa, CA
5790 Ocala, FL.....................................
Marion, FL 0.9243 0.9475
5800 Odessa-Midland, TX............................ 0.9205 0.9449
Ector, TX
Midland, TX
5880 \1\ Oklahoma City, OK......................... 0.8822 0.9177
Canadian, OK
Cleveland, OK
Logan, OK
McClain, OK
Oklahoma, OK
Pottawatomie, OK
5910 Olympia, WA................................... 1.0677 1.0459
Thurston, WA
5920 Omaha, NE-IA.................................. 0.9572 0.9705
Pottawattamie, IA
Cass, NE
Douglas, NE
Sarpy, NE
Washington, NE
5945 \1\ Orange County, CA......................... 1.1411 1.0946
Orange, CA
5960 \1\ Orlando, FL............................... 0.9610 0.9731
Lake, FL
Orange, FL
Osceola, FL
Seminole, FL
5990 Owensboro, KY................................. 0.8159 0.8699
Daviess, KY
6015 Panama City, FL............................... 0.9010 0.9311
Bay, FL
6020 Parkersburg-Marietta, WV-OH (WV Hospitals).... 0.8274 0.8783
Washington, OH
Wood, WV
6020 \2\ Parkersburg-Marietta, WV-OH (OH Hospitals) 0.8670 0.9069
Washington, OH
Wood, WV
6080 \2\ Pensacola, FL............................. 0.8928 0.9253
Escambia, FL
Santa Rosa, FL
6120 Peoria-Pekin, IL.............................. 0.8646 0.9052
Peoria, IL
Tazewell, IL
Woodford, IL
6160 \1\ Philadelphia, PA-NJ....................... 1.0937 1.0633
Burlington, NJ
Camden, NJ
Gloucester, NJ
Salem, NJ
Bucks, PA
Chester, PA
Delaware, PA
Montgomery, PA
Philadelphia, PA
6200 \1\ Phoenix-Mesa, AZ.......................... 0.9669 0.9772
[[Page 47154]]
Maricopa, AZ
Pinal, AZ
6240 Pine Bluff, AR................................ 0.7791 0.8429
Jefferson, AR
6280 \1\ Pittsburgh, PA............................ 0.9741 0.9822
Allegheny, PA
Beaver, PA
Butler, PA
Fayette, PA
Washington, PA
Westmoreland, PA
6323 \2\ Pittsfield, MA............................ 1.1204 1.0810
Berkshire, MA
6340 Pocatello, ID................................. 0.9076 0.9358
Bannock, ID
6360 Ponce, PR..................................... 0.5006 0.6226
Guayanilla, PR
Juana Diaz, PR
Penuelas, PR
Ponce, PR
Villalba, PR
Yauco, PR
6403 Portland, ME.................................. 0.9748 0.9827
Cumberland, ME
Sagadahoc, ME
York, ME
6440 \1\ Portland-Vancouver, OR-WA................. 1.0910 1.0615
Clackamas, OR
Columbia, OR
Multnomah, OR
Washington, OR
Yamhill, OR
Clark, WA
6483 \1\ Providence-Warwick-Pawtucket, RI.......... 1.0864 1.0584
Bristol, RI
Kent, RI
Newport, RI
Providence, RI
Washington, RI
6520 Provo-Orem, UT................................ 1.0041 1.0028
Utah, UT
6560 \2\ Pueblo, CO................................ 0.8968 0.9281
Pueblo, CO
6580 Punta Gorda, FL............................... 0.9613 0.9733
Charlotte, FL
6600 Racine, WI.................................... 0.9246 0.9477
Racine, WI
6640 \1\ Raleigh-Durham-Chapel Hill, NC............ 0.9646 0.9756
Chatham, NC
Durham, NC
Franklin, NC
Johnston, NC
Orange, NC
Wake, NC
6660 Rapid City, SD................................ 0.8865 0.9208
Pennington, SD
6680 Reading, PA................................... 0.9152 0.9411
Berks, PA
6690 Redding, CA................................... 1.1664 1.1112
Shasta, CA
6720 Reno, NV...................................... 1.0550 1.0373
Washoe, NV
6740 Richland-Kennewick-Pasco, WA.................. 1.1460 1.0978
Benton, WA
Franklin, WA
6760 Richmond-Petersburg, VA....................... 0.9617 0.9736
Charles City County, VA
Chesterfield, VA
Colonial Heights City, VA
Dinwiddie, VA
Goochland, VA
Hanover, VA
Henrico, VA
Hopewell City, VA
New Kent, VA
Petersburg City, VA
Powhatan, VA
Prince George, VA
Richmond City, VA
6780 \1\ Riverside-San Bernardino, CA.............. 1.1115 1.0751
Riverside, CA
San Bernardino, CA
6800 Roanoke, VA................................... 0.8782 0.9149
Botetourt, VA
Roanoke, VA
Roanoke City, VA
Salem City, VA
6820 Rochester, MN................................. 1.1315 1.0883
Olmsted, MN
6840 \1\ Rochester, NY............................. 0.9182 0.9432
Genesee, NY
Livingston, NY
Monroe, NY
Ontario, NY
Orleans, NY
Wayne, NY
6880 Rockford, IL.................................. 0.8819 0.9175
Boone, IL
Ogle, IL
Winnebago, IL
6895 Rocky Mount, NC............................... 0.8849 0.9197
Edgecombe, NC
Nash, NC
6920 \1\ Sacramento, CA............................ 1.1957 1.1302
El Dorado, CA
Placer, CA
Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.................. 0.9575 0.9707
Bay, MI
Midland, MI
Saginaw, MI
6980 St. Cloud, MN................................. 1.0016 1.0011
Benton, MN
Stearns, MN
7000 St. Joseph, MO................................ 0.9071 0.9354
Andrew, MO
Buchanan, MO
7040 \1\ 1St. Louis, MO-IL......................... 0.9049 0.9339
Clinton, IL
Jersey, IL
Madison, IL
Monroe, IL
St. Clair, IL
Franklin, MO
Jefferson, MO
Lincoln, MO
St. Charles, MO
St. Louis, MO
St. Louis City, MO
Warren, MO
7080 Salem, OR..................................... 1.0132 1.0090
Marion, OR
Polk, OR
7120 Salinas, CA................................... 1.4502 1.2899
Monterey, CA
7160 \1\ Salt Lake City-Ogden, UT.................. 0.9811 0.9870
Davis, UT
Salt Lake, UT
Weber, UT
7200 San Angelo, TX................................ 0.8083 0.8644
Tom Green, TX
7240 \1\ San Antonio, TX........................... 0.8580 0.9004
Bexar, TX
Comal, TX
Guadalupe, TX
Wilson, TX
7320 \1\ San Diego, CA............................. 1.1784 1.1190
San Diego, CA
7360 \1\ San Francisco, CA......................... 1.4193 1.2710
Marin, CA
San Francisco, CA
San Mateo, CA
7400 \1\ San Jose, CA.............................. 1.3564 1.2321
Santa Clara, CA
7440 \1\ San Juan-Bayamon, PR...................... 0.4690 0.5954
Aguas Buenas, PR
Barceloneta, PR
Bayamon, PR
Canovanas, PR
Carolina, PR
Catano, PR
Ceiba, PR
Comerio, PR
Corozal, PR
Dorado, PR
Fajardo, PR
Florida, PR
Guaynabo, PR
Humacao, PR
Juncos, PR
Los Piedras, PR
Loiza, PR
Luguillo, PR
Manati, PR
Morovis, PR
Naguabo, PR
Naranjito, PR
Rio Grande, PR
San Juan, PR
Toa Alta, PR
Toa Baja, PR
Trujillo Alto, PR
[[Page 47155]]
Vega Alta, PR
Vega Baja, PR
Yabucoa, PR
7460 San Luis Obispo-Atascadero-Paso Robles, CA.... 1.0673 1.0456
San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.......... 1.0597 1.0405
Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA.................... 1.4095 1.2650
Santa Cruz, CA
7490 Santa Fe, NM.................................. 1.0537 1.0365
Los Alamos, NM
Santa Fe, NM
7500 Santa Rosa, CA................................ 1.2646 1.1744
Sonoma, CA
7510 Sarasota-Bradenton, FL........................ 0.9809 0.9869
Manatee, FL
Sarasota, FL
7520 Savannah, GA.................................. 0.9697 0.9792
Bryan, GA
Chatham, GA
Effingham, GA
7560 \2\ Scranton--Wilkes-Barre--Hazleton, PA...... 0.8578 0.9003
Columbia, PA
Lackawanna, PA
Luzerne, PA
Wyoming, PA
7600 \1\ Seattle-Bellevue-Everett, WA.............. 1.1016 1.0685
Island, WA
King, WA
Snohomish, WA
7610 \2\ Sharon, PA................................ 0.8578 0.9003
Mercer, PA
7620 \2\ Sheboygan, WI............................. 0.8880 0.9219
Sheboygan, WI
7640 Sherman-Denison, TX........................... 0.8795 0.9158
Grayson, TX
7680 Shreveport-Bossier City, LA................... 0.8750 0.9126
Bossier, LA
Caddo, LA
Webster, LA
7720 Sioux City, IA-NE............................. 0.8473 0.8927
Woodbury, IA
Dakota, NE
7760 Sioux Falls, SD............................... 0.8790 0.9155
Lincoln, SD
Minnehaha, SD
7800 South Bend, IN................................ 1.0029 1.0020
St. Joseph, IN
7840 Spokane, WA................................... 1.0513 1.0349
Spokane, WA
7880 Springfield, IL............................... 0.8685 0.9080
Menard, IL
Sangamon, IL
7920 Springfield, MO............................... 0.8488 0.8938
Christian, MO
Greene, MO
Webster, MO
8003 \2\ Springfield, MA........................... 1.1204 1.0810
Hampden, MA
Hampshire, MA
8050 State College, PA............................. 0.9038 0.9331
Centre, PA
8080 \2\ Steubenville-Weirton, OH-WV (OH Hospitals) 0.8670 0.9069
Jefferson, OH
Brooke, WV
Hancock, WV
8080 Steubenville-Weirton, OH-WV (WV Hospitals).... 0.8548 0.8981
Jefferson, OH
Brooke, WV
Hancock, WV
8120 Stockton-Lodi, CA............................. 1.0629 1.0427
San Joaquin, CA
8140 \2\ Sumter, SC................................ 0.8370 0.8853
Sumter, SC
8160 Syracuse, NY.................................. 0.9594 0.9720
Cayuga, NY
Madison, NY
Onondaga, NY
Oswego, NY
8200 Tacoma, WA.................................... 1.1564 1.1046
Pierce, WA
8240 \2\ Tallahassee, FL........................... 0.8928 0.9253
Gadsden, FL
Leon, FL
8280 \1\ Tampa-St. Petersburg-Clearwater, FL....... 0.9099 0.9374
Hernando, FL
Hillsborough, FL
Pasco, FL
Pinellas, FL
8320 \2\ Terre Haute, IN........................... 0.8602 0.9020
Clay, IN
Vermillion, IN
Vigo, IN
8360 Texarkana, AR-Texarkana, TX................... 0.8427 0.8894
Miller, AR
Bowie, TX
8400 Toledo, OH.................................... 0.9664 0.9769
Fulton, OH
Lucas, OH
Wood, OH
8440 Topeka, KS.................................... 0.9117 0.9387
Shawnee, KS
8480 Trenton, NJ................................... 1.0137 1.0094
Mercer, NJ
8520 Tucson, AZ.................................... 0.8821 0.9177
Pima, AZ
8560 Tulsa, OK..................................... 0.8454 0.8914
Creek, OK
Osage, OK
Rogers, OK
Tulsa, OK
Wagoner, OK
8600 Tuscaloosa, AL................................ 0.8064 0.8630
Tuscaloosa, AL
8640 Tyler, TX..................................... 0.9404 0.9588
Smith, TX
8680 Utica-Rome, NY................................ 0.8560 0.8990
Herkimer, NY
Oneida, NY
8720 Vallejo-Fairfield-Napa, CA.................... 1.2266 1.1501
Napa, CA
Solano, CA
8735 Ventura, CA................................... 1.0479 1.0326
Ventura, CA
8750 Victoria, TX.................................. 0.8154 0.8696
Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.............. 1.0501 1.0340
Cumberland, NJ
8780 \2\ Visalia-Tulare-Porterville, CA............ 0.9861 0.9905
Tulare, CA
8800 Waco, TX...................................... 0.8314 0.8812
McLennan, TX
8840 \1\ Washington, DC-MD-VA-WV................... 1.0755 1.0511
District of Columbia, DC
Calvert, MD
Charles, MD
Frederick, MD
Montgomery, MD
Prince Georges, MD
Alexandria City, VA
Arlington, VA
Clarke, VA
Culpeper, VA
Fairfax, VA
Fairfax City, VA
Falls Church City, VA
Fauquier, VA
Fredericksburg City, VA
King George, VA
Loudoun, VA
Manassas City, VA
Manassas Park City, VA
Prince William, VA
Spotsylvania, VA
Stafford, VA
Warren, VA Berkeley, WV
Jefferson, WV
8920 Waterloo-Cedar Falls, IA...................... 0.8802 0.9163
Black Hawk, IA
8940 Wausau, WI.................................... 0.9426 0.9603
Marathon, WI
8960 \1\ 1West Palm Beach-Boca Raton, FL........... 0.9615 0.9735
Palm Beach, FL
9000 \2\ Wheeling, WV-OH (WV Hospitals)............ 0.8231 0.8752
Belmont, OH
Marshall, WV
[[Page 47156]]
Ohio, WV
9000 \2\ Wheeling, WV-OH (OH Hospitals)............ 0.8670 0.9069
Belmont, OH
Marshall, WV
Ohio, WV
9040 Wichita, KS................................... 0.9544 0.9685
Butler, KS
Harvey, KS
Sedgwick, KS
9080 Wichita Falls, TX............................. 0.7668 0.8337
Archer, TX
Wichita, TX
9140 \2\ Williamsport, PA.......................... 0.8578 0.9003
Lycoming, PA
9160 Wilmington-Newark, DE-MD...................... 1.1191 1.0801
New Castle, DE
Cecil, MD
9200 Wilmington, NC................................ 0.9402 0.9587
New Hanover, NC
Brunswick, NC
9260 \2\ Yakima, WA................................ 1.0434 1.0295
Yakima, WA
9270 Yolo, CA...................................... 1.0199 1.0136
Yolo, CA
9280 York, PA...................................... 0.9264 0.9490
York, PA
9320 Youngstown-Warren, OH......................... 0.9543 0.9685
Columbiana, OH
Mahoning, OH Trumbull, OH
9340 Yuba City, CA................................. 1.0706 1.0478
Sutter, CA
Yuba, CA
9360 Yuma, AZ...................................... 0.9529 0.9675
Yuma, AZ
------------------------------------------------------------------------
\1\ Large Urban Area.
\2\ Hospitals geographically located in the area are assigned the
statewide rural wage index for FY 2001.
Table 4b.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Rural Areas
------------------------------------------------------------------------
Wage
Nonurban area index GAF
------------------------------------------------------------------------
Alabama............................................. 0.7528 0.8233
Alaska.............................................. 1.2392 1.1582
Arizona............................................. 0.8317 0.8814
Arkansas............................................ 0.7445 0.8171
California.......................................... 0.9861 0.9905
Colorado............................................ 0.8968 0.9281
Connecticut......................................... 1.1715 1.1145
Delaware............................................ 0.9074 0.9356
Florida............................................. 0.8928 0.9253
Georgia............................................. 0.8329 0.8823
Hawaii.............................................. 1.1059 1.0714
Idaho............................................... 0.8678 0.9075
Illinois............................................ 0.8160 0.8700
Indiana............................................. 0.8602 0.9020
Iowa................................................ 0.8030 0.8605
Kansas.............................................. 0.7605 0.8290
Kentucky............................................ 0.7931 0.8532
Louisiana........................................... 0.7713 0.8371
Maine............................................... 0.8766 0.9138
Maryland............................................ 0.8651 0.9055
Massachusetts....................................... 1.1204 1.0810
Michigan............................................ 0.9021 0.9319
Minnesota........................................... 0.8881 0.9219
Mississippi......................................... 0.7491 0.8205
Missouri............................................ 0.7707 0.8366
Montana............................................. 0.8688 0.9082
Nebraska............................................ 0.8109 0.8663
Nevada.............................................. 0.9232 0.9467
New Hampshire....................................... 0.9845 0.9894
New Jersey \1\...................................... ........ ........
New Mexico.......................................... 0.8497 0.8945
New York............................................ 0.8499 0.8946
North Carolina...................................... 0.8441 0.8904
North Dakota........................................ 0.7716 0.8373
Ohio................................................ 0.8670 0.9069
Oklahoma............................................ 0.7491 0.8205
Oregon.............................................. 1.0132 1.0090
Pennsylvania........................................ 0.8578 0.9003
Puerto Rico......................................... 0.4264 0.5578
Rhode Island \1\.................................... ........ ........
South Carolina...................................... 0.8370 0.8853
South Dakota........................................ 0.7570 0.8264
Tennessee........................................... 0.7838 0.8464
Texas............................................... 0.7507 0.8217
Utah................................................ 0.9037 0.9330
Vermont............................................. 0.9427 0.9604
Virginia............................................ 0.8189 0.8721
Washington.......................................... 1.0434 1.0295
West Virginia....................................... 0.8231 0.8752
Wisconsin........................................... 0.8880 0.9219
Wyoming............................................. 0.8817 0.9174
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 4c.--Wage Index and Capital Geographic Adjustment Factor (GAF) for
Hospitals That Are Reclassified
------------------------------------------------------------------------
Wage
Area index GAF
------------------------------------------------------------------------
Abilene, TX......................................... 0.8240 0.8758
Akron, OH........................................... 0.9736 0.9818
Alexandria, LA...................................... 0.8170 0.8707
Amarillo, TX........................................ 0.8715 0.9101
Anchorage, AK....................................... 1.2865 1.1883
Ann Arbor, MI....................................... 1.1064 1.0717
Atlanta, GA......................................... 1.0096 1.0066
Atlantic-Cape May, NJ............................... 1.0822 1.0556
Augusta-Aiken, GA-SC................................ 0.9160 0.9417
Baton Rouge, LA..................................... 0.8734 0.9115
Benton Harbor, MI................................... 0.9021 0.9319
Bergen-Passaic, NJ.................................. 1.1605 1.1073
Billings, MT........................................ 0.9591 0.9718
Binghamton, NY...................................... 0.8690 0.9083
Birmingham, AL...................................... 0.8477 0.8930
Bismarck, ND........................................ 0.7897 0.8507
Bloomington-Normal, IL.............................. 0.9156 0.9414
Boise City, ID...................................... 0.9042 0.9334
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH 1.1160 1.0781
(NH, RI, and VT Hospitals).........................
Burlington, VT...................................... 1.0550 1.0373
Casper, WY.......................................... 0.8817 0.9174
Champaign-Urbana, IL................................ 0.9084 0.9363
Charleston-North Charleston, SC..................... 0.9067 0.9351
Charleston, WV...................................... 0.8904 0.9236
Charlotte-Gastonia-Rock Hill, NC-SC................. 0.9391 0.9579
Chattanooga, TN-GA.................................. 0.9624 0.9741
Chicago, IL......................................... 1.1015 1.0684
Cincinnati, OH-KY-IN................................ 0.9415 0.9596
Clarksville-Hopkinsville, TN-KY..................... 0.8277 0.8785
Cleveland-Lorain-Elyria, OH......................... 0.9593 0.9719
Columbia, MO........................................ 0.8756 0.9130
Columbia, SC........................................ 0.9433 0.9608
Columbus, OH........................................ 0.9619 0.9737
Dallas, TX.......................................... 0.9913 0.9940
Danville, VA........................................ 0.8212 0.8738
Davenport-Moline-Rock Island, IA-IL................. 0.8898 0.9232
Dayton-Springfield, OH.............................. 0.9442 0.9614
Denver, CO.......................................... 1.0181 1.0124
Des Moines, IA...................................... 0.9011 0.9312
Dothan, AL.......................................... 0.8013 0.8592
Dover, DE........................................... 0.9769 0.9841
Duluth-Superior, MN-WI.............................. 1.0043 1.0029
Eau Claire, WI...................................... 0.8880 0.9219
Erie, PA............................................ 0.8985 0.9293
Eugene-Springfield, OR.............................. 1.0965 1.0651
Fargo-Moorhead, ND-MN............................... 0.8517 0.8959
Fayetteville, NC.................................... 0.8469 0.8924
Flagstaff, AZ-UT.................................... 1.0525 1.0357
Flint, MI........................................... 1.1058 1.0713
Florence, AL........................................ 0.7652 0.8325
Florence, SC........................................ 0.8777 0.9145
Fort Collins-Loveland, CO........................... 1.0647 1.0439
Ft. Lauderdale, FL.................................. 1.0152 1.0104
Fort Pierce-Port St. Lucie, FL...................... 0.9622 0.9740
Fort Smith, AR-OK................................... 0.7947 0.8544
Fort Walton Beach, FL............................... 0.9358 0.9556
Fort Wayne, IN...................................... 0.8665 0.9065
Forth Worth-Arlington, TX........................... 0.9527 0.9674
Gadsden, AL......................................... 0.8423 0.8891
Grand Forks, ND-MN.................................. 0.8954 0.9271
Grand Junction, CO.................................. 0.9471 0.9635
Grand Rapids-Muskegon-Holland, MI................... 1.0248 1.0169
Great Falls, MT..................................... 0.9331 0.9537
Greeley, CO......................................... 0.9573 0.9706
Green Bay, WI....................................... 0.9308 0.9521
Greensboro-Winston-Salem-High Point, NC............. 0.9124 0.9391
Greenville, NC...................................... 0.9172 0.9425
Greenville-Spartanburg-Anderson, SC................. 0.9003 0.9306
Harrisburg-Lebanon-Carlisle, PA..................... 0.9386 0.9575
[[Page 47157]]
Hartford, CT (MA Hospital).......................... 1.1420 1.0952
Hattiesburg, MS..................................... 0.7491 0.8205
Hickory-Morganton-Lenoir, NC........................ 0.8577 0.9002
Honolulu, HI........................................ 1.1866 1.1243
Houston, TX......................................... 0.9732 0.9816
Huntington-Ashland, WV-KY-OH........................ 0.9605 0.9728
Huntsville, AL...................................... 0.8779 0.9147
Indianapolis, IN.................................... 0.9787 0.9854
Jackson, MS......................................... 0.8698 0.9089
Jackson, TN......................................... 0.8796 0.9159
Jacksonville, FL.................................... 0.9208 0.9451
Jersey City, NJ..................................... 1.1573 1.1052
Johnson City-Kingsport-Bristol, TN-VA............... 0.8328 0.8822
Joplin, MO.......................................... 0.8148 0.8691
Kalamazoo-Battlecreek, MI........................... 1.0311 1.0212
Kansas City, KS-MO.................................. 0.9498 0.9653
Knoxville, TN....................................... 0.8340 0.8831
Kokomo, IN.......................................... 0.9525 0.9672
Lafayette, LA....................................... 0.8490 0.8940
Lansing-East Lansing, MI............................ 0.9934 0.9955
Las Cruces, NM...................................... 0.8510 0.8954
Las Vegas, NV-AZ.................................... 1.0796 1.0538
Lexington, KY....................................... 0.8712 0.9099
Lima, OH............................................ 0.9320 0.9529
Lincoln, NE......................................... 0.9666 0.9770
Little Rock-North Little Rock, AR................... 0.8791 0.9155
Longview-Marshall, TX............................... 0.8732 0.9113
Los Angeles-Long Beach, CA.......................... 1.2033 1.1351
Louisville, KY-IN................................... 0.9350 0.9550
Lynchburg, VA....................................... 0.8749 0.9125
Macon, GA........................................... 0.8974 0.9285
Madison, WI......................................... 1.0271 1.0185
Mansfield, OH....................................... 0.8690 0.9083
Memphis, TN-AR-MS................................... 0.8584 0.9007
Milwaukee-Waukesha, WI.............................. 0.9767 0.9840
Minneapolis-St. Paul, MN-WI......................... 1.1017 1.0686
Missoula, MT........................................ 0.9332 0.9538
Mobile, AL.......................................... 0.8163 0.8702
Monmouth-Ocean, NJ.................................. 1.1283 1.0862
Montgomery, AL...................................... 0.7653 0.8326
Myrtle Beach, SC (NC Hospital)...................... 0.8441 0.8904
Nashville, TN....................................... 0.9301 0.9516
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT. 1.2034 1.1352
New London-Norwich, CT.............................. 1.1926 1.1282
New Orleans, LA..................................... 0.9295 0.9512
New York, NY........................................ 1.4463 1.2875
Newburgh, NY-PA..................................... 1.0666 1.0451
Norfolk-Virginia Beach-Newport News, VA-NC.......... 0.8441 0.8904
Oakland, CA......................................... 1.4983 1.3190
Ocala, FL........................................... 0.9243 0.9475
Odessa-Midland, TX.................................. 0.9074 0.9356
Oklahoma City, OK................................... 0.8822 0.9177
Omaha, NE-IA........................................ 0.9572 0.9705
Orange County, CA................................... 1.1411 1.0946
Orlando, FL......................................... 0.9610 0.9731
Peoria-Pekin, IL.................................... 0.8646 0.9052
Philadelphia, PA-NJ................................. 1.0937 1.0633
Pine Bluff, AR...................................... 0.7680 0.8346
Pittsburgh, PA...................................... 0.9575 0.9707
Pittsfield, MA (VT Hospital)........................ 0.9914 0.9941
Pocatello, ID....................................... 0.8715 0.9101
Portland, ME........................................ 0.9629 0.9744
Portland-Vancouver, OR-WA........................... 1.0910 1.0615
Provo-Orem, UT...................................... 1.0041 1.0028
Raleigh-Durham-Chapel Hill, NC...................... 0.9646 0.9756
Rapid City, SD...................................... 0.8865 0.9208
Redding, CA......................................... 1.1664 1.1112
Reno, NV............................................ 1.0438 1.0298
Richland-Kennewick-Pasco, WA........................ 1.1147 1.0772
Roanoke, VA......................................... 0.8782 0.9149
Rochester, MN....................................... 1.1315 1.0883
Rockford, IL........................................ 0.8819 0.9175
Sacramento, CA...................................... 1.1957 1.1302
Saginaw-Bay City-Midland, MI........................ 0.9575 0.9707
St. Cloud, MN....................................... 1.0016 1.0011
St. Joseph, MO...................................... 0.8848 0.9196
St. Louis, MO-IL.................................... 0.9049 0.9339
Salinas, CA......................................... 1.4502 1.2899
Salt Lake City-Ogden, UT............................ 0.9811 0.9870
San Diego, CA....................................... 1.1784 1.1190
Santa Cruz-Watsonville, CA.......................... 1.3897 1.2528
Santa Fe, NM........................................ 1.0000 1.0000
Santa Rosa, CA...................................... 1.2398 1.1586
Seattle-Bellevue-Everett, WA........................ 1.1016 1.0685
Sherman-Denison, TX................................. 0.8795 0.9158
Sioux City, IA-NE................................... 0.8473 0.8927
South Bend, IN...................................... 1.0029 1.0020
Spokane, WA......................................... 1.0333 1.0227
Springfield, IL..................................... 0.8685 0.9080
Springfield, MO..................................... 0.8212 0.8738
Syracuse, NY........................................ 0.9594 0.9720
Tampa-St. Petersburg-Clearwater, FL................. 0.9099 0.9374
Texarkana, AR-Texarkana, TX......................... 0.8427 0.8894
Toledo, OH.......................................... 0.9664 0.9769
Topeka, KS.......................................... 0.9117 0.9387
Tucson, AZ.......................................... 0.8821 0.9177
Tulsa, OK........................................... 0.8454 0.8914
Tuscaloosa, AL...................................... 0.8064 0.8630
Tyler, TX........................................... 0.9141 0.9403
Victoria, TX........................................ 0.8154 0.8696
Washington, DC-MD-VA-WV............................. 1.0755 1.0511
Waterloo-Cedar Falls, IA............................ 0.8802 0.9163
Wausau, WI.......................................... 0.9426 0.9603
Wichita, KS......................................... 0.9262 0.9489
Rural Alabama....................................... 0.7528 0.8233
Rural Florida....................................... 0.8928 0.9253
Rural Illinois...................................... 0.8160 0.8700
Rural Louisiana..................................... 0.7713 0.8371
Rural Michigan...................................... 0.9021 0.9319
Rural Minnesota..................................... 0.8881 0.9219
Rural Missouri...................................... 0.7707 0.8366
Rural Montana....................................... 0.8688 0.9082
Rural Oregon........................................ 1.0132 1.0090
Rural Texas......................................... 0.7507 0.8217
Rural Washington.................................... 1.0434 1.0295
Rural West Virginia................................. 0.8231 0.8752
Rural Wisconsin..................................... 0.8880 0.9219
Rural Wyoming (NE Hospital)......................... 0.8671 0.9070
------------------------------------------------------------------------
Table 4d.--Average Hourly Wage for Urban Areas
------------------------------------------------------------------------
Average
Urban area hourly
wage
------------------------------------------------------------------------
Abilene, TX.................................................. 17.9387
Aguadilla, PR................................................ 9.5583
Akron, OH.................................................... 21.1962
Albany, GA................................................... 21.6247
Albany-Schenectady-Troy, NY.................................. 18.6106
Albuquerque, NM.............................................. 19.8899
Alexandria, LA............................................... 17.7452
Allentown-Bethlehem-Easton, PA............................... 21.8571
Altoona, PA.................................................. 20.3472
Amarillo, TX................................................. 18.9724
Anchorage, AK................................................ 27.8515
Ann Arbor, MI................................................ 24.5003
Anniston, AL................................................. 18.0347
Appleton-Oshkosh-Neenah, WI.................................. 19.7058
Arecibo, PR.................................................. 9.8505
Asheville, NC................................................ 20.7157
Athens, GA................................................... 21.2027
Atlanta, GA.................................................. 21.9792
Atlantic-Cape May, NJ........................................ 24.3440
Auburn-Opelika, AL........................................... 17.6461
Augusta-Aiken, GA-SC......................................... 19.9424
Austin-San Marcos, TX........................................ 20.8502
Bakersfield, CA.............................................. 21.0688
Baltimore, MD................................................ 20.3888
Bangor, ME................................................... 20.8150
Barnstable-Yarmouth, MA...................................... 30.1277
Baton Rouge, LA.............................................. 19.2487
Beaumont-Port Arthur, TX..................................... 19.0352
Bellingham, WA............................................... 24.9039
Benton Harbor, MI............................................ 18.8768
Bergen-Passaic, NJ........................................... 25.7937
Billings, MT................................................. 20.8676
Biloxi-Gulfport-Pascagoula, MS............................... 17.9290
Binghamton, NY............................................... 18.9175
Birmingham, AL............................................... 18.4002
Bismarck, ND................................................. 16.7742
Bloomington,IN............................................... 19.0130
Bloomington-Normal, IL....................................... 19.8003
Boise City, ID............................................... 19.6053
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH............. 24.2959
Boulder-Longmont, CO......................................... 21.1843
Brazoria, TX................................................. 18.8483
Bremerton, WA................................................ 23.8918
Brownsville-Harlingen-San Benito, TX......................... 18.9870
[[Page 47158]]
Bryan-College Station, TX.................................... 17.9324
Buffalo-Niagara Falls, NY.................................... 20.8552
Burlington, VT............................................... 23.3707
Caguas, PR................................................... 9.9325
Canton-Massillon, OH......................................... 18.6867
Casper, WY................................................... 18.9923
Cedar Rapids, IA............................................. 19.0186
Champaign-Urbana, IL......................................... 20.0245
Charleston-North Charleston, SC.............................. 19.6765
Charleston, WV............................................... 20.1160
Charlotte-Gastonia-Rock Hill, NC-SC.......................... 20.4436
Charlottesville, VA.......................................... 23.4885
Chattanooga, TN-GA........................................... 21.4064
Cheyenne, WY................................................. 18.0869
Chicago, IL.................................................. 24.2653
Chico-Paradise, CA........................................... 21.5925
Cincinnati, OH-KY-IN......................................... 20.4967
Clarksville-Hopkinsville, TN-KY.............................. 17.8606
Cleveland-Lorain-Elyria, OH.................................. 20.8921
Colorado Springs, CO......................................... 21.1114
Columbia, MO................................................. 19.5074
Columbia, SC................................................. 20.7995
Columbus, GA-AL.............................................. 18.6521
Columbus, OH................................................. 20.9403
Corpus Christi, TX........................................... 18.9962
Corvallis, OR................................................ 24.6574
Cumberland, MD-WV............................................ 18.2190
Dallas, TX................................................... 21.5801
Danville, VA................................................. 18.6983
Davenport-Moline-Rock Island, IA-IL.......................... 19.3712
Dayton-Springfield, OH....................................... 20.5545
Daytona Beach, FL............................................ 20.0282
Decatur, AL.................................................. 18.5791
Decatur, IL.................................................. 17.6894
Denver, CO................................................... 22.1647
Des Moines, IA............................................... 19.8508
Detroit, MI.................................................. 22.8814
Dothan, AL................................................... 17.2926
Dover, DE.................................................... 21.9391
Dubuque, IA.................................................. 19.0397
Duluth-Superior, MN-WI....................................... 21.8388
Dutchess County, NY.......................................... 22.3121
Eau Claire, WI............................................... 19.1358
El Paso, TX.................................................. 20.3455
Elkhart-Goshen, IN........................................... 19.9093
Elmira, NY................................................... 18.6041
Enid, OK..................................................... 18.7450
Erie, PA..................................................... 19.5597
Eugene-Springfield, OR....................................... 23.8704
Evansville, Henderson, IN-KY................................. 17.7939
Fargo-Moorhead, ND-MN........................................ 19.0467
Fayetteville, NC............................................. 18.8418
Fayetteville-Springdale-Rogers, AR........................... 17.2213
Flagstaff, AZ-UT............................................. 23.2631
Flint, MI.................................................... 24.3942
Florence, AL................................................. 16.5808
Florence, SC................................................. 19.1069
Fort Collins-Loveland, CO.................................... 23.1791
Fort Lauderdale, FL.......................................... 22.0334
Fort Myers-Cape Coral, FL.................................... 20.1312
Fort Pierce-Port St. Lucie, FL............................... 20.7635
Fort Smith, AR-OK............................................ 17.5292
Fort Walton Beach, FL........................................ 20.9154
Fort Wayne, IN............................................... 18.8629
Fort Worth-Arlington, TX..................................... 20.7411
Fresno, CA................................................... 21.9976
Gadsden, AL.................................................. 18.3371
Gainesville, FL.............................................. 21.9311
Galveston-Texas City, TX..................................... 21.5917
Gary, IN..................................................... 20.5814
Glens Falls, NY.............................................. 18.2029
Goldsboro, NC................................................ 18.3380
Grand Forks, ND-MN........................................... 19.1930
Grand Junction, CO........................................... 19.8299
Grand Rapids-Muskegon-Holland, MI............................ 22.3091
Great Falls, MT.............................................. 19.7346
Greeley, CO.................................................. 21.3659
Green Bay, WI................................................ 20.0839
Greensboro-Winston-Salem-High Point, NC...................... 19.8775
Greenville, NC............................................... 20.4282
Greenville-Spartanburg-Anderson, SC.......................... 19.5991
Hagerstown, MD............................................... 20.4841
Hamilton-Middletown, OH...................................... 19.7254
Harrisburg-Lebanon-Carlisle, PA.............................. 20.4334
Hartford, CT................................................. 24.7589
Hattiesburg, MS.............................................. 16.3068
Hickory-Morganton-Lenoir, NC................................. 19.6096
Honolulu, HI................................................. 25.8269
Houma, LA.................................................... 17.6029
Houston, TX.................................................. 21.1868
Huntington-Ashland, WV-KY-OH................................. 21.4993
Huntsville, AL............................................... 19.4455
Indianapolis, IN............................................. 21.3060
Iowa City, IA................................................ 21.0244
Jackson, MI.................................................. 19.8852
Jackson, MS.................................................. 19.1842
Jackson, TN.................................................. 19.1498
Jacksonville, FL............................................. 20.0465
Jacksonville, NC............................................. 16.9298
Jamestown, NY................................................ 17.0195
Janesville-Beloit, WI........................................ 20.8677
Jersey City, NJ.............................................. 25.0412
Johnson City-Kingsport-Bristol, TN-VA........................ 18.0083
Johnstown, PA................................................ 19.2587
Jonesboro, AR................................................ 17.0500
Joplin, MO................................................... 17.7376
Kalamazoo-Battlecreek, MI.................................... 22.7571
Kankakee, IL................................................. 21.5573
Kansas City, KS-MO........................................... 20.6781
Kenosha, WI.................................................. 20.9242
Killeen-Temple, TX........................................... 22.0298
Knoxville, TN................................................ 18.1556
Kokomo, IN................................................... 20.7207
La Crosse, WI-MN............................................. 20.0533
Lafayette, LA................................................ 18.4838
Lafayette, IN................................................ 19.2317
Lake Charles, LA............................................. 16.1070
Lakeland-Winter Haven, FL.................................... 20.1126
Lancaster, PA................................................ 20.1576
Lansing-East Lansing, MI..................................... 21.6264
Laredo, TX................................................... 17.7822
Las Cruces, NM............................................... 18.8479
Las Vegas, NV-AZ............................................. 23.5027
Lawrence, KS................................................. 17.8290
Lawton, OK................................................... 19.5850
Lewiston-Auburn, ME.......................................... 19.6724
Lexington, KY................................................ 19.3007
Lima, OH..................................................... 20.2889
Lincoln, NE.................................................. 20.9569
Little Rock-North Little Rock, AR............................ 19.3875
Longview-Marshall, TX........................................ 19.4243
Los Angeles-Long Beach, CA................................... 26.1164
Louisville, KY-IN............................................ 20.3544
Lubbock, TX.................................................. 19.2404
Lynchburg, VA................................................ 19.3031
Macon, GA.................................................... 19.5357
Madison, WI.................................................. 22.3606
Mansfield, OH................................................ 18.9191
Mayaguez, PR................................................. 9.9900
McAllen-Edinburg-Mission, TX................................. 18.6487
Medford-Ashland, OR.......................................... 22.5185
Melbourne-Titusville-Palm Bay, FL............................ 21.0904
Memphis, TN-AR-MS............................................ 18.9896
Merced, CA................................................... 20.9989
Miami, FL.................................................... 21.8997
Middlesex-Somerset-Hunterdon, NJ............................. 24.1094
Milwaukee-Waukesha, WI....................................... 21.2638
Minneapolis-St. Paul, MN-WI.................................. 23.9833
Missoula, MT................................................. 20.1896
Mobile, AL................................................... 17.7700
Modesto, CA.................................................. 22.6325
Monmouth-Ocean, NJ........................................... 24.5529
Monroe, LA................................................... 18.2776
Montgomery, AL............................................... 16.6605
Muncie, IN................................................... 23.8791
Myrtle Beach, SC............................................. 18.3751
Naples, FL................................................... 21.0332
Nashville, TN................................................ 20.6601
Nassau-Suffolk, NY........................................... 30.3304
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT.......... 26.7711
New London-Norwich, CT....................................... 26.2605
New Orleans, LA.............................................. 20.2347
New York, NY................................................. 31.8954
Newark, NJ................................................... 25.7698
Newburgh, NY-PA.............................................. 23.6150
Norfolk-Virginia Beach-Newport News, VA-NC................... 18.3132
Oakland, CA.................................................. 32.6189
Ocala, FL.................................................... 20.1230
Odessa-Midland, TX........................................... 20.0403
Oklahoma City, OK............................................ 19.2048
Olympia, WA.................................................. 23.2441
Omaha, NE-IA................................................. 20.8374
Orange County, CA............................................ 24.9648
Orlando, FL.................................................. 20.9206
Owensboro, KY................................................ 17.7626
Panama City, FL.............................................. 19.6150
Parkersburg-Marietta, WV-OH.................................. 18.0122
Pensacola, FL................................................ 17.7997
Peoria-Pekin, IL............................................. 18.8206
Philadelphia, PA-NJ.......................................... 23.8095
Phoenix-Mesa, AZ............................................. 21.0494
Pine Bluff, AR............................................... 16.9610
Pittsburgh, PA............................................... 21.2070
Pittsfield, MA............................................... 22.3968
Pocatello, ID................................................ 19.7591
Ponce, PR.................................................... 10.8985
Portland, ME................................................. 21.2220
Portland-Vancouver, OR-WA.................................... 23.7513
Providence-Warwick, RI....................................... 23.6503
Provo-Orem, UT............................................... 21.8338
Pueblo, CO................................................... 19.1909
Punta Gorda, FL.............................................. 20.9268
Racine, WI................................................... 20.1287
Raleigh-Durham-Chapel Hill, NC............................... 21.0003
Rapid City, SD............................................... 19.2995
Reading, PA.................................................. 19.9251
Redding, CA.................................................. 25.3926
[[Page 47159]]
Reno, NV..................................................... 22.9669
Richland-Kennewick-Pasco, WA................................. 24.9481
Richmond-Petersburg, VA...................................... 20.9366
Riverside-San Bernardino, CA................................. 24.4685
Roanoke, VA.................................................. 19.0494
Rochester, MN................................................ 24.6337
Rochester, NY................................................ 19.9884
Rockford, IL................................................. 19.1994
Rocky Mount, NC.............................................. 19.2653
Sacramento, CA............................................... 26.0143
Saginaw-Bay City-Midland, MI................................. 20.8446
St. Cloud, MN................................................ 21.8042
St. Joseph, MO............................................... 19.7467
St. Louis, MO-IL............................................. 19.6997
Salem, OR.................................................... 22.1817
Salinas, CA.................................................. 31.5702
Salt Lake City-Ogden, UT..................................... 21.3500
San Angelo, TX............................................... 17.5980
San Antonio, TX.............................................. 18.6797
San Diego, CA................................................ 25.6544
San Francisco, CA............................................ 30.8184
San Jose, CA................................................. 29.7210
San Juan-Bayamon, PR......................................... 10.2110
San Luis Obispo-Atascadero-Paso Robles, CA................... 23.2360
Santa Barbara-Santa Maria-Lompoc, CA......................... 23.0707
Santa Cruz-Watsonville, CA................................... 30.5664
Santa Fe, NM................................................. 22.9400
Santa Rosa, CA............................................... 27.5311
Sarasota-Bradenton, FL....................................... 21.3554
Savannah, GA................................................. 21.1099
Scranton-Wilkes Barre-Hazleton, PA........................... 18.3332
Seattle-Bellevue-Everett, WA................................. 23.9393
Sharon, PA................................................... 17.2591
Sheboygan, WI................................................ 18.2407
Sherman-Denison, TX.......................................... 18.9273
Shreveport-Bossier City, LA.................................. 19.0499
Sioux City, IA-NE............................................ 18.4457
Sioux Falls, SD.............................................. 19.1359
South Bend, IN............................................... 21.7709
Spokane, WA.................................................. 22.8867
Springfield, IL.............................................. 18.9066
Springfield, MO.............................................. 18.4778
Springfield, MA.............................................. 23.1578
State College, PA............................................ 19.6769
Steubenville-Weirton, OH-WV.................................. 18.6092
Stockton-Lodi, CA............................................ 23.1397
Sumter, SC................................................... 18.0057
Syracuse, NY................................................. 20.7876
Tacoma, WA................................................... 25.1749
Tallahassee, FL.............................................. 18.6017
Tampa-St. Petersburg-Clearwater, FL.......................... 19.5532
Terre Haute, IN.............................................. 18.0773
Texarkana, AR-Texarkana, TX.................................. 18.2062
Toledo, OH................................................... 21.4050
Topeka, KS................................................... 19.8476
Trenton, NJ.................................................. 22.0690
Tucson, AZ................................................... 19.1447
Tulsa, OK.................................................... 18.4038
Tuscaloosa, AL............................................... 17.5550
Tyler, TX.................................................... 20.4737
Utica-Rome, NY............................................... 18.6360
Vallejo-Fairfield-Napa, CA................................... 27.9688
Ventura, CA.................................................. 24.0125
Victoria, TX................................................. 17.7514
Vineland-Millville-Bridgeton, NJ............................. 22.8607
Visalia-Tulare-Porterville, CA............................... 20.7921
Waco, TX..................................................... 18.1006
Washington, DC-MD-VA-WV...................................... 23.4147
Waterloo-Cedar Falls, IA..................................... 18.2949
Wausau, WI................................................... 20.5039
West Palm Beach-Boca Raton, FL............................... 21.0777
Wheeling, OH-WV.............................................. 16.8341
Wichita, KS.................................................. 20.7776
Wichita Falls, TX............................................ 16.6925
Williamsport, PA............................................. 18.2688
Wilmington-Newark, DE-MD..................................... 24.3629
Wilmington, NC............................................... 20.4690
Yakima, WA................................................... 21.5675
Yolo, CA..................................................... 22.2042
York, PA..................................................... 20.1674
Youngstown-Warren, OH........................................ 20.7757
Yuba City, CA................................................ 23.3065
Yuma, AZ..................................................... 20.7458
------------------------------------------------------------------------
Table 4e.--Average Hourly Wage for Rural Areas
------------------------------------------------------------------------
Average
Nonurban area hourly
wage
------------------------------------------------------------------------
Alabama...................................................... 16.3047
Alaska....................................................... 26.9769
Arizona...................................................... 18.1056
Arkansas..................................................... 16.2080
California................................................... 21.4673
Colorado..................................................... 19.5235
Connecticut.................................................. 25.5035
Delaware..................................................... 19.7543
Florida...................................................... 19.4165
Georgia...................................................... 18.1321
Hawaii....................................................... 24.0749
Idaho........................................................ 18.8912
Illinois..................................................... 17.7653
Indiana...................................................... 18.7277
Iowa......................................................... 17.4823
Kansas....................................................... 16.5568
Kentucky..................................................... 17.2663
Louisiana.................................................... 16.6925
Maine........................................................ 19.0838
Maryland..................................................... 18.8330
Massachusetts................................................ 24.3924
Michigan..................................................... 19.5659
Minnesota.................................................... 19.3332
Mississippi.................................................. 16.3073
Missouri..................................................... 16.7596
Montana...................................................... 18.9143
Nebraska..................................................... 17.6541
Nevada....................................................... 20.0985
New Hampshire................................................ 21.4334
New Jersey \1\............................................... .........
New Mexico................................................... 18.4985
New York..................................................... 18.5034
North Carolina............................................... 18.3772
North Dakota................................................. 16.7982
Ohio......................................................... 18.8756
Oklahoma..................................................... 16.3084
Oregon....................................................... 22.0574
Pennsylvania................................................. 18.6739
Puerto Rico.................................................. 9.2817
Rhode Island \1\............................................. .........
South Carolina............................................... 18.2215
South Dakota................................................. 16.4806
Tennessee.................................................... 17.0628
Texas........................................................ 16.3317
Utah......................................................... 19.6740
Vermont...................................................... 20.1891
Virginia..................................................... 17.8284
Washington................................................... 22.7144
West Virginia................................................ 17.9182
Wisconsin.................................................... 19.3321
Wyoming...................................................... 19.1944
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.
Table 4f.--Puerto Rico Wage Index and Capital Geographic Adjustment Factor (GAF)
----------------------------------------------------------------------------------------------------------------
Wage index-- GAF--
Area Wage index GAF reclass. reclass.
hospitals hospitals
----------------------------------------------------------------------------------------------------------------
Aguadilla, PR................................... 0.9380 0.9571 .............. ..............
Arecibo, PR..................................... 0.9667 0.9771 .............. ..............
Caguas, PR...................................... 0.9747 0.9826 .............. ..............
Mayaguez, PR.................................... 0.9803 0.9865 .............. ..............
Ponce, PR....................................... 1.0695 1.0471 .............. ..............
San Juan-Bayamon, PR............................ 1.0020 1.0014 .............. ..............
Rural Puerto Rico............................... 0.9108 0.9380 .............. ..............
----------------------------------------------------------------------------------------------------------------
[[Page 47160]]
Table 5.--List of Diagnosis Related Groups (DRGs), Relative Weighting Factors, Geometric and Arithmetic Mean
Length of Stay
----------------------------------------------------------------------------------------------------------------
Relative Geometric Arithmetic
DRG MDC Type DRG title weights mean LOS mean LOS
----------------------------------------------------------------------------------------------------------------
1.............. 01 SURG CRANIOTOMY AGE >17 EXCEPT 3.0970 6.3 9.1
FOR TRAUMA.
2.............. 01 SURG CRANIOTOMY FOR TRAUMA AGE 3.1142 7.3 9.7
>17.
3.............. 01 SURG *CRANIOTOMY AGE 0-17...... 1.9629 12.7 12.7
4.............. 01 SURG SPINAL PROCEDURES......... 2.2918 4.8 7.4
5.............. 01 SURG EXTRACRANIAL VASCULAR 1.4321 2.3 3.3
PROCEDURES.
6.............. 01 SURG CARPAL TUNNEL RELEASE..... .8246 2.2 3.2
7.............. 01 SURG PERIPH & CRANIAL NERVE & 2.5919 6.9 10.3
OTHER NERV SYST PROC W CC.
8.............. 01 SURG PERIPH & CRANIAL NERVE & 1.3948 2.1 3.0
OTHER NERV SYST PROC W/O
CC.
9.............. 01 MED SPINAL DISORDERS & 1.3134 4.7 6.6
INJURIES.
10............. 01 MED NERVOUS SYSTEM NEOPLASMS W 1.2273 4.9 6.7
CC.
11............. 01 MED NERVOUS SYSTEM NEOPLASMS W/ .8345 3.1 4.2
O CC.
12............. 01 MED DEGENERATIVE NERVOUS .8925 4.5 6.1
SYSTEM DISORDERS.
13............. 01 MED MULTIPLE SCLEROSIS & .7644 4.1 5.1
CEREBELLAR ATAXIA.
14............. 01 MED SPECIFIC CEREBROVASCULAR 1.2070 4.7 6.1
DISORDERS EXCEPT TIA.
15............. 01 MED TRANSIENT ISCHEMIC ATTACK .7480 2.9 3.6
& PRECEREBRAL OCCLUSIONS.
16............. 01 MED NONSPECIFIC 1.1652 4.7 6.2
CEREBROVASCULAR DISORDERS
W CC.
17............. 01 MED NONSPECIFIC .6539 2.6 3.4
CEREBROVASCULAR DISORDERS
W/O CC.
18............. 01 MED CRANIAL & PERIPHERAL NERVE .9600 4.3 5.6
DISORDERS W CC.
19............. 01 MED CRANIAL & PERIPHERAL NERVE .6963 2.9 3.7
DISORDERS W/O CC.
20............. 01 MED NERVOUS SYSTEM INFECTION 2.7744 7.9 10.6
EXCEPT VIRAL MENINGITIS.
21............. 01 MED VIRAL MENINGITIS.......... 1.4966 5.2 6.9
22............. 01 MED HYPERTENSIVE 1.0082 3.8 5.0
ENCEPHALOPATHY.
23............. 01 MED NONTRAUMATIC STUPOR & COMA .8027 3.2 4.2
24............. 01 MED SEIZURE & HEADACHE AGE >17 .9914 3.7 5.0
W CC.
25............. 01 MED SEIZURE & HEADACHE AGE >17 .6043 2.6 3.3
W/O CC.
26............. 01 MED SEIZURE & HEADACHE AGE 0- .6441 2.4 3.2
17.
27............. 01 MED TRAUMATIC STUPOR & COMA, 1.2912 3.2 5.1
COMA 1 HR.
28............. 01 MED TRAUMATIC STUPOR & COMA, 1.3102 4.5 6.3
COMA 1 HR AGE >17 W CC.
29............. 01 MED TRAUMATIC STUPOR & COMA, .7015 2.8 3.7
COMA 1 HR AGE 17 W/O CC.
30............. 01 MED *TRAUMATIC STUPOR & COMA, .3320 2.0 2.0
COMA 1 HR AGE 0-17.
31............. 01 MED CONCUSSION AGE >17 W CC... .8715 3.1 4.2
32............. 01 MED CONCUSSION AGE >17 W/O CC. .5422 2.1 2.7
33............. 01 MED *CONCUSSION AGE 0-17...... .2086 1.6 1.6
34............. 01 MED OTHER DISORDERS OF NERVOUS 1.0099 3.8 5.2
SYSTEM W CC.
35............. 01 MED OTHER DISORDERS OF NERVOUS .6027 2.7 3.4
SYSTEM W/O CC.
36............. 02 SURG RETINAL PROCEDURES........ .6639 1.2 1.4
37............. 02 SURG ORBITAL PROCEDURES........ 1.0016 2.6 3.7
38............. 02 SURG PRIMARY IRIS PROCEDURES... .4833 1.8 2.5
39............. 02 SURG LENS PROCEDURES WITH OR .5778 1.5 1.9
WITHOUT VITRECTOMY.
40............. 02 SURG EXTRAOCULAR PROCEDURES .8635 2.3 3.6
EXCEPT ORBIT AGE >17.
41............. 02 SURG *EXTRAOCULAR PROCEDURES .3380 1.6 1.6
EXCEPT ORBIT AGE 0-17.
42............. 02 SURG INTRAOCULAR PROCEDURES .6478 1.6 2.2
EXCEPT RETINA, IRIS &
LENS.
43............. 02 MED HYPHEMA................... .4977 2.6 3.4
44............. 02 MED ACUTE MAJOR EYE INFECTIONS .6337 4.1 5.0
45............. 02 MED NEUROLOGICAL EYE DISORDERS .7022 2.7 3.3
46............. 02 MED OTHER DISORDERS OF THE EYE .7749 3.5 4.6
AGE >17 W CC.
47............. 02 MED OTHER DISORDERS OF THE EYE .5085 2.5 3.3
AGE >17 W/O CC.
48............. 02 MED *OTHER DISORDERS OF THE .2977 2.9 2.9
EYE AGE 0-17.
49............. 03 SURG MAJOR HEAD & NECK 1.8301 3.5 5.0
PROCEDURES.
50............. 03 SURG SIALOADENECTOMY........... .8537 1.6 2.0
51............. 03 SURG SALIVARY GLAND PROCEDURES .7934 1.8 2.5
EXCEPT SIALOADENECTOMY.
52............. 03 SURG CLEFT LIP & PALATE REPAIR. .8410 1.6 2.1
53............. 03 SURG SINUS & MASTOID PROCEDURES 1.2118 2.3 3.7
AGE >17.
54............. 03 SURG *SINUS & MASTOID .4826 3.2 3.2
PROCEDURES AGE 0-17.
55............. 03 SURG MISCELLANEOUS EAR, NOSE, .9039 1.9 2.9
MOUTH & THROAT PROCEDURES.
56............. 03 SURG RHINOPLASTY............... .9451 2.1 3.1
57............. 03 SURG T&A PROC, EXCEPT 1.0704 2.5 4.0
TONSILLECTOMY &/OR
ADENOIDECTOMY ONLY, AGE
>17.
58............. 03 SURG *T&A PROC, EXCEPT .2740 1.5 1.5
TONSILLECTOMY &/OR
ADENOIDECTOMY ONLY, AGE 0-
17.
59............. 03 SURG TONSILLECTOMY &/OR .6943 1.8 2.5
ADENOIDECTOMY ONLY, AGE
>17.
60............. 03 SURG *TONSILLECTOMY &/OR .2087 1.5 1.5
ADENOIDECTOMY ONLY, AGE 0-
17.
61............. 03 SURG MYRINGOTOMY W TUBE 1.2660 2.8 4.8
INSERTION AGE >17.
62............. 03 SURG *MYRINGOTOMY W TUBE .2955 1.3 1.3
INSERTION AGE 0-17.
63............. 03 SURG OTHER EAR, NOSE, MOUTH & 1.3402 3.0 4.3
THROAT O.R. PROCEDURES.
64............. 03 MED EAR, NOSE, MOUTH & THROAT 1.2288 4.3 6.5
MALIGNANCY.
65............. 03 MED DYSEQUILIBRIUM............ .5385 2.3 2.9
[[Page 47161]]
66............. 03 MED EPISTAXIS................. .5590 2.5 3.2
67............. 03 MED EPIGLOTTITIS.............. .8105 2.8 3.5
68............. 03 MED OTITIS MEDIA & URI AGE >17 .6750 3.4 4.2
W CC.
69............. 03 MED OTITIS MEDIA & URI AGE >17 .5152 2.7 3.3
W/O CC.
70............. 03 MED OTITIS MEDIA & URI AGE 0- .4628 2.4 2.9
17.
71............. 03 MED LARYNGOTRACHEITIS......... .7712 3.0 3.9
72............. 03 MED NASAL TRAUMA & DEFORMITY.. .6428 2.6 3.3
73............. 03 MED OTHER EAR, NOSE, MOUTH & .7777 3.3 4.4
THROAT DIAGNOSES AGE >17.
74............. 03 MED *OTHER EAR, NOSE, MOUTH & .3358 2.1 2.1
THROAT DIAGNOSES AGE 0-17.
75............. 04 SURG MAJOR CHEST PROCEDURES.... 3.1331 7.8 10.0
76............. 04 SURG OTHER RESP SYSTEM O.R. 2.7908 8.4 11.3
PROCEDURES W CC.
77............. 04 SURG OTHER RESP SYSTEM O.R. 1.1887 3.5 5.0
PROCEDURES W/O CC.
78............. 04 MED PULMONARY EMBOLISM........ 1.3698 6.0 7.0
79............. 04 MED RESPIRATORY INFECTIONS & 1.6501 6.6 8.5
INFLAMMATIONS AGE >17 W
CC.
80............. 04 MED RESPIRATORY INFECTIONS & .9373 4.7 5.8
INFLAMMATIONS AGE >17 W/O
CC.
81............. 04 MED *RESPIRATORY INFECTIONS & 1.5204 6.1 6.1
INFLAMMATIONS AGE 0-17.
82............. 04 MED RESPIRATORY NEOPLASMS..... 1.3799 5.2 7.0
83............. 04 MED MAJOR CHEST TRAUMA W CC... .9808 4.4 5.6
84............. 04 MED MAJOR CHEST TRAUMA W/O CC. .5539 2.8 3.4
85............. 04 MED PLEURAL EFFUSION W CC..... 1.2198 4.9 6.4
86............. 04 MED PLEURAL EFFUSION W/O CC... .6984 2.9 3.8
87............. 04 MED PULMONARY EDEMA & 1.3781 4.8 6.3
RESPIRATORY FAILURE.
88............. 04 MED CHRONIC OBSTRUCTIVE .9317 4.2 5.2
PULMONARY DISEASE.
89............. 04 MED SIMPLE PNEUMONIA & 1.0647 5.0 6.0
PLEURISY AGE >17 W CC.
90............. 04 MED SIMPLE PNEUMONIA & .6590 3.6 4.2
PLEURISY AGE >17 W/O CC.
91............. 04 MED SIMPLE PNEUMONIA & .6890 2.8 3.4
PLEURISY AGE 0-17.
92............. 04 MED INTERSTITIAL LUNG DISEASE 1.1863 5.0 6.3
W CC.
93............. 04 MED INTERSTITIAL LUNG DISEASE .7309 3.3 4.1
W/O CC.
94............. 04 MED PNEUMOTHORAX W CC......... 1.1704 4.8 6.3
95............. 04 MED PNEUMOTHORAX W/O CC....... .6098 3.0 3.7
96............. 04 MED BRONCHITIS & ASTHMA AGE .7871 3.9 4.7
>17 W CC.
97............. 04 MED BRONCHITIS & ASTHMA AGE .5873 3.1 3.7
>17 W/O CC.
98............. 04 MED BRONCHITIS & ASTHMA AGE 0- .8768 3.2 4.7
17.
99............. 04 MED RESPIRATORY SIGNS & .7117 2.5 3.2
SYMPTOMS W CC.
100............ 04 MED RESPIRATORY SIGNS & .5437 1.8 2.2
SYMPTOMS W/O CC.
101............ 04 MED OTHER RESPIRATORY SYSTEM .8563 3.3 4.4
DIAGNOSES W CC.
102............ 04 MED OTHER RESPIRATORY SYSTEM .5550 2.1 2.7
DIAGNOSES W/O CC.
103............ PRE SURG HEART TRANSPLANT.......... 19.0098 30.7 51.8
104............ 05 SURG CARDIAC VALVE & OTHER 7.1843 8.9 11.7
MAJOR CARDIOTHORACIC PROC
W CARDIAC CATH.
105............ 05 SURG CARDIAC VALVE & OTHER 5.6567 7.4 9.3
MAJOR CARDIOTHORACIC PROC
W/O CARDIAC CATH.
106............ 05 SURG CORONARY BYPASS W PTCA.... 7.5203 9.3 11.2
107............ 05 SURG CORONARY BYPASS W CARDIAC 5.3762 9.2 10.3
CATH.
108............ 05 SURG OTHER CARDIOTHORACIC 5.6525 8.0 10.6
PROCEDURES.
109............ 05 SURG CORONARY BYPASS W/O PTCA 4.0198 6.8 7.7
OR CARDIAC CATH.
110............ 05 SURG MAJOR CARDIOVASCULAR 4.1358 7.1 9.5
PROCEDURES W CC.
111............ 05 SURG MAJOR CARDIOVASCULAR 2.2410 4.7 5.5
PROCEDURES W/O CC.
112............ 05 SURG PERCUTANEOUS 1.8677 2.6 3.8
CARDIOVASCULAR PROCEDURES.
113............ 05 SURG AMPUTATION FOR CIRC SYSTEM 2.7806 9.8 12.8
DISORDERS EXCEPT UPPER
LIMB & TOE.
114............ 05 SURG UPPER LIMB & TOE 1.5656 6.0 8.3
AMPUTATION FOR CIRC
SYSTEM DISORDERS.
115............ 05 SURG PRM CARD PACEM IMPL W 3.4711 6.0 8.4
AMI,HRT FAIL OR SHK,OR
AICD LEAD OR GNRTR PR.
116............ 05 SURG OTH PERM CARD PACEMAK IMPL 2.4190 2.6 3.7
OR PTCA W CORONARY ARTERY
STENT IMPLNT.
117............ 05 SURG CARDIAC PACEMAKER REVISION 1.2966 2.6 4.0
EXCEPT DEVICE REPLACEMENT.
118............ 05 SURG CARDIAC PACEMAKER DEVICE 1.4939 1.9 2.8
REPLACEMENT.
119............ 05 SURG VEIN LIGATION & STRIPPING. 1.2600 2.9 4.9
120............ 05 SURG OTHER CIRCULATORY SYSTEM 2.0352 4.9 8.1
O.R. PROCEDURES.
121............ 05 MED CIRCULATORY DISORDERS W 1.6194 5.5 6.7
AMI & MAJOR COMP,
DISCHARGED ALIVE.
122............ 05 MED CIRCULATORY DISORDERS W 1.0884 3.3 4.0
AMI W/O MAJOR COMP,
DISCHARGED ALIVE.
123............ 05 MED CIRCULATORY DISORDERS W 1.5528 2.8 4.6
AMI, EXPIRED.
[[Page 47162]]
124............ 05 MED CIRCULATORY DISORDERS 1.4134 3.3 4.4
EXCEPT AMI, W CARD CATH &
COMPLEX DIAG.
125............ 05 MED CIRCULATORY DISORDERS 1.0606 2.2 2.8
EXCEPT AMI, W CARD CATH W/
O COMPLEX DIAG.
126............ 05 MED ACUTE & SUBACUTE 2.5379 9.3 12.0
ENDOCARDITIS.
127............ 05 MED HEART FAILURE & SHOCK..... 1.0130 4.2 5.4
128............ 05 MED DEEP VEIN THROMBOPHLEBITIS .7651 5.0 5.8
129............ 05 MED CARDIAC ARREST, 1.0968 1.8 2.9
UNEXPLAINED.
130............ 05 MED PERIPHERAL VASCULAR .9471 4.7 5.9
DISORDERS W CC.
131............ 05 MED PERIPHERAL VASCULAR .5898 3.6 4.4
DISORDERS W/O CC.
132............ 05 MED ATHEROSCLEROSIS W CC...... .6707 2.4 3.1
133............ 05 MED ATHEROSCLEROSIS W/O CC.... .5663 1.9 2.4
134............ 05 MED HYPERTENSION.............. .5917 2.6 3.3
135............ 05 MED CARDIAC CONGENITAL & .9083 3.3 4.5
VALVULAR DISORDERS AGE
>17 W CC.
136............ 05 MED CARDIAC CONGENITAL & .6065 2.2 2.9
VALVULAR DISORDERS AGE
>17 W/O CC.
137............ 05 MED *CARDIAC CONGENITAL & .8192 3.3 3.3
VALVULAR DISORDERS AGE 0-
17.
138............ 05 MED CARDIAC ARRHYTHMIA & .8291 3.1 4.0
CONDUCTION DISORDERS W CC.
139............ 05 MED CARDIAC ARRHYTHMIA & .5141 2.0 2.5
CONDUCTION DISORDERS W/O
CC.
140............ 05 MED ANGINA PECTORIS........... .5740 2.2 2.7
141............ 05 MED SYNCOPE & COLLAPSE W CC... .7219 2.9 3.7
142............ 05 MED SYNCOPE & COLLAPSE W/O CC. .5552 2.2 2.7
143............ 05 MED CHEST PAIN................ .5402 1.8 2.2
144............ 05 MED OTHER CIRCULATORY SYSTEM 1.1668 3.8 5.4
DIAGNOSES W CC.
145............ 05 MED OTHER CIRCULATORY SYSTEM .6322 2.2 2.8
DIAGNOSES W/O CC.
146............ 06 SURG RECTAL RESECTION W CC..... 2.7430 8.9 10.2
147............ 06 SURG RECTAL RESECTION W/O CC... 1.6221 6.0 6.6
148............ 06 SURG MAJOR SMALL & LARGE BOWEL 3.4347 10.1 12.1
PROCEDURES W CC.
149............ 06 SURG MAJOR SMALL & LARGE BOWEL 1.5667 6.1 6.7
PROCEDURES W/O CC.
150............ 06 SURG PERITONEAL ADHESIOLYSIS W 2.8523 9.1 11.2
CC.
151............ 06 SURG PERITONEAL ADHESIOLYSIS W/ 1.3427 4.8 5.9
O CC.
152............ 06 SURG MINOR SMALL & LARGE BOWEL 1.9462 6.8 8.2
PROCEDURES W CC.
153............ 06 SURG MINOR SMALL & LARGE BOWEL 1.2080 4.9 5.5
PROCEDURES W/O CC.
154............ 06 SURG STOMACH, ESOPHAGEAL & 4.1475 10.1 13.3
DUODENAL PROCEDURES AGE
>17 W CC.
155............ 06 SURG STOMACH, ESOPHAGEAL & 1.3751 3.3 4.4
DUODENAL PROCEDURES AGE
>17 W/O CC.
156............ 06 SURG *STOMACH, ESOPHAGEAL & .8436 6.0 6.0
DUODENAL PROCEDURES AGE 0-
17.
157............ 06 SURG ANAL & STOMAL PROCEDURES W 1.2388 3.9 5.5
CC.
158............ 06 SURG ANAL & STOMAL PROCEDURES W/ .6638 2.1 2.6
O CC.
159............ 06 SURG HERNIA PROCEDURES EXCEPT 1.3347 3.8 5.0
INGUINAL & FEMORAL AGE
>17 W CC.
160............ 06 SURG HERNIA PROCEDURES EXCEPT .7837 2.2 2.7
INGUINAL & FEMORAL AGE
>17 W/O CC.
161............ 06 SURG INGUINAL & FEMORAL HERNIA 1.1017 2.9 4.2
PROCEDURES AGE >17 W CC.
162............ 06 SURG INGUINAL & FEMORAL HERNIA .6229 1.6 2.0
PROCEDURES AGE >17 W/O CC.
163............ 06 SURG HERNIA PROCEDURES AGE 0-17 .6921 2.4 2.9
164............ 06 SURG APPENDECTOMY W COMPLICATED 2.3760 7.1 8.4
PRINCIPAL DIAG W CC.
165............ 06 SURG APPENDECTOMY W COMPLICATED 1.2838 4.3 4.9
PRINCIPAL DIAG W/O CC.
166............ 06 SURG APPENDECTOMY W/O 1.4802 4.0 5.1
COMPLICATED PRINCIPAL
DIAG W CC.
167............ 06 SURG APPENDECTOMY W/O .8937 2.3 2.7
COMPLICATED PRINCIPAL
DIAG W/O CC.
168............ 03 SURG MOUTH PROCEDURES W CC..... 1.2141 3.2 4.7
169............ 03 SURG MOUTH PROCEDURES W/O CC... .7455 1.9 2.4
170............ 06 SURG OTHER DIGESTIVE SYSTEM 2.8686 7.7 11.2
O.R. PROCEDURES W CC.
171............ 06 SURG OTHER DIGESTIVE SYSTEM 1.1975 3.6 4.8
O.R. PROCEDURES W/O CC.
172............ 06 MED DIGESTIVE MALIGNANCY W CC. 1.3485 5.1 7.0
173............ 06 MED DIGESTIVE MALIGNANCY W/O .7700 2.8 3.9
CC.
174............ 06 MED G.I. HEMORRHAGE W CC...... .9985 3.9 4.8
175............ 06 MED G.I. HEMORRHAGE W/O CC.... .5501 2.5 2.9
176............ 06 MED COMPLICATED PEPTIC ULCER.. 1.1052 4.1 5.3
177............ 06 MED UNCOMPLICATED PEPTIC ULCER .8998 3.7 4.6
W CC.
178............ 06 MED UNCOMPLICATED PEPTIC ULCER .6604 2.6 3.1
W/O CC.
179............ 06 MED INFLAMMATORY BOWEL DISEASE 1.0576 4.7 6.0
180............ 06 MED G.I. OBSTRUCTION W CC..... .9423 4.2 5.4
181............ 06 MED G.I. OBSTRUCTION W/O CC... .5304 2.8 3.4
182............ 06 MED ESOPHAGITIS, GASTROENT & .7922 3.4 4.4
MISC DIGEST DISORDERS AGE
>17 W CC.
[[Page 47163]]
183............ 06 MED ESOPHAGITIS, GASTROENT & .5717 2.4 3.0
MISC DIGEST DISORDERS AGE
>17 W/O CC.
184............ 06 MED ESOPHAGITIS, GASTROENT & .5119 2.5 3.3
MISC DIGEST DISORDERS AGE
0-17.
185............ 03 MED DENTAL & ORAL DIS EXCEPT .8621 3.3 4.5
EXTRACTIONS &
RESTORATIONS, AGE >17.
186............ 03 MED *DENTAL & ORAL DIS EXCEPT .3216 2.9 2.9
EXTRACTIONS &
RESTORATIONS, AGE 0-17.
187............ 03 MED DENTAL EXTRACTIONS & .7649 2.9 3.8
RESTORATIONS.
188............ 06 MED OTHER DIGESTIVE SYSTEM 1.1005 4.1 5.6
DIAGNOSES AGE >17 W CC.
189............ 06 MED OTHER DIGESTIVE SYSTEM .5796 2.4 3.1
DIAGNOSES AGE >17 W/O CC.
190............ 06 MED OTHER DIGESTIVE SYSTEM .9884 4.1 6.0
DIAGNOSES AGE 0-17.
191............ 07 SURG PANCREAS, LIVER & SHUNT 4.3914 10.5 14.2
PROCEDURES W CC.
192............ 07 SURG PANCREAS, LIVER & SHUNT 1.7916 5.3 6.6
PROCEDURES W/O CC.
193............ 07 SURG BILIARY TRACT PROC EXCEPT 3.3861 10.3 12.6
ONLY CHOLECYST W OR W/O
C.D.E. W CC.
194............ 07 SURG BILIARY TRACT PROC EXCEPT 1.6191 5.6 6.8
ONLY CHOLECYST W OR W/O
C.D.E. W/O CC.
195............ 07 SURG CHOLECYSTECTOMY W C.D.E. W 2.9062 8.3 9.9
CC.
196............ 07 SURG CHOLECYSTECTOMY W C.D.E. W/ 1.6593 4.9 5.7
O CC.
197............ 07 SURG CHOLECYSTECTOMY EXCEPT BY 2.4544 7.2 8.7
LAPAROSCOPE W/O C.D.E. W
CC.
198............ 07 SURG CHOLECYSTECTOMY EXCEPT BY 1.2339 3.9 4.5
LAPAROSCOPE W/O C.D.E. W/
O CC.
199............ 07 SURG HEPATOBILIARY DIAGNOSTIC 2.3584 7.2 9.7
PROCEDURE FOR MALIGNANCY.
200............ 07 SURG HEPATOBILIARY DIAGNOSTIC 3.2262 7.0 10.8
PROCEDURE FOR NON-
MALIGNANCY.
201............ 07 SURG OTHER HEPATOBILIARY OR 3.4035 10.2 13.9
PANCREAS O.R. PROCEDURES.
202............ 07 MED CIRRHOSIS & ALCOHOLIC 1.3001 4.9 6.5
HEPATITIS.
203............ 07 MED MALIGNANCY OF 1.3250 5.0 6.7
HEPATOBILIARY SYSTEM OR
PANCREAS.
204............ 07 MED DISORDERS OF PANCREAS 1.2018 4.5 5.9
EXCEPT MALIGNANCY.
205............ 07 MED DISORDERS OF LIVER EXCEPT 1.2048 4.7 6.3
MALIG,CIRR,ALC HEPA W CC.
206............ 07 MED DISORDERS OF LIVER EXCEPT .6751 3.0 3.9
MALIG,CIRR,ALC HEPA W/O
CC.
207............ 07 MED DISORDERS OF THE BILIARY 1.1032 4.0 5.2
TRACT W CC.
208............ 07 MED DISORDERS OF THE BILIARY .6538 2.3 2.9
TRACT W/O CC.
209............ 08 SURG MAJOR JOINT & LIMB 2.0912 4.6 5.2
REATTACHMENT PROCEDURES
OF LOWER EXTREMITY.
210............ 08 SURG HIP & FEMUR PROCEDURES 1.8152 6.0 6.9
EXCEPT MAJOR JOINT AGE
>17 W CC.
211............ 08 SURG HIP & FEMUR PROCEDURES 1.2647 4.5 4.9
EXCEPT MAJOR JOINT AGE
>17 W/O CC.
212............ 08 SURG *HIP & FEMUR PROCEDURES .8472 11.1 11.1
EXCEPT MAJOR JOINT AGE 0-
17.
213............ 08 SURG AMPUTATION FOR 1.7726 6.4 8.7
MUSCULOSKELETAL SYSTEM &
CONN TISSUE DISORDERS.
214............ 08 SURG NO LONGER VALID........... .0000 .0 .0
215............ 08 SURG NO LONGER VALID........... .0000 .0 .0
216............ 08 SURG BIOPSIES OF 2.2042 7.1 9.8
MUSCULOSKELETAL SYSTEM &
CONNECTIVE TISSUE.
217............ 08 SURG WND DEBRID & SKN GRFT 2.9230 8.9 13.2
EXCEPT HAND,FOR
MUSCSKELET & CONN TISS
DIS.
218............ 08 SURG LOWER EXTREM & HUMER PROC 1.5337 4.2 5.4
EXCEPT HIP, FOOT, FEMUR
AGE >17 W CC.
219............ 08 SURG LOWER EXTREM & HUMER PROC 1.0255 2.7 3.3
EXCEPT HIP, FOOT, FEMUR
AGE >17 W/O CC.
220............ 08 SURG *LOWER EXTREM & HUMER PROC .5844 5.3 5.3
EXCEPT HIP, FOOT, FEMUR
AGE 0-17.
221............ 08 SURG NO LONGER VALID........... .0000 .0 .0
222............ 08 SURG NO LONGER VALID........... .0000 .0 .0
223............ 08 SURG MAJOR SHOULDER/ELBOW PROC, .9585 2.0 2.6
OR OTHER UPPER EXTREMITY
PROC W CC.
224............ 08 SURG SHOULDER, ELBOW OR FOREARM .7997 1.7 2.1
PROC, EXC MAJOR JOINT
PROC, W/O CC.
225............ 08 SURG FOOT PROCEDURES........... 1.0851 3.3 4.7
226............ 08 SURG SOFT TISSUE PROCEDURES W 1.4770 4.3 6.3
CC.
227............ 08 SURG SOFT TISSUE PROCEDURES W/O .8036 2.1 2.7
CC.
228............ 08 SURG MAJOR THUMB OR JOINT 1.0664 2.4 3.6
PROC,OR OTH HAND OR WRIST
PROC W CC.
229............ 08 SURG HAND OR WRIST PROC, EXCEPT .7169 1.8 2.4
MAJOR JOINT PROC, W/O CC.
[[Page 47164]]
230............ 08 SURG LOCAL EXCISION & REMOVAL 1.2490 3.4 5.1
OF INT FIX DEVICES OF HIP
& FEMUR.
231............ 08 SURG LOCAL EXCISION & REMOVAL 1.3825 3.2 4.8
OF INT FIX DEVICES EXCEPT
HIP & FEMUR.
232............ 08 SURG ARTHROSCOPY............... 1.0828 2.3 3.6
233............ 08 SURG OTHER MUSCULOSKELET SYS & 2.0890 5.3 7.7
CONN TISS O.R. PROC W CC.
234............ 08 SURG OTHER MUSCULOSKELET SYS & 1.2661 2.7 3.6
CONN TISS O.R. PROC W/O
CC.
235............ 08 MED FRACTURES OF FEMUR........ .7582 3.8 5.2
236............ 08 MED FRACTURES OF HIP & PELVIS. .7218 4.0 5.0
237............ 08 MED SPRAINS, STRAINS, & .5681 3.0 3.7
DISLOCATIONS OF HIP,
PELVIS & THIGH.
238............ 08 MED OSTEOMYELITIS............. 1.3496 6.4 8.6
239............ 08 MED PATHOLOGICAL FRACTURES & .9745 4.9 6.2
MUSCULOSKELETAL & CONN
TISS MALIGNANCY.
240............ 08 MED CONNECTIVE TISSUE 1.2712 4.9 6.6
DISORDERS W CC.
241............ 08 MED CONNECTIVE TISSUE .6177 3.1 3.9
DISORDERS W/O CC.
242............ 08 MED SEPTIC ARTHRITIS.......... 1.0724 5.1 6.6
243............ 08 MED MEDICAL BACK PROBLEMS..... .7262 3.7 4.7
244............ 08 MED BONE DISEASES & SPECIFIC .7155 3.7 4.8
ARTHROPATHIES W CC.
245............ 08 MED BONE DISEASES & SPECIFIC .4832 2.8 3.6
ARTHROPATHIES W/O CC.
246............ 08 MED NON-SPECIFIC ARTHROPATHIES .5570 2.9 3.6
247............ 08 MED SIGNS & SYMPTOMS OF .5696 2.6 3.5
MUSCULOSKELETAL SYSTEM &
CONN TISSUE.
248............ 08 MED TENDONITIS, MYOSITIS & .7864 3.7 4.8
BURSITIS.
249............ 08 MED AFTERCARE, MUSCULOSKELETAL .6913 2.6 3.8
SYSTEM & CONNECTIVE
TISSUE.
250............ 08 MED FX, SPRN, STRN & DISL OF .6929 3.3 4.3
FOREARM, HAND, FOOT AGE
>17 W CC.
251............ 08 MED FX, SPRN, STRN & DISL OF .4995 2.4 3.0
FOREARM, HAND, FOOT AGE
>17 W/O CC.
252............ 08 MED *FX, SPRN, STRN & DISL OF .2538 1.8 1.8
FOREARM, HAND, FOOT AGE 0-
17.
253............ 08 MED FX, SPRN, STRN & DISL OF .7253 3.7 4.7
UPARM,LOWLEG EX FOOT AGE
>17 W CC.
254............ 08 MED FX, SPRN, STRN & DISL OF .4413 2.6 3.2
UPARM,LOWLEG EX FOOT AGE
>17 W/O CC.
255............ 08 MED *FX, SPRN, STRN & DISL OF .2956 2.9 2.9
UPARM,LOWLEG EX FOOT AGE
0-17.
256............ 08 MED OTHER MUSCULOSKELETAL .7959 3.8 5.2
SYSTEM & CONNECTIVE
TISSUE DIAGNOSES.
257............ 09 SURG TOTAL MASTECTOMY FOR .9107 2.3 2.8
MALIGNANCY W CC.
258............ 09 SURG TOTAL MASTECTOMY FOR .7232 1.8 2.0
MALIGNANCY W/O CC.
259............ 09 SURG SUBTOTAL MASTECTOMY FOR .9068 1.8 2.8
MALIGNANCY W CC.
260............ 09 SURG SUBTOTAL MASTECTOMY FOR .6532 1.3 1.4
MALIGNANCY W/O CC.
261............ 09 SURG BREAST PROC FOR NON- .9362 1.7 2.2
MALIGNANCY EXCEPT BIOPSY
& LOCAL EXCISION.
262............ 09 SURG BREAST BIOPSY & LOCAL .8754 2.7 3.8
EXCISION FOR NON-
MALIGNANCY.
263............ 09 SURG SKIN GRAFT &/OR DEBRID FOR 2.1219 8.9 12.2
SKN ULCER OR CELLULITIS W
CC.
264............ 09 SURG SKIN GRAFT &/OR DEBRID FOR 1.1479 5.4 7.2
SKN ULCER OR CELLULITIS W/
O CC.
265............ 09 SURG SKIN GRAFT &/OR DEBRID 1.5309 4.3 6.6
EXCEPT FOR SKIN ULCER OR
CELLULITIS W CC.
266............ 09 SURG SKIN GRAFT &/OR DEBRID .8707 2.4 3.3
EXCEPT FOR SKIN ULCER OR
CELLULITIS W/O CC.
267............ 09 SURG PERIANAL & PILONIDAL 1.0792 3.1 5.2
PROCEDURES.
268............ 09 SURG SKIN, SUBCUTANEOUS TISSUE 1.1405 2.4 3.7
& BREAST PLASTIC
PROCEDURES.
269............ 09 SURG OTHER SKIN, SUBCUT TISS & 1.7004 5.8 8.3
BREAST PROC W CC.
270............ 09 SURG OTHER SKIN, SUBCUT TISS & .7670 2.3 3.3
BREAST PROC W/O CC.
271............ 09 MED SKIN ULCERS............... 1.0104 5.5 7.1
272............ 09 MED MAJOR SKIN DISORDERS W CC. .9994 4.8 6.3
273............ 09 MED MAJOR SKIN DISORDERS W/O .6179 3.2 4.2
CC.
274............ 09 MED MALIGNANT BREAST DISORDERS 1.2061 4.9 7.0
W CC.
275............ 09 MED MALIGNANT BREAST DISORDERS .5301 2.4 3.4
W/O CC.
276............ 09 MED NON-MALIGANT BREAST .6899 3.6 4.6
DISORDERS.
277............ 09 MED CELLULITIS AGE >17 W CC... .8396 4.7 5.7
278............ 09 MED CELLULITIS AGE >17 W/O CC. .5522 3.6 4.3
279............ 09 MED *CELLULITIS AGE 0-17...... .6644 4.2 4.2
280............ 09 MED TRAUMA TO THE SKIN, SUBCUT .6788 3.2 4.2
TISS & BREAST AGE >17 W
CC.
[[Page 47165]]
281............ 09 MED TRAUMA TO THE SKIN, SUBCUT .4729 2.4 3.1
TISS & BREAST AGE >17 W/O
CC.
282............ 09 MED *TRAUMA TO THE SKIN, .2570 2.2 2.2
SUBCUT TISS & BREAST AGE
0-17.
283............ 09 MED MINOR SKIN DISORDERS W CC. .6917 3.5 4.6
284............ 09 MED MINOR SKIN DISORDERS W/O .4336 2.5 3.2
CC.
285............ 10 SURG AMPUTAT OF LOWER LIMB FOR 1.9961 7.7 10.5
ENDOCRINE, NUTRIT, &
METABOL DISORDERS.
286............ 10 SURG ADRENAL & PITUITARY 2.1299 4.9 6.2
PROCEDURES.
287............ 10 SURG SKIN GRAFTS & WOUND DEBRID 1.8283 7.8 10.5
FOR ENDOC, NUTRIT & METAB
DISORDERS.
288............ 10 SURG O.R. PROCEDURES FOR 2.1607 4.5 5.7
OBESITY.
289............ 10 SURG PARATHYROID PROCEDURES.... .9914 2.0 3.1
290............ 10 SURG THYROID PROCEDURES........ .9193 1.8 2.4
291............ 10 SURG THYROGLOSSAL PROCEDURES... .5487 1.4 1.6
292............ 10 SURG OTHER ENDOCRINE, NUTRIT & 2.4538 6.9 10.0
METAB O.R. PROC W CC.
293............ 10 SURG OTHER ENDOCRINE, NUTRIT & 1.2289 3.6 5.1
METAB O.R. PROC W/O CC.
294............ 10 MED DIABETES AGE >35.......... .7589 3.6 4.7
295............ 10 MED DIABETES AGE 0-35......... .7587 2.9 3.9
296............ 10 MED NUTRITIONAL & MISC .8594 4.0 5.2
METABOLIC DISORDERS AGE
>17 W CC.
297............ 10 MED NUTRITIONAL & MISC .5179 2.8 3.5
METABOLIC DISORDERS AGE
>17 W/O CC.
298............ 10 MED NUTRITIONAL & MISC .5269 2.5 3.1
METABOLIC DISORDERS AGE 0-
17.
299............ 10 MED INBORN ERRORS OF .9632 4.0 5.6
METABOLISM.
300............ 10 MED ENDOCRINE DISORDERS W CC.. 1.0829 4.7 6.1
301............ 10 MED ENDOCRINE DISORDERS W/O CC .6133 2.9 3.7
302............ 11 SURG KIDNEY TRANSPLANT......... 3.4241 7.9 9.4
303............ 11 SURG KIDNEY, URETER & MAJOR 2.4602 7.0 8.5
BLADDER PROCEDURES FOR
NEOPLASM.
304............ 11 SURG KIDNEY, URETER & MAJOR 2.3407 6.4 8.9
BLADDER PROC FOR NON-
NEOPL W CC.
305............ 11 SURG KIDNEY, URETER & MAJOR 1.1825 3.1 3.8
BLADDER PROC FOR NON-
NEOPL W/O CC.
306............ 11 SURG PROSTATECTOMY W CC........ 1.2489 3.7 5.5
307............ 11 SURG PROSTATECTOMY W/O CC...... .6460 1.9 2.3
308............ 11 SURG MINOR BLADDER PROCEDURES W 1.6449 4.2 6.4
CC.
309............ 11 SURG MINOR BLADDER PROCEDURES W/ .9339 2.0 2.5
O CC.
310............ 11 SURG TRANSURETHRAL PROCEDURES W 1.1172 3.0 4.4
CC.
311............ 11 SURG TRANSURETHRAL PROCEDURES W/ .6174 1.6 1.9
O CC.
312............ 11 SURG URETHRAL PROCEDURES, AGE 1.0173 3.0 4.5
>17 W CC.
313............ 11 SURG URETHRAL PROCEDURES, AGE .6444 1.7 2.1
>17 W/O CC.
314............ 11 SURG *URETHRAL PROCEDURES, AGE .4953 2.3 2.3
0-17.
315............ 11 SURG OTHER KIDNEY & URINARY 2.0474 4.2 7.5
TRACT O.R. PROCEDURES.
316............ 11 MED RENAL FAILURE............. 1.3424 4.9 6.7
317............ 11 MED ADMIT FOR RENAL DIALYSIS.. .7395 2.1 3.2
318............ 11 MED KIDNEY & URINARY TRACT 1.1313 4.3 6.0
NEOPLASMS W CC.
319............ 11 MED KIDNEY & URINARY TRACT .6040 2.2 2.9
NEOPLASMS W/O CC.
320............ 11 MED KIDNEY & URINARY TRACT .8621 4.3 5.4
INFECTIONS AGE >17 W CC.
321............ 11 MED KIDNEY & URINARY TRACT .5686 3.2 3.8
INFECTIONS AGE >17 W/O CC.
322............ 11 MED KIDNEY & URINARY TRACT .4939 3.3 4.1
INFECTIONS AGE 0-17.
323............ 11 MED URINARY STONES W CC, &/OR .7996 2.4 3.2
ESW LITHOTRIPSY.
324............ 11 MED URINARY STONES W/O CC..... .4509 1.6 1.9
325............ 11 MED KIDNEY & URINARY TRACT .6460 3.0 3.9
SIGNS & SYMPTOMS AGE >17
W CC.
326............ 11 MED KIDNEY & URINARY TRACT .4297 2.1 2.7
SIGNS & SYMPTOMS AGE >17
W/O CC.
327............ 11 MED *KIDNEY & URINARY TRACT .3543 3.1 3.1
SIGNS & SYMPTOMS AGE 0-17.
328............ 11 MED URETHRAL STRICTURE AGE >17 .7455 2.8 3.9
W CC.
329............ 11 MED URETHRAL STRICTURE AGE >17 .5253 1.7 2.0
W/O CC.
330............ 11 MED *URETHRAL STRICTURE AGE 0- .3191 1.6 1.6
17.
331............ 11 MED OTHER KIDNEY & URINARY 1.0221 4.1 5.6
TRACT DIAGNOSES AGE >17 W
CC.
332............ 11 MED OTHER KIDNEY & URINARY .5997 2.5 3.3
TRACT DIAGNOSES AGE >17 W/
O CC.
333............ 11 MED OTHER KIDNEY & URINARY .8247 3.5 5.0
TRACT DIAGNOSES AGE 0-17.
334............ 12 SURG MAJOR MALE PELVIC 1.5591 4.2 4.9
PROCEDURES W CC.
335............ 12 SURG MAJOR MALE PELVIC 1.1697 3.2 3.4
PROCEDURES W/O CC.
336............ 12 SURG TRANSURETHRAL .8880 2.7 3.5
PROSTATECTOMY W CC.
337............ 12 SURG TRANSURETHRAL .6152 1.9 2.2
PROSTATECTOMY W/O CC.
338............ 12 SURG TESTES PROCEDURES, FOR 1.1900 3.5 5.3
MALIGNANCY.
339............ 12 SURG TESTES PROCEDURES, NON- 1.0769 3.0 4.6
MALIGNANCY AGE >17.
[[Page 47166]]
340............ 12 SURG *TESTES PROCEDURES, NON- .2835 2.4 2.4
MALIGNANCY AGE 0-17.
341............ 12 SURG PENIS PROCEDURES.......... 1.1709 2.1 3.2
342............ 12 SURG CIRCUMCISION AGE >17...... .8240 2.5 3.1
343............ 12 SURG *CIRCUMCISION AGE 0-17.... .1541 1.7 1.7
344............ 12 SURG OTHER MALE REPRODUCTIVE 1.1519 1.6 2.3
SYSTEM O.R. PROCEDURES
FOR MALIGNANCY.
345............ 12 SURG OTHER MALE REPRODUCTIVE .8800 2.6 3.8
SYSTEM O.R. PROC EXCEPT
FOR MALIGNANCY.
346............ 12 MED MALIGNANCY, MALE .9756 4.3 5.8
REPRODUCTIVE SYSTEM, W CC.
347............ 12 MED MALIGNANCY, MALE .5922 2.4 3.4
REPRODUCTIVE SYSTEM, W/O
CC.
348............ 12 MED BENIGN PROSTATIC .7142 3.2 4.2
HYPERTROPHY W CC.
349............ 12 MED BENIGN PROSTATIC .4380 2.0 2.6
HYPERTROPHY W/O CC.
350............ 12 MED INFLAMMATION OF THE MALE .6992 3.6 4.4
REPRODUCTIVE SYSTEM.
351............ 12 MED *STERILIZATION, MALE...... .2364 1.3 1.3
352............ 12 MED OTHER MALE REPRODUCTIVE .6858 2.8 3.8
SYSTEM DIAGNOSES.
353............ 13 SURG PELVIC EVISCERATION, 1.9292 5.3 6.7
RADICAL HYSTERECTOMY &
RADICAL VULVECTOMY.
354............ 13 SURG UTERINE, ADNEXA PROC FOR 1.5284 4.9 5.9
NON-OVARIAN/ADNEXAL MALIG
W CC.
355............ 13 SURG UTERINE, ADNEXA PROC FOR .9278 3.1 3.3
NON-OVARIAN/ADNEXAL MALIG
W/O CC.
356............ 13 SURG FEMALE REPRODUCTIVE SYSTEM .7846 2.1 2.4
RECONSTRUCTIVE PROCEDURES.
357............ 13 SURG UTERINE & ADNEXA PROC FOR 2.3628 6.9 8.5
OVARIAN OR ADNEXAL
MALIGNANCY.
358............ 13 SURG UTERINE & ADNEXA PROC FOR 1.2263 3.7 4.4
NON-MALIGNANCY W CC.
359............ 13 SURG UTERINE & ADNEXA PROC FOR .8593 2.6 2.8
NON-MALIGNANCY W/O CC.
360............ 13 SURG VAGINA, CERVIX & VULVA .8860 2.4 3.0
PROCEDURES.
361............ 13 SURG LAPAROSCOPY & INCISIONAL 1.2318 2.2 3.5
TUBAL INTERRUPTION.
362............ 13 SURG *ENDOSCOPIC TUBAL .3022 1.4 1.4
INTERRUPTION.
363............ 13 SURG D&C, CONIZATION & RADIO- .8136 2.5 3.5
IMPLANT, FOR MALIGNANCY.
364............ 13 SURG D&C, CONIZATION EXCEPT FOR .7530 2.6 3.6
MALIGNANCY.
365............ 13 SURG OTHER FEMALE REPRODUCTIVE 1.8425 4.9 7.3
SYSTEM O.R. PROCEDURES.
366............ 13 MED MALIGNANCY, FEMALE 1.2467 4.8 6.8
REPRODUCTIVE SYSTEM W CC.
367............ 13 MED MALIGNANCY, FEMALE .5676 2.4 3.2
REPRODUCTIVE SYSTEM W/O
CC.
368............ 13 MED INFECTIONS, FEMALE 1.1205 5.0 6.7
REPRODUCTIVE SYSTEM.
369............ 13 MED MENSTRUAL & OTHER FEMALE .5704 2.4 3.2
REPRODUCTIVE SYSTEM
DISORDERS.
370............ 14 SURG CESAREAN SECTION W CC..... 1.0631 4.4 5.7
371............ 14 SURG CESAREAN SECTION W/O CC... .7157 3.3 3.6
372............ 14 MED VAGINAL DELIVERY W .6077 2.7 3.5
COMPLICATING DIAGNOSES.
373............ 14 MED VAGINAL DELIVERY W/O .4169 2.0 2.3
COMPLICATING DIAGNOSES.
374............ 14 SURG VAGINAL DELIVERY W .7565 2.6 3.4
STERILIZATION &/OR D&C.
375............ 14 SURG *VAGINAL DELIVERY W O.R. .6860 4.4 4.4
PROC EXCEPT STERIL &/OR
D&C.
376............ 14 MED POSTPARTUM & POST ABORTION .5224 2.6 3.5
DIAGNOSES W/O O.R.
PROCEDURE.
377............ 14 SURG POSTPARTUM & POST ABORTION .8899 2.6 3.8
DIAGNOSES W O.R.
PROCEDURE.
378............ 14 MED ECTOPIC PREGNANCY......... .7664 2.0 2.3
379............ 14 MED THREATENED ABORTION....... .3959 2.0 3.1
380............ 14 MED ABORTION W/O D&C.......... .4843 1.8 2.2
381............ 14 SURG ABORTION W D&C, ASPIRATION .5331 1.5 1.9
CURETTAGE OR HYSTEROTOMY.
382............ 14 MED FALSE LABOR............... .2127 1.3 1.5
383............ 14 MED OTHER ANTEPARTUM DIAGNOSES .5137 2.7 3.9
W MEDICAL COMPLICATIONS.
384............ 14 MED OTHER ANTEPARTUM DIAGNOSES .3161 1.6 2.3
W/O MEDICAL COMPLICATIONS.
385............ 15 MED *NEONATES, DIED OR 1.3767 1.8 1.8
TRANSFERRED TO ANOTHER
ACUTE CARE FACILITY.
386............ 15 MED *EXTREME IMMATURITY OR 4.5400 17.9 17.9
RESPIRATORY DISTRESS
SYNDROME, NEONATE.
387............ 15 MED *PREMATURITY W MAJOR 3.1007 13.3 13.3
PROBLEMS.
388............ 15 MED *PREMATURITY W/O MAJOR 1.8709 8.6 8.6
PROBLEMS.
389............ 15 MED *FULL TERM NEONATE W MAJOR 1.8408 4.7 4.7
PROBLEMS.
390............ 15 MED NEONATE W OTHER .9471 3.0 4.0
SIGNIFICANT PROBLEMS.
391............ 15 MED *NORMAL NEWBORN........... .1527 3.1 3.1
392............ 16 SURG SPLENECTOMY AGE >17....... 3.1739 7.1 9.5
393............ 16 SURG *SPLENECTOMY AGE 0-17..... 1.3486 9.1 9.1
[[Page 47167]]
394............ 16 SURG OTHER O.R. PROCEDURES OF 1.5969 4.1 6.7
THE BLOOD AND BLOOD
FORMING ORGANS.
395............ 16 MED RED BLOOD CELL DISORDERS .8257 3.3 4.5
AGE >17.
396............ 16 MED RED BLOOD CELL DISORDERS 1.1573 2.5 3.8
AGE 0-17.
397............ 16 MED COAGULATION DISORDERS..... 1.2278 3.8 5.2
398............ 16 MED RETICULOENDOTHELIAL & 1.2750 4.7 6.0
IMMUNITY DISORDERS W CC.
399............ 16 MED RETICULOENDOTHELIAL & .6881 2.8 3.6
IMMUNITY DISORDERS W/O CC.
400............ 17 SURG LYMPHOMA & LEUKEMIA W 2.6309 5.8 9.1
MAJOR O.R. PROCEDURE.
401............ 17 SURG LYMPHOMA & NON-ACUTE 2.7198 7.8 11.2
LEUKEMIA W OTHER O.R.
PROC W CC.
402............ 17 SURG LYMPHOMA & NON-ACUTE 1.0985 2.8 4.0
LEUKEMIA W OTHER O.R.
PROC W/O CC.
403............ 17 MED LYMPHOMA & NON-ACUTE 1.7594 5.7 8.1
LEUKEMIA W CC.
404............ 17 MED LYMPHOMA & NON-ACUTE .8480 3.1 4.2
LEUKEMIA W/O CC.
405............ 17 MED *ACUTE LEUKEMIA W/O MAJOR 1.9120 4.9 4.9
O.R. PROCEDURE AGE 0-17.
406............ 17 SURG MYELOPROLIF DISORD OR 2.8275 7.6 10.3
POORLY DIFF NEOPL W MAJ
O.R.PROC W CC.
407............ 17 SURG MYELOPROLIF DISORD OR 1.3179 3.6 4.4
POORLY DIFF NEOPL W MAJ
O.R.PROC W/O CC.
408............ 17 SURG MYELOPROLIF DISORD OR 2.0008 4.8 7.7
POORLY DIFF NEOPL W OTHER
O.R.PROC.
409............ 17 MED RADIOTHERAPY.............. 1.1215 4.4 5.9
410............ 17 MED CHEMOTHERAPY W/O ACUTE .9468 2.9 3.7
LEUKEMIA AS SECONDARY
DIAGNOSIS.
411............ 17 MED HISTORY OF MALIGNANCY W/O .3305 2.0 2.3
ENDOSCOPY.
412............ 17 MED HISTORY OF MALIGNANCY W .4841 2.0 2.7
ENDOSCOPY.
413............ 17 MED OTHER MYELOPROLIF DIS OR 1.3645 5.3 7.3
POORLY DIFF NEOPL DIAG W
CC.
414............ 17 MED OTHER MYELOPROLIF DIS OR .7548 3.0 4.1
POORLY DIFF NEOPL DIAG W/
O CC.
415............ 18 SURG O.R. PROCEDURE FOR 3.5925 10.4 14.3
INFECTIOUS & PARASITIC
DISEASES.
416............ 18 MED SEPTICEMIA AGE >17........ 1.5278 5.5 7.4
417............ 18 MED SEPTICEMIA AGE 0-17....... 1.1717 3.7 6.0
418............ 18 MED POSTOPERATIVE & POST- 1.0074 4.8 6.2
TRAUMATIC INFECTIONS.
419............ 18 MED FEVER OF UNKNOWN ORIGIN .8709 3.7 4.8
AGE >17 W CC.
420............ 18 MED FEVER OF UNKNOWN ORIGIN .6057 3.0 3.6
AGE >17 W/O CC.
421............ 18 MED VIRAL ILLNESS AGE >17..... .6796 3.1 3.9
422............ 18 MED VIRAL ILLNESS & FEVER OF .7854 2.8 5.1
UNKNOWN ORIGIN AGE 0-17.
423............ 18 MED OTHER INFECTIOUS & 1.7250 5.9 8.2
PARASITIC DISEASES
DIAGNOSES.
424............ 19 SURG O.R. PROCEDURE W PRINCIPAL 2.2810 8.7 13.5
DIAGNOSES OF MENTAL
ILLNESS.
425............ 19 MED ACUTE ADJUSTMENT REACTION .7031 3.0 4.1
& PSYCHOLOGICAL
DYSFUNCTION.
426............ 19 MED DEPRESSIVE NEUROSES....... .5301 3.3 4.6
427............ 19 MED NEUROSES EXCEPT DEPRESSIVE .5637 3.3 5.0
428............ 19 MED DISORDERS OF PERSONALITY & .7342 4.4 7.1
IMPULSE CONTROL.
429............ 19 MED ORGANIC DISTURBANCES & .8530 4.9 6.7
MENTAL RETARDATION.
430............ 19 MED PSYCHOSES................. .7644 5.8 8.2
431............ 19 MED CHILDHOOD MENTAL DISORDERS .6392 4.8 6.6
432............ 19 MED OTHER MENTAL DISORDER .6546 3.2 4.8
DIAGNOSES.
433............ 20 MED ALCOHOL/DRUG ABUSE OR .2824 2.2 3.0
DEPENDENCE, LEFT AMA.
434............ 20 MED ALC/DRUG ABUSE OR DEPEND, .7256 3.9 5.1
DETOX OR OTH SYMPT TREAT
W CC.
435............ 20 MED ALC/DRUG ABUSE OR DEPEND, .4176 3.4 4.3
DETOX OR OTH SYMPT TREAT
W/O CC.
436............ 20 MED ALC/DRUG DEPENDENCE W .7433 10.3 12.9
REHABILITATION THERAPY.
437............ 20 MED ALC/DRUG DEPENDENCE, .6606 7.5 9.0
COMBINED REHAB & DETOX
THERAPY.
438............ 20 ................... NO LONGER VALID........... .0000 .0 .0
439............ 21 SURG SKIN GRAFTS FOR INJURIES.. 1.7092 5.3 8.2
440............ 21 SURG WOUND DEBRIDEMENTS FOR 1.9096 5.8 8.9
INJURIES.
441............ 21 SURG HAND PROCEDURES FOR .9463 2.2 3.3
INJURIES.
442............ 21 SURG OTHER O.R. PROCEDURES FOR 2.3403 5.4 8.3
INJURIES W CC.
443............ 21 SURG OTHER O.R. PROCEDURES FOR .9978 2.5 3.4
INJURIES W/O CC.
444............ 21 MED TRAUMATIC INJURY AGE >17 W .7243 3.2 4.2
CC.
445............ 21 MED TRAUMATIC INJURY AGE >17 W/ .5076 2.4 3.0
O CC.
446............ 21 MED *TRAUMATIC INJURY AGE 0-17 .2964 2.4 2.4
447............ 21 MED ALLERGIC REACTIONS AGE >17 .5166 1.9 2.5
448............ 21 MED *ALLERGIC REACTIONS AGE 0- .0975 2.9 2.9
17.
[[Page 47168]]
449............ 21 MED POISONING & TOXIC EFFECTS .8076 2.6 3.7
OF DRUGS AGE >17 W CC.
450............ 21 MED POISONING & TOXIC EFFECTS .4406 1.6 2.0
OF DRUGS AGE >17 W/O CC.
451............ 21 MED *POISONING & TOXIC EFFECTS .2632 2.1 2.1
OF DRUGS AGE 0-17.
452............ 21 MED COMPLICATIONS OF TREATMENT 1.0152 3.5 5.0
W CC.
453............ 21 MED COMPLICATIONS OF TREATMENT .4987 2.2 2.8
W/O CC.
454............ 21 MED OTHER INJURY, POISONING & .8593 3.2 4.6
TOXIC EFFECT DIAG W CC.
455............ 21 MED OTHER INJURY, POISONING & .4672 2.0 2.6
TOXIC EFFECT DIAG W/O CC.
456............ NO LONGER VALID........... .0000 .0 .0
457............ NO LONGER VALID........... .0000 .0 .0
458............ NO LONGER VALID........... .0000 .0 .0
459............ NO LONGER VALID........... .0000 .0 .0
460............ NO LONGER VALID........... .0000 .0 .0
461............ 23 SURG O.R. PROC W DIAGNOSES OF 1.2101 2.4 4.6
OTHER CONTACT W HEALTH
SERVICES.
462............ 23 MED REHABILITATION............ 1.2401 9.4 11.7
463............ 23 MED SIGNS & SYMPTOMS W CC..... .6936 3.3 4.3
464............ 23 MED SIGNS & SYMPTOMS W/O CC... .4775 2.4 3.1
465............ 23 MED AFTERCARE W HISTORY OF .5756 2.1 3.4
MALIGNANCY AS SECONDARY
DIAGNOSIS.
466............ 23 MED AFTERCARE W/O HISTORY OF .6840 2.3 3.9
MALIGNANCY AS SECONDARY
DIAGNOSIS.
467............ 23 MED OTHER FACTORS INFLUENCING .5112 2.3 4.1
HEALTH STATUS.
468............ EXTENSIVE O.R. PROCEDURE 3.6399 9.2 13.0
UNRELATED TO PRINCIPAL
DIAGNOSIS.
469............ **PRINCIPAL DIAGNOSIS .0000 .0 .0
INVALID AS DISCHARGE
DIAGNOSIS.
470............ **UNGROUPABLE............. .0000 .0 .0
471............ 08 SURG BILATERAL OR MULTIPLE 3.1957 5.0 5.7
MAJOR JOINT PROCS OF
LOWER EXTREMITY.
472............ NO LONGER VALID........... .0000 .0 .0
473............ 17 SURG ACUTE LEUKEMIA W/O MAJOR 3.5822 7.6 13.2
O.R. PROCEDURE AGE >17.
474............ NO LONGER VALID........... .0000 .0 .0
475............ 04 MED RESPIRATORY SYSTEM 3.6936 8.1 11.3
DIAGNOSIS WITH VENTILATOR
SUPPORT.
476............ SURG PROSTATIC O.R. PROCEDURE 2.2547 8.4 11.7
UNRELATED TO PRINCIPAL
DIAGNOSIS.
477............ SURG NON-EXTENSIVE O.R. 1.8204 5.4 8.1
PROCEDURE UNRELATED TO
PRINCIPAL DIAGNOSIS.
478............ 05 SURG OTHER VASCULAR PROCEDURES 2.3333 4.9 7.3
W CC.
479............ 05 SURG OTHER VASCULAR PROCEDURES 1.4326 2.8 3.6
W/O CC.
480............ PRE SURG LIVER TRANSPLANT.......... 9.4744 14.7 19.5
481............ PRE SURG BONE MARROW TRANSPLANT.... 8.6120 23.8 26.6
482............ PRE SURG TRACHEOSTOMY FOR FACE, 3.5785 10.0 12.9
MOUTH & NECK DIAGNOSES.
483............ PRE SURG TRACHEOSTOMY EXCEPT FOR 15.9677 33.7 41.2
FACE, MOUTH & NECK
DIAGNOSES.
484............ 24 SURG CRANIOTOMY FOR MULTIPLE 5.5606 8.8 13.1
SIGNIFICANT TRAUMA.
485............ 24 SURG LIMB REATTACHMENT, HIP AND 3.0998 7.7 9.5
FEMUR PROC FOR MULTIPLE
SIGNIFICANT TRA.
486............ 24 SURG OTHER O.R. PROCEDURES FOR 4.9048 8.1 12.2
MULTIPLE SIGNIFICANT
TRAUMA.
487............ 24 MED OTHER MULTIPLE SIGNIFICANT 2.0604 5.6 7.8
TRAUMA.
488............ 25 SURG HIV W EXTENSIVE O.R. 4.5574 11.5 17.0
PROCEDURE.
489............ 25 MED HIV W MAJOR RELATED 1.7414 6.0 8.6
CONDITION.
490............ 25 MED HIV W OR W/O OTHER RELATED .9680 3.7 5.1
CONDITION.
491............ 08 SURG MAJOR JOINT & LIMB 1.6685 2.9 3.5
REATTACHMENT PROCEDURES
OF UPPER EXTREMITY.
492............ 17 MED CHEMOTHERAPY W ACUTE 4.2467 10.9 16.1
LEUKEMIA AS SECONDARY
DIAGNOSIS.
493............ 07 SURG LAPAROSCOPIC 1.8180 4.3 5.7
CHOLECYSTECTOMY W/O
C.D.E. W CC.
494............ 07 SURG LAPAROSCOPIC 1.0388 2.0 2.5
CHOLECYSTECTOMY W/O
C.D.E. W/O CC.
495............ PRE SURG LUNG TRANSPLANT........... 8.6087 13.4 20.5
496............ 08 SURG COMBINED ANTERIOR/ 5.5532 7.8 10.0
POSTERIOR SPINAL FUSION.
497............ 08 SURG SPINAL FUSION W CC........ 2.9441 4.9 6.2
498............ 08 SURG SPINAL FUSION W/O CC...... 1.9057 2.8 3.4
499............ 08 SURG BACK & NECK PROCEDURES 1.4572 3.6 4.8
EXCEPT SPINAL FUSION W CC.
500............ 08 SURG BACK & NECK PROCEDURES .9805 2.2 2.7
EXCEPT SPINAL FUSION W/O
CC.
501............ 08 SURG KNEE PROCEDURES W PDX OF 2.6283 8.4 10.6
INFECTION W CC.
502............ 08 SURG KNEE PROCEDURES W PDX OF 1.4434 4.9 6.0
INFECTION W/O CC.
503............ 08 SURG KNEE PROCEDURES W/O PDX OF 1.2156 3.1 4.0
INFECTION.
504............ 22 SURG EXTENSIVE 3RD DEGREE BURNS 12.6064 24.1 30.5
W SKIN GRAFT.
[[Page 47169]]
505............ 22 MED EXTENSIVE 3RD DEGREE BURNS 2.0166 2.5 4.7
W/O SKIN GRAFT.
506............ 22 SURG FULL THICKNESS BURN W SKIN 4.4825 12.9 17.6
GRAFT OR INHAL INJ W CC
OR SIG TRAUMA.
507............ 22 SURG FULL THICKNESS BURN W SKIN 1.8560 6.6 9.3
GRFT OR INHAL INJ W/O CC
OR SIG TRAUMA.
508............ 22 MED FULL THICKNESS BURN W/O 1.3302 5.1 7.3
SKIN GRFT OR INHAL INJ W
CC OR SIG TRAUMA.
509............ 22 MED FULL THICKNESS BURN W/O .8071 4.1 6.2
SKIN GRFT OR INH INJ W/O
CC OR SIG TRAUMA.
510............ 22 MED NON-EXTENSIVE BURNS W CC 1.4088 5.2 7.9
OR SIGNIFICANT TRAUMA.
511............ 22 MED NON-EXTENSIVE BURNS W/O CC .6536 3.1 4.5
OR SIGNIFICANT TRAUMA.
----------------------------------------------------------------------------------------------------------------
* MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS.
** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS.
NOTE: GEOMETRIC MEAN IS USED ONLY TO DETERMINE PAYMENT FOR TRANSFER CASES.
NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY.
NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS.
Table 6a.--New Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
007.5 Cyclosporiasis.............. N 6 182, 183,184
082.40 Unspecified ehrlichiosis.... N 18 423
082.41 Ehrlichiosis Chafiensis (E. N 18 423
Chafiensis).
082.49 Other ehrlichiosis.......... N 18 423
285.21 Anemia in end-stage renal N 16 395, 396
disease.
285.22 Anemia in neoplastic disease N 16 395, 396
285.29 Anemia of other chronic N 16 395, 396
illness.
294.10 Dementia in conditions N 19 429
classified elsewhere
without behavioral
disturbance.
294.11 Dementia in conditions N 19 429
classified elsewhere with
behavioral disturbance.
372.81 Conjunctivochalasis......... N 2 46, 47, 48
372.89 Other disorders of N 2 46, 47, 48
conjunctiva.
477.1 Allergic rhinitis, due to N 3 68, 69, 70
food.
493.02 Extrinsic asthma, with acute Y 4 96, 97, 98
exacerbation.
493.12 Intrinsic asthma, with acute Y 4 96, 97, 98
exacerbation.
493.22 Chronic obstructive asthma, Y 4 88
with acute exacerbation.
493.92 Unspecified asthma, with Y 4 96, 97, 98
acute exacerbation.
494.0 Bronchiectasis without acute N 4 88
exacerbation.
494.1 Bronchiectasis with acute Y 4 88
exacerbation.
558.3 Allergic gastroenteritis and N 6 182, 183, 184
colitis.
600.0 Hypertrophy (benign) of N 12 348, 349
prostate.
600.1 Nodular prostate............ N 12 348, 349
600.2 Benign localized hyperplasia N 12 348, 349
of prostate.
600.3 Cyst of prostate............ N 12 348, 349
600.9 Unspecified hyperplasia of N 12 348, 349
prostate.
645.10 Post term pregnancy, N 14 469
unspecified as to episode
of care or not applicable.
645.11 Post term pregnancy, N 14 370, 371, 372, 373, 374, 375
delivered, with or without
mention of antepartum
condition.
645.13 Post term pregnancy, N 14 383, 384
antepartum condition or
complication.
645.20 Prolonged pregnancy, N 14 469
unspecified as to episode
of care or not applicable.
645.21 Prolonged pregnancy, N 14 370, 371, 372, 373, 374, 375
delivered, with or without
mention of antepartum
condition.
645.23 Prolonged pregnancy, N 14 383, 384
antepartum condition or
complication.
692.75 Disseminated superficial N 9 283, 284
actinic porokeratosis
(DSAP).
707.10 Unspecified ulcer of lower Y 9 263, 264, 271
limb.
707.11 Ulcer of thigh.............. Y 9 263, 264, 271
707.12 Ulcer of calf............... Y 9 263, 264, 271
707.13 Ulcer of ankle.............. Y 9 263, 264, 271
707.14 Ulcer of heel and midfoot... Y 9 263, 264, 271
707.15 Ulcer of other part of foot. Y 9 263, 264, 271
707.19 Ulcer of other part of lower Y 9 263, 264, 271
limb.
727.83 Plica syndrome.............. N 8 248
781.91 Loss of height.............. N 1 34, 35
781.92 Abnormal posture............ N 1 34, 35
781.99 Other symptoms involving N 1 34, 35
nervous and musculoskeletal
systems.
783.21 Loss of weight.............. N 10 296, 297, 298
783.22 Underweight................. N 10 296, 297, 298
783.40 Unspecified lack of normal N 10 296, 297, 298
physiological development.
[[Page 47170]]
783.41 Failure to thrive........... N 10 296, 297, 298
783.42 Delayed milestones.......... N 10 296, 297, 298
783.43 Short stature............... N 10 296, 297, 298
783.7 Adult failure to thrive..... N 10 296, 297, 298
790.01 Precipitous drop in N 16 395, 396
hematocrit.
790.09 Other abnormality of red N 16 395, 396
blood cells.
792.5 Cloudy (hemodialysis) N 23 463, 464
(peritoneal) dialysis
effluent.
995.7 Other adverse food N 21 454, 455
reactions, not elsewhere
classified.
996.87 Complications of Y 21 452, 453
transplanted organ,
intestine.
V15.01 Allergy to peanuts.......... N 23 467
V15.02 Allergy to milk products.... N 23 467
V15.03 Allergy to eggs............. N 23 467
V15.04 Allergy to seafood.......... N 23 467
V15.05 Allergy to other foods...... N 23 467
V15.06 Allergy to insects.......... N 23 467
V15.07 Allergy to latex............ N 23 467
V15.08 Allergy to radiographic dye. N 23 467
V15.09 Other allergy, other than to N 23 467
medicinal agents.
V21.30 Unspecified low birth weight N 23 467
status.
V21.31 Low birth weight status, N 23 467
less than 500 grams.
V21.32 Low birth weight status, 500- N 23 467
999 grams.
V21.33 Low birth weight status, N 23 467
1000-1499 grams.
V21.34 Low birth weight status, N 23 467
1500-1999 grams.
V21.35 Low birth weight status, N 23 467
2000-2500 grams.
V26.21 Fertility testing........... N 23 467
V26.22 Aftercare following N 23 467
sterilization reversal.
V26.29 Other investigation and N 23 467
testing.
V42.84 Organ or tissue replaced by Y 23 467
transplant, intestines.
V45.74 Acquired absence of organ, N 11 331, 332, 333
other parts of urinary
tract.
V45.75 Acquired absence of organ, N 23 467
stomach.
V45.76 Acquired absence of organ, N 4 101, 102
lung.
V45.77 Acquired absence of organ, N 12 352
genital organs. 13 358, 359, 369
V45.78 Acquired absence of organ, N 2 46, 47, 48
eye.
V45.79 Other acquired absence of N 23 467
organ.
V49.81 Postmenopausal status (age- N 23 467
related) (natural).
V49.89 Other specified conditions N 23 467
influencing health status.
V56.31 Encounter for adequacy N 11 317
testing for hemodialysis.
V56.32 Encounter for adequacy N 11 317
testing for peritoneal
dialysis.
V58.83 Encounter for therapeutic N 23 465, 466
drug monitoring.
V67.00 Follow-up examination, N 23 465, 466
following unspecified
surgery.
V67.01 Following surgery, follow-up N 23 465, 466
vaginal pap smear.
V67.09 Follow-up examination, N 23 465, 466
following other surgery.
V71.81 Observation for suspected N 23 467
abuse and neglect.
V71.89 Observation for other N 23 467
specified suspected
conditions.
V76.46 Special screening for N 23 467
malignant neoplasms, ovary.
V76.47 Special screening for N 23 467
malignant neoplasms, Vagina.
V76.50 Special screening for N 23 467
malignant neoplasms,
unspecified intestine.
V76.51 Special screening for N 23 467
malignant neoplasms, colon.
V76.52 Special screening for N 23 467
malignant neoplasms, small
intestine.
V76.81 Special screening for N 23 467
malignant neoplasms,
nervous system.
V76.89 Special screening for other N 23 467
malignant neoplasm.
V77.91 Screening for lipoid N 23 467
disorders.
V77.99 Other and unspecified N 23 467
endocrine, nutritional,
metabolic, and immunity
disorders.
V82.81 Special screening for N 23 467
osteoporosis.
V82.89 Special screening for other N 23 467
specified conditions.
----------------------------------------------------------------------------------------------------------------
Table 6b.--New Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
39.71 Endovascular implantation of Y 5 110, 111
graft in abdominal aorta. 11 315
21 442, 443
24 486
[[Page 47171]]
39.79 Other endovascular graft Y 1 1, 2, 3
repair of aneurysm. 5 110, 111
11 315
21 442, 443
24 486
41.07 Autologous hematopoietic Y PRE 481
stem cell transplant with
purging.
41.08 Allogeneic hematopoietic Y PRE 481
stem cell transplant with
purging.
41.09 Autologous bone marrow Y PRE 481
transplant with purging.
46.97 Transplant of intestine..... Y 6 148, 149
7 201
17 400, 406, 407
21 442, 443
24 486
60.96 Transurethral destruction of Y 11 306, 307
prostate tissue by 12 1336, 337
microwave thermotherapy. UNR 476
60.97 Other transurethral Y 11 306, 307
destruction of prostate 12 336, 337
tissue by other UNR 476
thermotherapy.
99.75 Administration of N
neuroprotective agent.
----------------------------------------------------------------------------------------------------------------
Table 6c.--Invalid Diagnosis Codes
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
294.1 Dementia in conditions N 19 429
classified elsewhere.
372.8 Other disorders of N 2 46, 47, 48
conjunctiva.
494 Bronchiectasis.............. Y 4 88
600 Hyperplasia of prostate..... N 12 348, 349
645.00 Prolonged pregnancy, N 14 469
unspecified as to episode
of care or not applicable.
645.01 Prolonged pregnancy, N 14 370, 371, 372, 373, 374, 375
delivered, with or without
mention of antepartum
condition.
645.03 Prolonged pregnancy, N 14 383, 384
antepartum condition or
complication.
707.1 Ulcer of lower limb, except Y 9 263, 264, 271
decubitus.
781.9 Other symptoms involving N 1 34, 35
nervous and musculoskeletal
systems.
783.2 Abnormal loss of weight..... N 10 296, 297, 298
783.4 Lack of expected normal N 10 296, 297, 298
physiological development.
790.0 Abnormality of red blood N 16 395, 396
cells.
V15.0 Allergy, other than to N 23 467
medicinal agents.
V26.2 Investigation and testing... N 23 467
V49.8 Other specified problems N 23 467
influencing health status.
V67.0 Follow-up examination N 23 465, 466
following surgery.
V71.8 Observation for other N 23 467
specified suspected
conditions.
V76.8 Special screening for N 23 467
malignant neoplasms, other
neoplasm.
V77.9 Other and unspecified N 23 467
endocrine, nutritional,
metabolic, and immunity
disorders.
V82.8 Special screening for other N 23 467
specified conditions.
----------------------------------------------------------------------------------------------------------------
Table 6d.--Revised Diagnosis Code Titles
----------------------------------------------------------------------------------------------------------------
Diagnosis
code Description CC MDC DRG
----------------------------------------------------------------------------------------------------------------
564.1 Irritable bowel syndrome.... N 6 182
183
184
V26.3 Genetic counseling and N 23 467
testing.
V76.49 Special screening for N 23 467
malignant, other sites.
----------------------------------------------------------------------------------------------------------------
Table 6e.--Revised Procedure Codes
----------------------------------------------------------------------------------------------------------------
Procedure
code Description OR MDC DRG
----------------------------------------------------------------------------------------------------------------
41.01 Autologous bone marrow Y PRE 481
transplant without purging.
41.04 Autologous hematopoietic Y PRE 481
stem cell transplant
without purging.
41.05 Allogeneic hematopoietic Y PRE 481
stem cell transplant
without purging.
[[Page 47172]]
86.59 Closure of skin and N
subcutaneous tissue other
sites.
----------------------------------------------------------------------------------------------------------------
Table 6f.--Additions to the CC Exclusions List
[CCs that are added to the list are in Table 6F--Additions to the CC
Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.]
------------------------------------------------------------------------
------------------------------------------------------------------------
*0075 2818 70713 49312 01170 4870 01152 4829
00841 2824 70714 49322 01171 4950 01153 4830
00842 28260 70715 49392 01172 4951 01154 4831
00843 28261 70719 *49391 01173 4952 01155 4838
00844 28262 *4871 49302 01174 4953 01156 4841
00845 28263 4941 49312 01175 4954 01160 4843
00846 28269 *49300 49322 01176 4955 01161 4845
00847 2830 49302 49392 01180 4956 01162 4846
00849 28310 49312 *49392 01181 4957 01163 4847
*01790 28311 49322 49301 01182 4958 01164 4848
4941 28319 49392 49302 01183 4959 01165 485
*01791 2832 *49301 49311 01184 496 01166 486
4941 2839 49302 49312 01185 5060 01170 4870
*01792 2840 49312 49320 01186 5061 01171 4941
4941 2848 49322 49321 01190 5070 01172 4950
*01793 2849 49392 49322 01191 5071 01173 4951
4941 2850 *49302 49391 01192 5078 01174 4952
*01794 2851 49301 49392 01193 5080 01175 4953
4941 *29410 49302 *4940 01194 5081 01176 4954
*01795 2910 49311 01100 01195 515 01180 4955
4941 2911 49312 01101 01196 5160 01181 4956
*01796 2912 49320 01102 01200 5161 01182 4957
4941 2913 49321 01103 01201 5162 01183 4958
*28521 2914 49322 01104 01202 5163 01184 4959
2800 29181 49391 01105 01203 5168 01185 496
2814 29189 49392 01106 01204 5169 01186 5060
2818 2919 *49310 01110 01205 5171 01190 5061
2824 2920 49302 01111 01206 5172 01191 5070
28260 29211 49312 01112 01210 5178 01192 5071
28261 29212 49322 01113 01211 74861 01193 5078
28262 2922 49392 01114 01212 *4941 01194 5080
28263 29281 *49311 01115 01213 01100 01195 5081
28269 29282 49302 01116 01214 01101 01196 515
2830 29283 49312 01120 01215 01102 01200 5160
28310 29284 49322 01121 01216 01103 01201 5161
28311 29289 49392 01122 0310 01104 01202 5162
28319 2929 *49312 01123 11505 01105 01203 5163
2832 29381 49301 01124 11515 01106 01204 5168
2839 29382 49302 01125 1304 01110 01205 5169
2840 29383 49311 01126 1363 01111 01206 5171
2848 29384 49312 01130 481 01112 01210 5172
2849 *29411 49320 01131 4820 01113 01211 5178
2850 2910 49321 01132 4821 01114 01212 74861
2851 2911 49322 01133 4822 01115 01213 *496
*28522 2912 49391 01134 48230 01116 01214 4941
2800 2913 49392 01135 48231 01120 01215 *5061
2814 2914 *49320 01136 48232 01121 01216 4941
2818 29181 49302 01140 48239 01122 0310 *5064
2824 29189 49312 01141 48240 01123 11505 4941
28260 2919 49322 01142 48241 01124 11515 *5069
28261 2920 49392 01143 48249 01125 1304 4941
28262 29211 *49321 01144 48281 01126 1363 *5178
28263 29212 49302 01145 48282 01130 481 49302
28269 2922 49312 01146 48283 01131 4820 49312
2830 29281 49322 01150 48284 01132 4821 49322
28310 29282 49392 01151 48289 01133 4822 49392
28311 29283 *49322 01152 4829 01134 48230 *51889
28319 29284 49301 01153 4830 01135 48231 49302
2832 29289 49302 01154 4831 01136 48232 49312
2839 2929 49311 01155 4838 01140 48239 49322
2840 29381 49312 01156 4841 01141 48240 49392
2848 29382 49320 01160 4843 01142 48241 *5198
2849 29383 49321 01161 4845 01143 48249 49302
2850 29384 49322 01162 4846 01144 48281 49312
2851 *44023 49391 01163 4847 01145 48282 49322
*28529 70710 49392 01164 4848 01146 48283 49392
2800 70711 *49390 01165 485 01150 48284 *5199
2814 70712 49302 01166 486 01151 48289 49302
49312 *70712 V421
49322 70710 V426
49392 70711 V427
*5583 70712 V4281
[[Page 47173]]
00841 70713 V4282
00842 70714 V4283
00843 70715 V4289
00844 70719 V432
00845 *70713 *99689
00846 70710 V4284
00847 70711 *99791
00849 70712 99687
*6000 70713 *99799
5960 70714 99687
5996 70715 *V4284
6010 70719 V4284
6012 *70714 *V4289
6013 70710 V4284
6021 70711 *V429
78820 70712 V4284
78829 70713
*6001 70714
5960 70715
5996 70719
6010 *70715
6012 70710
6013 70711
6021 70712
78820 70713
78829 70714
*6002 70715
5960 70719
5996 *70719
6010 70710
6012 70711
6013 70712
6021 70713
78820 70714
78829 70715
*6003 70719
5960 *7078
5996 70710
6010 70711
6012 70712
6013 70713
6021 70714
78820 70715
78829 70719
*6009 *7079
5960 70710
5996 70711
6010 70712
6012 70713
6013 70714
6021 70715
78820 70719
78829 *7098
*70710 70710
70710 70711
70711 70712
70712 70713
70713 70714
70714 70715
70715 70719
70719 *74861
*70711 4941
70710 *99680
70711 99687
70712 V4284
70713 *99687
70714 99680
70715 99687
70719 V420
------------------------------------------------------------------------
[[Page 47174]]
Table 6g.--Deletions to the CC Exclusions List
[CCs that are deleted from the list are in Table 6G--Deletions to the CC
Exclusions List. Each of the principal diagnoses is shown with an
asterisk, and the revisions to the CC Exclusions List are provided in an
indented column immediately following the affected principal diagnosis.]
------------------------------------------------------------------------
------------------------------------------------------------------------
*01790 01135 48231 6021
494 01136 48232 78820
*01791 01140 48239 78829
494 01141 48240 *7071
*01792 01142 48241 7071
494 01143 48249 *7078
*01793 01144 48281 7071
494 01145 48282 *7079
*01794 01146 48283 7071
494 01150 48284 *7098
*01795 01151 48289 7071
494 01152 4829 *74861
*01796 01153 4830 494
494 01154 4831
*2941 01155 4838
2910 01156 4841
2911 01160 4843
2912 01161 4845
2913 01162 4846
2914 01163 4847
29181 01164 4848
29189 01165 485
2919 01166 486
2920 01170 4870
29211 01171 494
29212 01172 4950
2922 01173 4951
29281 01174 4952
29282 01175 4953
29283 01176 4954
29284 01180 4955
29289 01181 4956
2929 01182 4957
29381 01183 4958
29382 01184 4959
29383 01185 496
29384 01186 5060
*44023 01190 5061
7071 01191 5070
*4871 01192 5071
494 01193 5078
*494 01194 5080
01100 01195 5081
01101 01196 515
01102 01200 5160
01103 01201 5161
01104 01202 5162
01105 01203 5163
01106 01204 5168
01110 01205 5169
01111 01206 5171
01112 01210 5172
01113 01211 5178
01114 01212 74861
01115 01213 *496
01116 01214 494
01120 01215 *5061
01121 01216 494
01122 0310 *5064
01123 11505 494
01124 11515 *5069
01125 1304 494
01126 1363 *600
01130 481 5960
01131 4820 5996
01132 4821 6010
01133 4822 6012
01134 48230 6013
------------------------------------------------------------------------
Table 7a.--Medicare prospective Payment System, Selected Percentile Lengths of Stay
[FY99 MEDPAR update 03/00 Grouper V17.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number Arithmetic 10th 25th 50th 75th 90th
DRG discharges mean LOS percentile percentile percentile percentile percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1....................................... 35352 9.1033 2 3 6 12 19
2....................................... 7158 9.6855 3 5 7 12 19
4....................................... 6095 7.3505 1 2 5 9 16
5....................................... 95604 3.2875 1 1 2 4 7
6....................................... 341 3.2405 1 1 2 4 7
7....................................... 12148 10.2934 2 4 7 13 21
8....................................... 3705 3.0103 1 1 2 4 7
9....................................... 1657 6.4484 1 3 5 8 12
10...................................... 18437 6.5993 2 3 5 8 13
11...................................... 3331 4.1654 1 2 3 5 8
12...................................... 45110 6.0509 2 3 4 7 11
13...................................... 6256 5.0973 2 3 4 6 9
14...................................... 331649 5.9608 2 3 5 7 11
15...................................... 140366 3.6304 1 2 3 5 7
16...................................... 11170 6.1346 2 3 5 7 12
17...................................... 3453 3.3687 1 2 3 4 6
18...................................... 26134 5.5426 2 3 4 7 10
19...................................... 8011 3.7410 1 2 3 5 7
20...................................... 5780 10.2894 3 5 8 13 20
21...................................... 1368 6.8575 2 3 5 9 13
22...................................... 2519 4.9389 2 2 4 6 9
23...................................... 8375 4.2302 1 2 3 5 8
24...................................... 52871 5.0135 1 2 4 6 10
25...................................... 24604 3.3081 1 2 3 4 6
26...................................... 20 3.2000 1 1 2 3 7
27...................................... 3645 5.1084 1 1 3 6 12
28...................................... 10833 6.2260 1 3 5 8 13
29...................................... 3985 3.7064 1 2 3 5 7
31...................................... 3301 4.2293 1 2 3 5 8
32...................................... 1585 2.7356 1 1 2 3 5
34...................................... 19657 5.1974 1 2 4 6 10
35...................................... 5225 3.4195 1 2 3 4 6
36...................................... 4249 1.3641 1 1 1 1 2
37...................................... 1494 3.6921 1 1 3 5 8
38...................................... 115 2.5304 1 1 1 3 5
39...................................... 1160 1.9112 1 1 1 2 4
40...................................... 1765 3.5955 1 1 2 4 8
41...................................... 1 4.0000 4 4 4 4 4
42...................................... 2723 2.2277 1 1 1 3 5
[[Page 47175]]
43...................................... 86 3.3605 1 2 3 4 7
44...................................... 1237 4.9871 2 3 4 6 9
45...................................... 2509 3.2790 1 2 3 4 6
46...................................... 2971 4.5796 1 2 4 6 9
47...................................... 1180 3.3034 1 1 3 4 6
49...................................... 2245 4.9675 1 2 4 6 9
50...................................... 2587 1.9849 1 1 1 2 3
51...................................... 264 2.5303 1 1 1 3 6
52...................................... 198 2.1414 1 1 1 2 5
53...................................... 2594 3.6727 1 1 2 4 8
54...................................... 4 1.5000 1 1 1 1 3
55...................................... 1573 2.8843 1 1 1 3 6
56...................................... 533 3.0507 1 1 2 4 6
57...................................... 587 3.9642 1 1 2 4 8
59...................................... 115 2.5304 1 1 2 3 5
60...................................... 2 1.0000 1 1 1 1 1
61...................................... 212 4.8302 1 1 2 6 13
62...................................... 2 3.5000 2 2 5 5 5
63...................................... 3207 4.2728 1 2 3 5 9
64...................................... 3189 6.5124 1 2 4 8 14
65...................................... 31923 2.8964 1 1 2 4 5
66...................................... 6984 3.1714 1 1 3 4 6
67...................................... 482 3.5270 1 2 3 4 7
68...................................... 13482 4.1567 1 2 3 5 8
69...................................... 4254 3.2795 1 2 3 4 6
70...................................... 33 2.9091 1 2 3 4 5
71...................................... 105 3.8667 1 2 3 6 7
72...................................... 824 3.2961 1 2 3 4 6
73...................................... 6461 4.3439 1 2 3 5 8
75...................................... 39513 10.0058 3 5 8 12 20
76...................................... 40171 11.2717 3 5 9 14 21
77...................................... 2385 4.8776 1 2 4 7 10
78...................................... 30651 6.9464 3 5 6 8 11
79...................................... 183896 8.4642 3 4 7 11 16
80...................................... 8331 5.6766 2 3 5 7 10
81...................................... 5 9.2000 2 2 10 10 19
82...................................... 64149 6.9422 2 3 5 9 14
83...................................... 6603 5.5326 2 3 4 7 10
84...................................... 1549 3.3719 1 2 3 4 6
85...................................... 20158 6.3636 2 3 5 8 12
86...................................... 1940 3.7845 1 2 3 5 7
87...................................... 63294 6.2499 1 3 5 8 12
88...................................... 405792 5.2217 2 3 4 7 9
89...................................... 526310 6.0247 2 3 5 7 11
90...................................... 51516 4.2278 2 3 4 5 7
91...................................... 49 3.3469 1 2 3 4 5
92...................................... 13842 6.2457 2 3 5 8 12
93...................................... 1557 3.9878 1 2 3 5 7
94...................................... 12470 6.3005 2 3 5 8 12
95...................................... 1589 3.6916 1 2 3 5 7
96...................................... 65180 4.7269 2 3 4 6 8
97...................................... 31758 3.6849 1 2 3 5 7
98...................................... 20 4.7000 1 1 3 6 7
99...................................... 18316 3.2260 1 1 2 4 6
100..................................... 7279 2.2124 1 1 2 3 4
101..................................... 19889 4.4315 1 2 3 6 8
102..................................... 5030 2.7356 1 1 2 3 5
103..................................... 461 49.5466 9 12 30 68 118
104..................................... 33364 11.6306 3 6 10 15 22
105..................................... 29546 9.2855 4 5 7 11 17
106..................................... 3820 11.2010 5 7 9 13 19
107..................................... 91043 10.3489 5 7 9 12 17
108..................................... 5267 10.5590 3 5 8 13 20
109..................................... 61942 7.7332 4 5 6 9 13
110..................................... 55263 9.4599 2 5 8 11 18
111..................................... 7172 5.4762 2 4 5 7 8
112..................................... 61239 3.7597 1 1 3 5 8
113..................................... 44445 12.0916 3 6 9 15 24
114..................................... 8543 8.2800 2 4 7 10 16
115..................................... 14129 8.4099 1 4 7 11 16
[[Page 47176]]
116..................................... 309840 3.7279 1 1 3 5 8
117..................................... 3419 4.0433 1 1 2 5 9
118..................................... 6687 2.8065 1 1 1 3 6
119..................................... 1461 4.8542 1 1 3 6 12
120..................................... 36980 8.1173 1 2 5 10 18
121..................................... 164131 6.4386 2 3 5 8 12
122..................................... 81181 3.8293 1 2 3 5 7
123..................................... 41102 4.5805 1 1 3 6 11
124..................................... 135568 4.3735 1 2 3 6 8
125..................................... 75438 2.7854 1 1 2 4 5
126..................................... 5171 11.7343 3 6 9 14 23
127..................................... 683849 5.3364 2 3 4 7 10
128..................................... 11601 5.8042 3 4 5 7 9
129..................................... 4224 2.8570 1 1 1 3 7
130..................................... 89606 5.8064 2 3 5 7 10
131..................................... 27035 4.3769 1 3 4 6 7
132..................................... 153726 3.0483 1 1 2 4 6
133..................................... 7633 2.3958 1 1 2 3 4
134..................................... 33046 3.2976 1 2 3 4 6
135..................................... 7144 4.4709 1 2 3 5 9
136..................................... 1170 2.9103 1 1 2 4 6
138..................................... 192439 4.0078 1 2 3 5 8
139..................................... 77691 2.5071 1 1 2 3 5
140..................................... 76921 2.7133 1 1 2 3 5
141..................................... 86225 3.7087 1 2 3 5 7
142..................................... 42891 2.6783 1 1 2 3 5
143..................................... 186941 2.1669 1 1 2 3 4
144..................................... 79553 5.3212 1 2 4 7 11
145..................................... 6948 2.8094 1 1 2 4 5
146..................................... 11289 10.1758 5 7 9 12 17
147..................................... 2427 6.6135 3 5 6 8 10
148..................................... 135012 12.1210 5 7 10 14 22
149..................................... 17660 6.6535 4 5 6 8 10
150..................................... 20425 11.1526 4 7 9 14 20
151..................................... 4513 5.9280 2 3 5 8 10
152..................................... 4470 8.1953 3 5 7 10 14
153..................................... 1931 5.4604 3 4 5 7 8
154..................................... 29554 13.2574 4 7 10 16 25
155..................................... 6109 4.3495 1 2 3 6 8
156..................................... 2 28.0000 28 28 28 28 28
157..................................... 8234 5.4966 1 2 4 7 11
158..................................... 4427 2.6286 1 1 2 3 5
159..................................... 16536 5.0206 1 2 4 6 10
160..................................... 11065 2.7237 1 1 2 4 5
161..................................... 11551 4.1674 1 2 3 5 9
162..................................... 7067 1.9544 1 1 1 2 4
163..................................... 10 2.9000 1 1 3 3 6
164..................................... 4748 8.3981 4 5 7 10 14
165..................................... 1953 4.8561 2 3 5 6 8
166..................................... 3332 5.0789 2 3 4 6 9
167..................................... 2935 2.7097 1 2 2 3 5
168..................................... 1530 4.6556 1 2 3 6 9
169..................................... 810 2.4247 1 1 2 3 5
170..................................... 11351 11.1690 2 5 8 14 23
171..................................... 1132 4.8012 1 2 4 6 9
172..................................... 30708 6.9805 2 3 5 9 14
173..................................... 2516 3.8557 1 1 3 5 8
174..................................... 237582 4.8236 2 3 4 6 9
175..................................... 28223 2.9429 1 2 3 4 5
176..................................... 15708 5.2687 2 3 4 6 10
177..................................... 9539 4.5524 2 2 4 6 8
178..................................... 3601 3.1427 1 2 3 4 6
179..................................... 12290 6.0134 2 3 5 7 11
180..................................... 85528 5.3979 2 3 4 7 10
181..................................... 24458 3.4102 1 2 3 4 6
182..................................... 234044 4.3621 1 2 3 5 8
183..................................... 79010 2.9636 1 1 2 4 6
184..................................... 99 3.2525 1 2 3 4 5
185..................................... 4361 4.5015 1 2 3 6 9
186..................................... 2 4.5000 2 2 7 7 7
[[Page 47177]]
187..................................... 747 3.8220 1 2 3 5 8
188..................................... 75016 5.5813 1 2 4 7 11
189..................................... 11186 3.1402 1 1 2 4 6
190..................................... 70 5.9857 2 3 4 6 11
191..................................... 9437 14.1379 4 7 10 18 28
192..................................... 984 6.5996 2 4 6 8 11
193..................................... 5705 12.5550 5 7 10 15 23
194..................................... 763 6.7720 2 4 6 8 12
195..................................... 4898 9.8944 4 6 8 12 17
196..................................... 1197 5.6942 2 4 5 7 9
197..................................... 20367 8.7332 3 5 7 11 16
198..................................... 6123 4.5065 2 3 4 6 8
199..................................... 1745 9.6682 3 4 8 13 19
200..................................... 1084 10.7694 2 4 8 14 22
201..................................... 1483 13.8206 3 6 11 18 27
202..................................... 25781 6.5065 2 3 5 8 13
203..................................... 29166 6.6874 2 3 5 9 13
204..................................... 55210 5.8583 2 3 4 7 11
205..................................... 22715 6.2907 2 3 5 8 12
206..................................... 1792 3.8337 1 2 3 5 7
207..................................... 30992 5.1140 1 2 4 6 10
208..................................... 9690 2.8994 1 1 2 4 6
209..................................... 343780 5.1256 3 3 4 6 8
210..................................... 127326 6.8134 3 4 6 8 11
211..................................... 31422 4.9172 3 4 4 6 7
212..................................... 7 3.0000 2 2 2 3 4
213..................................... 8933 8.7283 2 4 7 11 17
216..................................... 5871 9.7808 2 4 7 12 20
217..................................... 17768 13.1592 3 5 9 16 28
218..................................... 21587 5.3674 2 3 4 6 10
219..................................... 19362 3.2518 1 2 3 4 5
220..................................... 3 2.3333 1 1 2 4 4
223..................................... 17578 2.5862 1 1 2 3 5
224..................................... 8041 2.0520 1 1 2 3 4
225..................................... 5639 4.7074 1 2 3 6 10
226..................................... 5033 6.3012 1 2 4 8 13
227..................................... 4462 2.6627 1 1 2 3 5
228..................................... 2477 3.5620 1 1 2 4 8
229..................................... 1092 2.4011 1 1 2 3 5
230..................................... 2116 5.0865 1 2 3 6 10
231..................................... 10738 4.8361 1 2 3 6 10
232..................................... 571 3.5692 1 1 2 4 9
233..................................... 4608 7.7129 2 3 6 10 16
234..................................... 2701 3.5724 1 2 3 4 7
235..................................... 5378 5.1264 1 2 4 6 10
236..................................... 38845 4.8570 1 3 4 6 9
237..................................... 1587 3.7284 1 2 3 5 7
238..................................... 7674 8.4730 3 4 6 10 16
239..................................... 51992 6.2172 2 3 5 8 12
240..................................... 11950 6.5921 2 3 5 8 13
241..................................... 2981 3.9410 1 2 3 5 7
242..................................... 2498 6.5524 2 3 5 8 12
243..................................... 85571 4.7006 1 3 4 6 9
244..................................... 11962 4.7800 1 2 4 6 9
245..................................... 4967 3.7246 1 2 3 4 7
246..................................... 1344 3.6384 1 2 3 4 7
247..................................... 15158 3.4474 1 1 3 4 7
248..................................... 9412 4.7385 1 2 4 6 9
249..................................... 10792 3.7782 1 1 3 5 8
250..................................... 3543 4.2484 1 2 3 5 8
251..................................... 2382 2.9866 1 1 3 4 5
252..................................... 1 2.0000 2 2 2 2 2
253..................................... 19064 4.6962 1 3 4 6 9
254..................................... 10447 3.2049 1 2 3 4 6
255..................................... 1 1.0000 1 1 1 1 1
256..................................... 5875 5.1384 1 2 4 6 10
257..................................... 16895 2.8284 1 2 2 3 5
258..................................... 15820 2.0011 1 1 2 2 3
259..................................... 3743 2.7919 1 1 1 3 6
260..................................... 4815 1.4332 1 1 1 2 2
[[Page 47178]]
261..................................... 1766 2.1682 1 1 1 2 4
262..................................... 686 3.7886 1 1 3 5 7
263..................................... 24706 11.6014 3 5 8 14 23
264..................................... 3910 6.9575 2 3 5 8 14
265..................................... 3905 6.6197 1 2 4 8 14
266..................................... 2557 3.3136 1 1 2 4 7
267..................................... 257 5.2140 1 1 3 6 12
268..................................... 915 3.6907 1 1 2 4 8
269..................................... 8941 8.2543 2 3 6 10 16
270..................................... 2767 3.2754 1 1 2 4 7
271..................................... 21233 7.1222 2 4 6 8 13
272..................................... 5503 6.3353 2 3 5 8 12
273..................................... 1346 4.2132 1 2 3 5 8
274..................................... 2381 6.9475 2 3 5 9 14
275..................................... 229 3.3886 1 1 2 4 7
276..................................... 1089 4.6272 1 2 4 6 9
277..................................... 84246 5.7203 2 3 5 7 10
278..................................... 28748 4.3341 2 3 4 5 7
279..................................... 5 5.4000 2 2 5 5 11
280..................................... 15232 4.1962 1 2 3 5 8
281..................................... 6791 3.0711 1 1 3 4 6
283..................................... 5370 4.5551 1 2 3 6 9
284..................................... 1858 3.1975 1 1 2 4 6
285..................................... 6174 10.4691 3 5 8 13 20
286..................................... 2009 6.2225 2 3 5 7 11
287..................................... 6029 10.5382 3 5 8 13 20
288..................................... 2316 5.6973 2 3 4 6 9
289..................................... 4349 3.1474 1 1 2 3 7
290..................................... 8262 2.4317 1 1 2 2 4
291..................................... 58 1.6379 1 1 1 2 2
292..................................... 4999 9.9930 2 4 7 13 21
293..................................... 326 5.0644 1 2 4 7 10
294..................................... 84584 4.7150 1 2 4 6 9
295..................................... 3506 3.8811 1 2 3 5 7
296..................................... 233633 5.2417 2 3 4 6 10
297..................................... 41115 3.4726 1 2 3 4 6
298..................................... 112 3.1429 1 2 2 4 6
299..................................... 1067 5.6148 1 2 4 6 11
300..................................... 15674 6.1301 2 3 5 8 12
301..................................... 3130 3.7089 1 2 3 5 7
302..................................... 7834 9.3957 4 5 7 11 16
303..................................... 19520 8.4840 4 5 7 10 15
304..................................... 12114 8.9145 2 4 7 11 18
305..................................... 2886 3.8486 1 2 3 5 7
306..................................... 7971 5.4874 1 2 3 7 12
307..................................... 2231 2.2761 1 1 2 3 4
308..................................... 7729 6.3946 1 2 4 8 14
309..................................... 3973 2.4896 1 1 2 3 5
310..................................... 23848 4.3651 1 2 3 5 9
311..................................... 8261 1.8895 1 1 1 2 3
312..................................... 1576 4.5184 1 1 3 6 10
313..................................... 633 2.1137 1 1 1 3 4
314..................................... 2 1.0000 1 1 1 1 1
315..................................... 28842 7.5038 1 1 5 10 17
316..................................... 97171 6.6773 2 3 5 8 13
317..................................... 1237 3.1997 1 1 2 3 6
318..................................... 5569 6.0084 1 3 4 7 12
319..................................... 468 2.8782 1 1 2 4 6
320..................................... 182681 5.3860 2 3 4 7 10
321..................................... 28362 3.8457 1 2 3 5 7
322..................................... 72 4.1111 1 2 3 5 7
323..................................... 16489 3.2195 1 1 2 4 7
324..................................... 7423 1.8792 1 1 1 2 3
325..................................... 7844 3.8986 1 2 3 5 7
326..................................... 2434 2.6619 1 1 2 3 5
327..................................... 8 8.2500 1 1 1 4 13
328..................................... 724 3.8909 1 1 3 5 8
329..................................... 106 2.0472 1 1 1 3 4
331..................................... 43627 5.5325 1 2 4 7 11
332..................................... 4854 3.2701 1 1 2 4 7
[[Page 47179]]
333..................................... 306 5.0163 1 2 3 6 10
334..................................... 12207 4.8955 2 3 4 6 8
335..................................... 11491 3.4115 2 3 3 4 5
336..................................... 40724 3.5245 1 2 3 4 7
337..................................... 30688 2.1779 1 1 2 3 3
338..................................... 1647 5.3024 1 2 3 7 12
339..................................... 1514 4.5594 1 1 3 6 10
340..................................... 1 1.0000 1 1 1 1 1
341..................................... 3866 3.2219 1 1 2 3 7
342..................................... 778 3.1221 1 2 2 4 6
344..................................... 3962 2.2532 1 1 1 2 4
345..................................... 1285 3.7681 1 1 2 5 8
346..................................... 4659 5.8032 1 3 4 7 11
347..................................... 399 3.3734 1 1 2 4 7
348..................................... 3125 4.2074 1 2 3 5 8
349..................................... 595 2.6101 1 1 2 3 5
350..................................... 6202 4.3955 2 2 4 5 8
352..................................... 651 3.8218 1 2 3 5 8
353..................................... 2646 6.7154 3 3 5 8 13
354..................................... 8252 5.8838 3 3 4 7 10
355..................................... 5732 3.3217 2 3 3 4 5
356..................................... 26097 2.4163 1 1 2 3 4
357..................................... 5799 8.5049 3 4 7 10 16
358..................................... 21776 4.3958 2 3 3 5 8
359..................................... 29307 2.8120 2 2 3 3 4
360..................................... 16206 2.9646 1 2 2 3 5
361..................................... 427 3.4637 1 1 2 4 7
362..................................... 2 2.0000 1 1 3 3 3
363..................................... 3100 3.4668 1 2 2 3 7
364..................................... 1626 3.5689 1 1 2 5 7
365..................................... 1936 7.2758 1 3 5 9 16
366..................................... 4266 6.7203 1 3 5 8 14
367..................................... 478 3.1695 1 1 2 4 7
368..................................... 2889 6.7196 2 3 5 8 13
369..................................... 2858 3.1963 1 1 2 4 6
370..................................... 1175 5.7174 3 3 4 5 9
371..................................... 1232 3.6445 2 3 3 4 5
372..................................... 942 3.4809 1 2 2 3 5
373..................................... 3992 2.2856 1 2 2 2 3
374..................................... 138 3.3696 1 2 2 3 5
375..................................... 6 2.6667 2 2 2 3 3
376..................................... 260 3.4577 1 2 2 4 7
377..................................... 54 3.8333 1 1 2 5 8
378..................................... 156 2.3333 1 1 2 3 4
379..................................... 370 3.0676 1 1 2 3 6
380..................................... 77 2.1688 1 1 2 2 4
381..................................... 179 1.9441 1 1 1 2 3
382..................................... 43 1.4884 1 1 1 2 2
383..................................... 1582 3.8957 1 1 3 5 8
384..................................... 128 2.2969 1 1 1 2 4
389..................................... 8 5.8750 3 3 4 8 10
390..................................... 20 3.9500 1 1 3 6 8
392..................................... 2524 9.4624 3 4 7 12 19
393..................................... 2 7.5000 7 7 8 8 8
394..................................... 1742 6.6791 1 2 4 8 15
395..................................... 81014 4.5335 1 2 3 6 9
396..................................... 20 3.8000 1 1 2 5 7
397..................................... 18191 5.2238 1 2 4 7 10
398..................................... 18207 5.9565 2 3 5 7 11
399..................................... 1633 3.5536 1 2 3 4 7
400..................................... 6897 9.0738 1 3 6 12 20
401..................................... 5881 11.1770 2 5 8 14 23
402..................................... 1501 3.9480 1 1 3 5 8
403..................................... 33467 8.0557 2 3 6 10 17
404..................................... 4520 4.2199 1 2 3 6 9
406..................................... 2572 10.3476 3 4 7 13 21
407..................................... 701 4.4051 1 2 4 6 8
408..................................... 2260 7.7088 1 2 5 10 18
409..................................... 3308 5.9344 2 3 4 6 11
410..................................... 41166 3.7183 1 2 3 5 6
[[Page 47180]]
411..................................... 13 2.3077 1 1 2 4 4
412..................................... 29 2.7241 1 1 2 3 6
413..................................... 6216 7.2497 2 3 6 9 14
414..................................... 721 4.0902 1 2 3 5 8
415..................................... 40206 14.2110 4 6 11 18 28
416..................................... 196848 7.3514 2 4 6 9 14
417..................................... 36 5.8889 1 1 4 6 13
418..................................... 22285 6.1233 2 3 5 7 11
419..................................... 15990 4.8206 2 2 4 6 9
420..................................... 3108 3.5618 1 2 3 4 6
421..................................... 12326 3.8695 1 2 3 5 7
422..................................... 98 5.2551 1 2 2 5 7
423..................................... 8137 8.1292 2 3 6 10 17
424..................................... 1368 13.4561 2 5 9 16 28
425..................................... 15108 4.0764 1 2 3 5 8
426..................................... 4357 4.5582 1 2 3 6 9
427..................................... 1679 4.9803 1 2 3 6 10
428..................................... 849 7.0813 1 2 4 8 15
429..................................... 27615 6.4861 2 3 5 8 12
430..................................... 58361 8.1902 2 3 6 10 16
431..................................... 297 6.5758 2 3 5 8 13
432..................................... 394 4.8020 1 2 3 5 9
433..................................... 5831 3.0045 1 1 2 4 6
434..................................... 22063 5.0861 1 2 4 6 9
435..................................... 14652 4.3057 1 2 4 5 8
436..................................... 3548 12.8503 4 7 11 17 25
437..................................... 9841 8.9511 3 5 8 11 15
439..................................... 1306 8.1646 1 3 5 10 17
440..................................... 5063 8.8766 2 3 6 10 19
441..................................... 585 3.2496 1 1 2 4 7
442..................................... 16061 8.2365 1 3 6 10 17
443..................................... 3586 3.3943 1 1 2 4 7
444..................................... 5210 4.2263 1 2 3 5 8
445..................................... 2276 2.9921 1 1 2 4 5
447..................................... 4891 2.5113 1 1 2 3 5
448..................................... 1 4.0000 4 4 4 4 4
449..................................... 26785 3.6730 1 1 3 4 7
450..................................... 6439 2.0449 1 1 1 2 4
451..................................... 1 1.0000 1 1 1 1 1
452..................................... 21849 4.9674 1 2 3 6 10
453..................................... 4499 2.8137 1 1 2 3 5
454..................................... 4999 4.5603 1 2 3 6 9
455..................................... 1083 2.6214 1 1 2 3 5
461..................................... 3396 4.6184 1 1 2 5 11
462..................................... 12718 11.5531 4 6 9 15 21
463..................................... 19068 4.2743 1 2 3 5 8
464..................................... 5509 3.0764 1 1 2 4 6
465..................................... 228 3.3509 1 1 2 3 7
466..................................... 1752 3.9258 1 1 2 4 8
467..................................... 1320 4.0485 1 1 2 4 7
468..................................... 58920 12.9558 3 6 10 17 26
471..................................... 11488 5.7349 3 4 5 6 9
473..................................... 7674 12.8610 2 3 7 19 32
475..................................... 109697 11.1882 2 5 9 15 22
476..................................... 4474 11.6623 2 5 10 15 22
477..................................... 25946 8.1242 1 3 6 10 17
478..................................... 111979 7.3211 1 3 5 9 15
479..................................... 22533 3.6234 1 2 3 5 7
480..................................... 500 19.4980 7 9 14 23 39
481..................................... 274 26.7372 16 19 23 31 43
482..................................... 6178 12.8124 4 7 10 15 24
483..................................... 43726 39.1790 14 21 32 49 71
484..................................... 340 13.0853 2 5 10 18 28
485..................................... 3002 9.4867 4 5 7 11 18
486..................................... 2127 12.1208 1 5 9 16 25
487..................................... 3666 7.6328 1 3 6 10 15
488..................................... 779 16.9718 4 7 12 21 34
489..................................... 14444 8.5516 2 3 6 10 18
490..................................... 5357 5.1286 1 2 4 6 10
491..................................... 11403 3.4912 2 2 3 4 6
[[Page 47181]]
492..................................... 2695 16.1221 4 5 9 26 34
493..................................... 54404 5.7190 1 3 5 7 11
494..................................... 27453 2.4829 1 1 2 3 5
495..................................... 156 20.5000 6 8 12 19 33
496..................................... 1293 10.0093 4 5 7 12 18
497..................................... 22769 6.2233 2 3 5 7 11
498..................................... 19358 3.4145 1 2 3 4 6
499..................................... 30924 4.7726 1 2 4 6 9
500..................................... 42404 2.6896 1 1 2 3 5
501..................................... 1959 10.5630 4 5 8 13 20
502..................................... 621 5.9775 2 3 5 7 10
503..................................... 5625 3.9733 1 2 3 5 7
504..................................... 124 30.4677 10 15 25 40 63
505..................................... 155 4.7161 1 1 2 6 12
506..................................... 968 17.5651 4 8 14 24 37
507..................................... 285 9.2491 2 4 7 13 19
508..................................... 648 7.1605 2 3 5 9 15
509..................................... 167 6.0719 1 2 4 8 12
510..................................... 1673 7.8171 2 3 5 9 17
511..................................... 605 4.4413 1 1 3 6 10
----------------
11001029
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 7b.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay
[FY99 MEDPAR update 03/00 Grouper V.18.0]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Number Arithmetic 10th 25th 50th 75th 90th
DRG discharges mean LOS percentile percentile percentile percentile percentile
--------------------------------------------------------------------------------------------------------------------------------------------------------
1....................................... 35352 9.1033 2 3 6 12 19
2....................................... 7158 9.6855 3 5 7 12 19
4....................................... 6095 7.3505 1 2 5 9 16
5....................................... 95604 3.2875 1 1 2 4 7
6....................................... 341 3.2405 1 1 2 4 7
7....................................... 12147 10.2938 2 4 7 13 21
8....................................... 3706 3.0108 1 1 2 4 7
9....................................... 1657 6.4484 1 3 5 8 12
10...................................... 18433 6.5983 2 3 5 8 13
11...................................... 3335 4.1739 1 2 3 5 8
12...................................... 45110 6.0509 2 3 4 7 11
13...................................... 6256 5.0973 2 3 4 6 9
14...................................... 331649 5.9608 2 3 5 7 11
15...................................... 140366 3.6304 1 2 3 5 7
16...................................... 11166 6.1358 2 3 5 7 12
17...................................... 3457 3.3679 1 2 3 4 6
18...................................... 26127 5.5433 2 3 4 7 10
19...................................... 8018 3.7403 1 2 3 5 7
20...................................... 5780 10.2894 3 5 8 13 20
21...................................... 1368 6.8575 2 3 5 9 13
22...................................... 2519 4.9389 2 2 4 6 9
23...................................... 8375 4.2302 1 2 3 5 8
24...................................... 52856 5.0134 1 2 4 6 10
25...................................... 24619 3.3092 1 2 3 4 6
26...................................... 20 3.2000 1 1 2 3 7
27...................................... 3645 5.1084 1 1 3 6 12
28...................................... 10832 6.2250 1 3 5 8 13
29...................................... 3985 3.7064 1 2 3 5 7
31...................................... 3299 4.2301 1 2 3 5 8
32...................................... 1587 2.7360 1 1 2 3 5
34...................................... 19649 5.1979 1 2 4 6 10
35...................................... 5233 3.4204 1 2 3 4 6
36...................................... 4249 1.3641 1 1 1 1 2
37...................................... 1494 3.6921 1 1 3 5 8
38...................................... 115 2.5304 1 1 1 3 5
39...................................... 1160 1.9112 1 1 1 2 4
40...................................... 1765 3.5955 1 1 2 4 8
41...................................... 1 4.0000 4 4 4 4 4
42...................................... 2723 2.2277 1 1 1 3 5
43...................................... 86 3.3605 1 2 3 4 7
[[Page 47182]]
44...................................... 1237 4.9871 2 3 4 6 9
45...................................... 2509 3.2790 1 2 3 4 6
46...................................... 2970 4.5805 1 2 4 6 9
47...................................... 1181 3.3023 1 1 3 4 6
49...................................... 2245 4.9675 1 2 4 6 9
50...................................... 2587 1.9849 1 1 1 2 3
51...................................... 264 2.5303 1 1 1 3 6
52...................................... 198 2.1414 1 1 1 2 5
53...................................... 2594 3.6727 1 1 2 4 8
54...................................... 4 1.5000 1 1 1 1 3
55...................................... 1573 2.8843 1 1 1 3 6
56...................................... 533 3.0507 1 1 2 4 6
57...................................... 587 3.9642 1 1 2 4 8
59...................................... 115 2.5304 1 1 2 3 5
60...................................... 2 1.0000 1 1 1 1 1
61...................................... 212 4.8302 1 1 2 6 13
62...................................... 2 3.5000 2 2 5 5 5
63...................................... 3207 4.2728 1 2 3 5 9
64...................................... 3189 6.5124 1 2 4 8 14
65...................................... 31923 2.8964 1 1 2 4 5
66...................................... 6984 3.1714 1 1 3 4 6
67...................................... 482 3.5270 1 2 3 4 7
68...................................... 13468 4.1556 1 2 3 5 7
69...................................... 4268 3.2856 1 2 3 4 6
70...................................... 33 2.9091 1 2 3 4 5
71...................................... 105 3.8667 1 2 3 6 7
72...................................... 824 3.2961 1 2 3 4 6
73...................................... 6461 4.3439 1 2 3 5 8
75...................................... 39513 10.0058 3 5 8 12 20
76...................................... 40109 11.2755 3 5 9 14 21
77...................................... 2447 4.9775 1 2 4 7 10
78...................................... 30651 6.9464 3 5 6 8 11
79...................................... 183420 8.4683 3 4 7 11 16
80...................................... 8807 5.7434 2 3 5 7 10
81...................................... 5 9.2000 2 2 10 10 19
82...................................... 64149 6.9422 2 3 5 9 14
83...................................... 6599 5.5342 2 3 4 7 10
84...................................... 1553 3.3709 1 2 3 4 6
85...................................... 20150 6.3637 2 3 5 8 12
86...................................... 1948 3.7936 1 2 3 5 7
87...................................... 63294 6.2499 1 3 5 8 12
88...................................... 405792 5.2217 2 3 4 7 9
89...................................... 525499 6.0257 2 3 5 7 11
90...................................... 52326 4.2457 2 3 4 5 7
91...................................... 49 3.3469 1 2 3 4 5
92...................................... 13772 6.2509 2 3 5 8 12
93...................................... 1627 4.0412 1 2 3 5 7
94...................................... 12463 6.3016 2 3 5 8 12
95...................................... 1596 3.6942 1 2 3 5 7
96...................................... 65045 4.7268 2 3 4 6 8
97...................................... 31893 3.6895 1 2 3 5 7
98...................................... 20 4.7000 1 1 3 6 7
99...................................... 18262 3.2254 1 1 2 4 6
100..................................... 7333 2.2215 1 1 2 3 4
101..................................... 19863 4.4312 1 2 3 6 8
102..................................... 5056 2.7455 1 1 2 3 5
103..................................... 480 51.7875 9 13 31 70 121
104..................................... 33648 11.6443 3 6 10 15 22
105..................................... 29689 9.3034 4 5 7 11 17
106..................................... 3805 11.2100 5 7 9 13 19
107..................................... 90905 10.3450 5 7 9 12 17
108..................................... 5246 10.5442 3 5 8 13 20
109..................................... 61881 7.7309 4 5 6 9 13
110..................................... 55081 9.4414 2 5 8 11 18
111..................................... 7168 5.4788 2 4 5 7 8
112..................................... 61237 3.7595 1 1 3 5 8
113..................................... 44445 12.0916 3 6 9 15 24
114..................................... 8543 8.2800 2 4 7 10 16
115..................................... 14129 8.4099 1 4 7 11 16
116..................................... 309839 3.7278 1 1 3 5 8
[[Page 47183]]
117..................................... 3419 4.0433 1 1 2 5 9
118..................................... 6687 2.8065 1 1 1 3 6
119..................................... 1461 4.8542 1 1 3 6 12
120..................................... 36979 8.1175 1 2 5 10 18
121..................................... 164131 6.4386 2 3 5 8 12
122..................................... 81181 3.8293 1 2 3 5 7
123..................................... 41101 4.5805 1 1 3 6 11
124..................................... 135568 4.3735 1 2 3 6 8
125..................................... 75438 2.7854 1 1 2 4 5
126..................................... 5171 11.7343 3 6 9 14 23
127..................................... 683849 5.3364 2 3 4 7 10
128..................................... 11601 5.8042 3 4 5 7 9
129..................................... 4224 2.8570 1 1 1 3 7
130..................................... 89585 5.8066 2 3 5 7 10
131..................................... 27056 4.3774 1 3 4 6 7
132..................................... 153720 3.0483 1 1 2 4 6
133..................................... 7639 2.3961 1 1 2 3 4
134..................................... 33046 3.2976 1 2 3 4 6
135..................................... 7143 4.4714 1 2 3 5 9
136..................................... 1171 2.9086 1 1 2 4 6
138..................................... 192312 4.0086 1 2 3 5 8
139..................................... 77818 2.5076 1 1 2 3 5
140..................................... 76921 2.7133 1 1 2 3 5
141..................................... 86200 3.7088 1 2 3 5 7
142..................................... 42916 2.6786 1 1 2 3 5
143..................................... 186941 2.1669 1 1 2 3 4
144..................................... 79537 5.3212 1 2 4 7 11
145..................................... 6964 2.8153 1 1 2 4 6
146..................................... 11289 10.1758 5 7 9 12 17
147..................................... 2427 6.6135 3 5 6 8 10
148..................................... 134992 12.1212 5 7 10 14 22
149..................................... 17679 6.6565 4 5 6 8 10
150..................................... 20422 11.1531 4 7 9 14 20
151..................................... 4516 5.9289 2 3 5 8 10
152..................................... 4469 8.1962 3 5 7 10 14
153..................................... 1932 5.4596 3 4 5 7 8
154..................................... 29550 13.2586 4 7 10 16 25
155..................................... 6113 4.3496 1 2 3 6 8
156..................................... 2 28.0000 28 28 28 28 28
157..................................... 8234 5.4966 1 2 4 7 11
158..................................... 4427 2.6286 1 1 2 3 5
159..................................... 16531 5.0216 1 2 4 6 10
160..................................... 11070 2.7232 1 1 2 4 5
161..................................... 11547 4.1684 1 2 3 5 9
162..................................... 7071 1.9542 1 1 1 2 4
163..................................... 10 2.9000 1 1 3 3 6
164..................................... 4747 8.3994 4 5 7 10 14
165..................................... 1954 4.8547 2 3 5 6 8
166..................................... 3331 5.0793 2 3 4 6 9
167..................................... 2936 2.7101 1 2 2 3 5
168..................................... 1530 4.6556 1 2 3 6 9
169..................................... 810 2.4247 1 1 2 3 5
170..................................... 11351 11.1690 2 5 8 14 23
171..................................... 1132 4.8012 1 2 4 6 9
172..................................... 30705 6.9802 2 3 5 9 14
173..................................... 2519 3.8626 1 1 3 5 8
174..................................... 237539 4.8239 2 3 4 6 9
175..................................... 28266 2.9435 1 2 3 4 5
176..................................... 15708 5.2687 2 3 4 6 10
177..................................... 9537 4.5531 2 2 4 6 8
178..................................... 3603 3.1415 1 2 3 4 6
179..................................... 12290 6.0134 2 3 5 7 11
180..................................... 85505 5.3984 2 3 4 7 10
181..................................... 24481 3.4105 1 2 3 4 6
182..................................... 233949 4.3625 1 2 3 5 8
183..................................... 79105 2.9644 1 1 2 4 6
184..................................... 99 3.2525 1 2 3 4 5
185..................................... 4361 4.5015 1 2 3 6 9
186..................................... 2 4.5000 2 2 7 7 7
187..................................... 747 3.8220 1 2 3 5 8
[[Page 47184]]
188..................................... 75007 5.5817 1 2 4 7 11
189..................................... 11195 3.1401 1 1 2 4 6
190..................................... 70 5.9857 2 3 4 6 11
191..................................... 9434 14.1406 4 7 10 18 28
192..................................... 987 6.5968 2 4 6 8 11
193..................................... 5705 12.5550 5 7 10 15 23
194..................................... 763 6.7720 2 4 6 8 12
195..................................... 4898 9.8944 4 6 8 12 17
196..................................... 1197 5.6942 2 4 5 7 9
197..................................... 20365 8.7337 3 5 7 11 16
198..................................... 6125 4.5063 2 3 4 6 8
199..................................... 1745 9.6682 3 4 8 13 19
200..................................... 1084 10.7694 2 4 8 14 22
201..................................... 1483 13.8206 3 6 11 18 27
202..................................... 25781 6.5065 2 3 5 8 13
203..................................... 29166 6.6874 2 3 5 9 13
204..................................... 55210 5.8583 2 3 4 7 11
205..................................... 22715 6.2907 2 3 5 8 12
206..................................... 1792 3.8337 1 2 3 5 7
207..................................... 30984 5.1140 1 2 4 6 10
208..................................... 9698 2.9013 1 1 2 4 6
209..................................... 343780 5.1256 3 3 4 6 8
210..................................... 127278 6.8141 3 4 6 8 11
211..................................... 31470 4.9173 3 4 4 6 7
212..................................... 7 3.0000 2 2 2 3 4
213..................................... 8933 8.7283 2 4 7 11 17
216..................................... 5871 9.7808 2 4 7 12 20
217..................................... 17768 13.1592 3 5 9 16 28
218..................................... 21572 5.3690 2 3 4 6 10
219..................................... 19377 3.2517 1 2 3 4 5
220..................................... 3 2.3333 1 1 2 4 4
223..................................... 17575 2.5861 1 1 2 3 5
224..................................... 8044 2.0525 1 1 2 3 4
225..................................... 5639 4.7074 1 2 3 6 10
226..................................... 4927 6.3028 1 2 4 8 13
227..................................... 4410 2.6689 1 1 2 3 5
228..................................... 2477 3.5620 1 1 2 4 8
229..................................... 1092 2.4011 1 1 2 3 5
230..................................... 2274 5.0721 1 2 3 6 10
231..................................... 10738 4.8361 1 2 3 6 10
232..................................... 571 3.5692 1 1 2 4 9
233..................................... 4607 7.7141 2 3 6 10 16
234..................................... 2702 3.5718 1 2 3 4 7
235..................................... 5378 5.1264 1 2 4 6 10
236..................................... 38845 4.8570 1 3 4 6 9
237..................................... 1587 3.7284 1 2 3 5 7
238..................................... 7674 8.4730 3 4 6 10 16
239..................................... 51992 6.2172 2 3 5 8 12
240..................................... 11944 6.5936 2 3 5 8 13
241..................................... 2987 3.9404 1 2 3 5 7
242..................................... 2498 6.5524 2 3 5 8 12
243..................................... 85571 4.7006 1 3 4 6 9
244..................................... 11961 4.7800 1 2 4 6 9
245..................................... 4968 3.7246 1 2 3 4 7
246..................................... 1344 3.6384 1 2 3 4 7
247..................................... 15158 3.4474 1 1 3 4 7
248..................................... 9412 4.7385 1 2 4 6 9
249..................................... 10792 3.7782 1 1 3 5 8
250..................................... 3542 4.2490 1 2 3 5 8
251..................................... 2383 2.9862 1 1 3 4 5
252..................................... 1 2.0000 2 2 2 2 2
253..................................... 19051 4.6967 1 3 4 6 9
254..................................... 10460 3.2059 1 2 3 4 6
255..................................... 1 1.0000 1 1 1 1 1
256..................................... 5875 5.1384 1 2 4 6 10
257..................................... 16871 2.8291 1 2 2 3 5
258..................................... 15844 2.0016 1 1 2 2 3
259..................................... 3741 2.7928 1 1 1 3 6
260..................................... 4817 1.4330 1 1 1 2 2
261..................................... 1766 2.1682 1 1 1 2 4
[[Page 47185]]
262..................................... 686 3.7886 1 1 3 5 7
263..................................... 24706 11.6014 3 5 8 14 23
264..................................... 3910 6.9575 2 3 5 8 14
265..................................... 3904 6.6201 1 2 4 8 14
266..................................... 2558 3.3143 1 1 2 4 7
267..................................... 257 5.2140 1 1 3 6 12
268..................................... 915 3.6907 1 1 2 4 8
269..................................... 8938 8.2558 2 3 6 10 16
270..................................... 2770 3.2762 1 1 2 4 7
271..................................... 21233 7.1222 2 4 6 8 13
272..................................... 5501 6.3356 2 3 5 8 12
273..................................... 1348 4.2151 1 2 3 5 8
274..................................... 2381 6.9475 2 3 5 9 14
275..................................... 229 3.3886 1 1 2 4 7
276..................................... 1089 4.6272 1 2 4 6 9
277..................................... 84223 5.7207 2 3 5 7 10
278..................................... 28771 4.3340 2 3 4 5 7
279..................................... 5 5.4000 2 2 5 5 11
280..................................... 15227 4.1968 1 2 3 5 8
281..................................... 6796 3.0705 1 1 3 4 6
283..................................... 5368 4.5561 1 2 3 6 9
284..................................... 1860 3.1962 1 1 2 4 6
285..................................... 6166 10.4710 3 5 8 13 20
286..................................... 2009 6.2225 2 3 5 7 11
287..................................... 6029 10.5382 3 5 8 13 20
288..................................... 2324 5.7087 2 3 4 6 9
289..................................... 4349 3.1474 1 1 2 3 7
290..................................... 8262 2.4317 1 1 2 2 4
291..................................... 58 1.6379 1 1 1 2 2
292..................................... 4999 9.9930 2 4 7 13 21
293..................................... 326 5.0644 1 2 4 7 10
294..................................... 84584 4.7150 1 2 4 6 9
295..................................... 3506 3.8811 1 2 3 5 7
296..................................... 233520 5.2416 2 3 4 6 10
297..................................... 41231 3.4777 1 2 3 4 6
298..................................... 112 3.1429 1 2 2 4 6
299..................................... 1067 5.6148 1 2 4 6 11
300..................................... 15669 6.1305 2 3 5 8 12
301..................................... 3135 3.7107 1 2 3 5 7
302..................................... 7834 9.3957 4 5 7 11 16
303..................................... 19520 8.4840 4 5 7 10 15
304..................................... 12114 8.9145 2 4 7 11 18
305..................................... 2886 3.8486 1 2 3 5 7
306..................................... 7970 5.4877 1 2 3 7 12
307..................................... 2232 2.2764 1 1 2 3 4
308..................................... 7725 6.3969 1 2 4 8 14
309..................................... 3977 2.4891 1 1 2 3 5
310..................................... 23844 4.3654 1 2 3 5 9
311..................................... 8265 1.8897 1 1 1 2 3
312..................................... 1576 4.5184 1 1 3 6 10
313..................................... 633 2.1137 1 1 1 3 4
314..................................... 2 1.0000 1 1 1 1 1
315..................................... 28842 7.5038 1 1 5 10 17
316..................................... 97170 6.6773 2 3 5 8 13
317..................................... 1237 3.1997 1 1 2 3 6
318..................................... 5569 6.0084 1 3 4 7 12
319..................................... 468 2.8782 1 1 2 4 6
320..................................... 182655 5.3861 2 3 4 7 10
321..................................... 28388 3.8467 1 2 3 5 7
322..................................... 72 4.1111 1 2 3 5 7
323..................................... 16486 3.2195 1 1 2 4 7
324..................................... 7426 1.8796 1 1 1 2 3
325..................................... 7844 3.8986 1 2 3 5 7
326..................................... 2434 2.6619 1 1 2 3 5
327..................................... 8 8.2500 1 1 1 4 13
328..................................... 724 3.8909 1 1 3 5 8
329..................................... 106 2.0472 1 1 1 3 4
331..................................... 43621 5.5330 1 2 4 7 11
332..................................... 4860 3.2687 1 1 2 4 7
333..................................... 306 5.0163 1 2 3 6 10
[[Page 47186]]
334..................................... 12201 4.8961 2 3 4 6 8
335..................................... 11497 3.4117 2 3 3 4 5
336..................................... 40717 3.5248 1 2 3 4 7
337..................................... 30695 2.1778 1 1 2 3 3
338..................................... 1647 5.3024 1 2 3 7 12
339..................................... 1514 4.5594 1 1 3 6 10
340..................................... 1 1.0000 1 1 1 1 1
341..................................... 3866 3.2219 1 1 2 3 7
342..................................... 778 3.1221 1 2 2 4 6
344..................................... 3962 2.2532 1 1 1 2 4
345..................................... 1285 3.7681 1 1 2 5 8
346..................................... 4659 5.8032 1 3 4 7 11
347..................................... 399 3.3734 1 1 2 4 7
348..................................... 3125 4.2074 1 2 3 5 8
349..................................... 595 2.6101 1 1 2 3 5
350..................................... 6202 4.3955 2 2 4 5 8
352..................................... 651 3.8218 1 2 3 5 8
353..................................... 2646 6.7154 3 3 5 8 13
354..................................... 8251 5.8841 3 3 4 7 10
355..................................... 5733 3.3216 2 3 3 4 5
356..................................... 26097 2.4163 1 1 2 3 4
357..................................... 5799 8.5049 3 4 7 10 16
358..................................... 21754 4.3966 2 3 3 5 8
359..................................... 29329 2.8125 2 2 3 3 4
360..................................... 16206 2.9646 1 2 2 3 5
361..................................... 427 3.4637 1 1 2 4 7
362..................................... 2 2.0000 1 1 3 3 3
363..................................... 3100 3.4668 1 2 2 3 7
364..................................... 1626 3.5689 1 1 2 5 7
365..................................... 1936 7.2758 1 3 5 9 16
366..................................... 4266 6.7203 1 3 5 8 14
367..................................... 478 3.1695 1 1 2 4 7
368..................................... 2889 6.7196 2 3 5 8 13
369..................................... 2858 3.1963 1 1 2 4 6
370..................................... 1175 5.7174 3 3 4 5 9
371..................................... 1232 3.6445 2 3 3 4 5
372..................................... 952 3.4758 2 2 2 3 5
373..................................... 3982 2.2838 1 2 2 2 3
374..................................... 138 3.3696 1 2 2 3 5
375..................................... 6 2.6667 2 2 2 3 3
376..................................... 260 3.4577 1 2 2 4 7
377..................................... 54 3.8333 1 1 2 5 8
378..................................... 156 2.3333 1 1 2 3 4
379..................................... 370 3.0676 1 1 2 3 6
380..................................... 77 2.1688 1 1 2 2 4
381..................................... 179 1.9441 1 1 1 2 3
382..................................... 43 1.4884 1 1 1 2 2
383..................................... 1582 3.8957 1 1 3 5 8
384..................................... 128 2.2969 1 1 1 2 4
389..................................... 8 5.8750 3 3 4 8 10
390..................................... 20 3.9500 1 1 3 6 8
392..................................... 2524 9.4624 3 4 7 12 19
393..................................... 2 7.5000 7 7 8 8 8
394..................................... 1742 6.6791 1 2 4 8 15
395..................................... 81014 4.5335 1 2 3 6 9
396..................................... 20 3.8000 1 1 2 5 7
397..................................... 18191 5.2238 1 2 4 7 10
398..................................... 18199 5.9577 2 3 5 7 11
399..................................... 1641 3.5521 1 2 3 4 7
400..................................... 6893 9.0730 1 3 6 12 20
401..................................... 5865 11.1758 2 5 8 14 23
402..................................... 1503 3.9508 1 1 3 5 8
403..................................... 33074 8.0664 2 3 6 10 17
404..................................... 4484 4.2219 1 2 3 6 9
406..................................... 2574 10.3528 3 4 7 13 21
407..................................... 703 4.4040 1 2 4 6 8
408..................................... 2275 7.7354 1 2 5 10 18
409..................................... 3308 5.9344 2 3 4 6 11
410..................................... 41165 3.7184 1 2 3 5 6
411..................................... 13 2.3077 1 1 2 4 4
[[Page 47187]]
412..................................... 29 2.7241 1 1 2 3 6
413..................................... 6605 7.2450 2 3 6 9 14
414..................................... 761 4.0933 1 2 3 5 8
415..................................... 40206 14.2110 4 6 11 18 28
416..................................... 196848 7.3514 2 4 6 9 14
417..................................... 36 5.8889 1 1 4 6 13
418..................................... 22285 6.1233 2 3 5 7 11
419..................................... 15984 4.8204 2 2 4 6 9
420..................................... 3114 3.5649 1 2 3 4 6
421..................................... 12326 3.8695 1 2 3 5 7
422..................................... 98 5.2551 1 2 2 5 7
423..................................... 8137 8.1292 2 3 6 10 17
424..................................... 1368 13.4561 2 5 9 16 28
425..................................... 15108 4.0764 1 2 3 5 8
426..................................... 4357 4.5582 1 2 3 6 9
427..................................... 1679 4.9803 1 2 3 6 10
428..................................... 849 7.0813 1 2 4 8 15
429..................................... 27615 6.4861 2 3 5 8 12
430..................................... 58361 8.1902 2 3 6 10 16
431..................................... 297 6.5758 2 3 5 8 13
432..................................... 394 4.8020 1 2 3 5 9
433..................................... 5831 3.0045 1 1 2 4 6
434..................................... 22061 5.0864 1 2 4 6 9
435..................................... 14654 4.3052 1 2 4 5 8
436..................................... 3548 12.8503 4 7 11 17 25
437..................................... 9841 8.9511 3 5 8 11 15
439..................................... 1306 8.1646 1 3 5 10 17
440..................................... 5063 8.8766 2 3 6 10 19
441..................................... 585 3.2496 1 1 2 4 7
442..................................... 16061 8.2365 1 3 6 10 17
443..................................... 3586 3.3943 1 1 2 4 7
444..................................... 5206 4.2274 1 2 3 5 8
445..................................... 2280 2.9917 1 1 2 4 5
447..................................... 4891 2.5113 1 1 2 3 5
448..................................... 1 4.0000 4 4 4 4 4
449..................................... 26781 3.6732 1 1 3 4 7
450..................................... 6443 2.0449 1 1 1 2 4
451..................................... 1 1.0000 1 1 1 1 1
452..................................... 21847 4.9676 1 2 3 6 10
453..................................... 4501 2.8136 1 1 2 3 5
454..................................... 4997 4.5603 1 2 3 6 9
455..................................... 1085 2.6249 1 1 2 3 5
461..................................... 3397 4.6194 1 1 2 5 11
462..................................... 12718 11.5531 4 6 9 15 21
463..................................... 19065 4.2742 1 2 3 5 8
464..................................... 5511 3.0766 1 1 2 4 6
465..................................... 228 3.3509 1 1 2 3 7
466..................................... 1752 3.9258 1 1 2 4 8
467..................................... 1320 4.0485 1 1 2 4 7
468..................................... 58922 12.9489 3 6 10 17 26
471..................................... 11488 5.7349 3 4 5 6 9
473..................................... 7674 12.8610 2 3 7 19 32
475..................................... 109695 11.1883 2 5 9 15 22
476..................................... 4474 11.6623 2 5 10 15 22
477..................................... 25946 8.1242 1 3 6 10 17
478..................................... 111969 7.3211 1 3 5 9 15
479..................................... 22542 3.6236 1 2 3 5 7
480..................................... 500 19.4980 7 9 14 23 39
481..................................... 273 26.5641 16 19 23 31 41
482..................................... 6195 12.8199 4 7 10 15 24
483..................................... 43695 39.1662 14 22 32 49 71
484..................................... 340 13.0853 2 5 10 18 28
485..................................... 3002 9.4867 4 5 7 11 18
486..................................... 2127 12.1208 1 5 9 16 25
487..................................... 3666 7.6328 1 3 6 10 15
488..................................... 779 16.9718 4 7 12 21 34
489..................................... 14444 8.5516 2 3 6 10 18
490..................................... 5354 5.1291 1 2 4 6 10
491..................................... 11403 3.4912 2 2 3 4 6
492..................................... 2695 16.1221 4 5 9 26 34
[[Page 47188]]
493..................................... 54388 5.7197 1 3 5 7 11
494..................................... 27469 2.4832 1 1 2 3 5
495..................................... 156 20.5000 6 8 12 19 33
496..................................... 1293 10.0093 4 5 7 12 18
497..................................... 22761 6.2244 2 3 5 7 11
498..................................... 19366 3.4143 1 2 3 4 6
499..................................... 30892 4.7750 1 2 4 6 9
500..................................... 42436 2.6894 1 1 2 3 5
501..................................... 1959 10.5630 4 5 8 13 20
502..................................... 621 5.9775 2 3 5 7 10
503..................................... 5625 3.9733 1 2 3 5 7
504..................................... 124 30.4677 10 15 25 40 63
505..................................... 155 4.7161 1 1 2 6 12
506..................................... 968 17.5651 4 8 14 24 37
507..................................... 285 9.2491 2 4 7 13 19
508..................................... 648 7.1605 2 3 5 9 15
509..................................... 167 6.0719 1 2 4 8 12
510..................................... 1673 7.8171 2 3 5 9 17
511..................................... 605 4.4413 1 1 3 6 10
----------------
11001029
--------------------------------------------------------------------------------------------------------------------------------------------------------
Table 8a.--Statewide Average Operating Cost-to-Charge Ratios for Urban
and Rural Hospitals (Case Weighted) March 2000
------------------------------------------------------------------------
State Urban Rural
------------------------------------------------------------------------
ALABAMA............................................. 0.401 0.355
ALASKA.............................................. 0.470 0.723
ARIZONA............................................. 0.373 0.517
ARKANSAS............................................ 0.478 0.454
CALIFORNIA.......................................... 0.342 0.441
COLORADO............................................ 0.436 0.559
CONNECTICUT......................................... 0.495 0.503
DELAWARE............................................ 0.507 0.449
DISTRICT OF COLUMBIA................................ 0.521 ........
FLORIDA............................................. 0.363 0.381
GEORGIA............................................. 0.475 0.486
HAWAII.............................................. 0.409 0.554
IDAHO............................................... 0.549 0.571
ILLINOIS............................................ 0.425 0.509
INDIANA............................................. 0.532 0.544
IOWA................................................ 0.493 0.624
KANSAS.............................................. 0.444 0.652
KENTUCKY............................................ 0.478 0.493
LOUISIANA........................................... 0.410 0.496
MAINE............................................... 0.597 0.550
MARYLAND............................................ 0.759 0.821
MASSACHUSETTS....................................... 0.526 0.538
MICHIGAN............................................ 0.466 0.572
MINNESOTA........................................... 0.509 0.591
MISSISSIPPI......................................... 0.456 0.454
MISSOURI............................................ 0.413 0.507
MONTANA............................................. 0.524 0.572
NEBRASKA............................................ 0.468 0.623
NEVADA.............................................. 0.292 0.486
NEW HAMPSHIRE....................................... 0.541 0.579
NEW JERSEY.......................................... 0.401 ........
NEW MEXICO.......................................... 0.452 0.498
NEW YORK............................................ 0.529 0.611
NORTH CAROLINA...................................... 0.540 0.489
NORTH DAKOTA........................................ 0.622 0.661
OHIO................................................ 0.511 0.578
OKLAHOMA............................................ 0.423 0.509
OREGON.............................................. 0.607 0.582
PENNSYLVANIA........................................ 0.396 0.517
PUERTO RICO......................................... 0.479 0.579
RHODE ISLAND........................................ 0.522 ........
SOUTH CAROLINA...................................... 0.447 0.451
SOUTH DAKOTA........................................ 0.537 0.600
TENNESSEE........................................... 0.441 0.482
TEXAS............................................... 0.404 0.503
UTAH................................................ 0.504 0.619
VERMONT............................................. 0.623 0.595
VIRGINIA............................................ 0.466 0.498
WASHINGTON.......................................... 0.576 0.653
WEST VIRGINIA....................................... 0.575 0.532
WISCONSIN........................................... 0.551 0.621
WYOMING............................................. 0.475 0.682
------------------------------------------------------------------------
Table 8b.--Statewide Average Capital Cost-to-Charge Ratios (Case
Weighted) March 2000
------------------------------------------------------------------------
State Ratio
------------------------------------------------------------------------
ALABAMA....................................................... 0.040
ALASKA........................................................ 0.070
ARIZONA....................................................... 0.041
ARKANSAS...................................................... 0.050
CALIFORNIA.................................................... 0.036
COLORADO...................................................... 0.046
CONNECTICUT................................................... 0.036
DELAWARE...................................................... 0.051
DISTRICT OF COLUMBIA.......................................... 0.039
FLORIDA....................................................... 0.045
GEORGIA....................................................... 0.056
HAWAII........................................................ 0.043
IDAHO......................................................... 0.049
ILLINOIS...................................................... 0.042
INDIANA....................................................... 0.057
IOWA.......................................................... 0.056
KANSAS........................................................ 0.054
KENTUCKY...................................................... 0.046
LOUISIANA..................................................... 0.050
MAINE......................................................... 0.039
MARYLAND...................................................... 0.013
MASSACHUSETTS................................................. 0.055
MICHIGAN...................................................... 0.045
MINNESOTA..................................................... 0.049
MISSISSIPPI................................................... 0.045
MISSOURI...................................................... 0.046
MONTANA....................................................... 0.055
NEBRASKA...................................................... 0.054
NEVADA........................................................ 0.030
NEW HAMPSHIRE................................................. 0.061
NEW JERSEY.................................................... 0.036
NEW MEXICO.................................................... 0.044
NEW YORK...................................................... 0.051
NORTH CAROLINA................................................ 0.050
NORTH DAKOTA.................................................. 0.074
OHIO.......................................................... 0.050
OKLAHOMA...................................................... 0.048
OREGON........................................................ 0.049
PENNSYLVANIA.................................................. 0.040
PUERTO RICO................................................... 0.043
RHODE ISLAND.................................................. 0.030
SOUTH CAROLINA................................................ 0.047
SOUTH DAKOTA.................................................. 0.066
TENNESSEE..................................................... 0.051
TEXAS......................................................... 0.048
UTAH.......................................................... 0.049
VERMONT....................................................... 0.051
VIRGINIA...................................................... 0.058
WASHINGTON.................................................... 0.064
WEST VIRGINIA................................................. 0.047
WISCONSIN..................................................... 0.053
WYOMING....................................................... 0.057
------------------------------------------------------------------------
[[Page 47189]]
Appendix A--Regulatory Impact Analysis
I. Introduction
Section 804(2) of Title 5, United States Code (as added by
section 251 of Public Law 104-121), specifies that a major rule is
any rule that the Office of Management and Budget finds is likely to
result in--
An annual effect on the economy of $100 million or
more;
A major increase in costs or prices for consumers
individual industries, Federal, State or local government agencies
or geographic regions; or
Significant adverse effects on competition, employment,
investment, productivity, innovation or on the ability of United
States based enterprises to compete with foreign based enterprises
in domestic and export markets.
We estimate that the impact of this final rule relating to the
annual update in payment rates and policy changes for hospital
inpatient services and the implementation of the specified changes
under Public Law 106-113 will be to increase payments to hospitals
by approximately $1.5 billion in FY 2001. We estimate that the
impact of the final changes relating to the Medicare inpatient DSH
adjustment calculation (a finalization of the January 20, 2000
interim final rule) to be $350 million for FY 2001. Therefore, this
rule is a major rule as defined in Title 5, United States Code,
section 804(2).
We generally prepare a regulatory flexibility analysis that is
consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601
through 612), unless we certify that a final rule would not have a
significant economic impact on a substantial number of small
entities. For purposes of the RFA, we consider all hospitals to be
small entities.
Also, section 1102(b) of the Act requires us to prepare a
regulatory impact analysis for any rule that may have a significant
impact on the operations of a substantial number of small rural
hospitals. Such an analysis must conform to the provisions of
section 603 of the RFA. With the exception of hospitals located in
certain New England counties, for purposes of section 1102(b) of the
Act, we define a small rural hospital as a hospital with fewer than
100 beds that is located outside of a Metropolitan Statistical Area
(MSA) or New England County Metropolitan Area (NECMA). Section
601(g) of the Social Security Amendments of 1983 (Pub. L. 98-21)
designated hospitals in certain New England counties as belonging to
the adjacent NECMA. Thus, for purposes of the hospital inpatient
prospective payment system, we classify these hospitals as urban
hospitals.
It is clear that the changes in this final rule will affect both
a substantial number of small rural hospitals as well as other
classes of hospitals, and the effects on some may be significant.
Therefore, the discussion below, in combination with the rest of
this final rule, constitutes a combined regulatory impact analysis
and regulatory flexibility analysis.
We have reviewed this final rule under the threshold criteria of
Executive Order 13132, Federalism, and have determined that the
final rule will not have any negative impact on the rights, roles,
and responsibilities of State, local, or tribal governments.
Section 202 of the Unfunded Mandates Reform Act of 1995 also
requires that agencies assess anticipated costs and benefits before
issuing any rule that may result in an expenditure in any one year
by State, local or tribal governments, in the aggregate, or by the
private sector, of $100 million. This final rule does not mandate
any requirements for State, local, or tribal governments.
In accordance with the provisions of Executive Order 12866, this
final rule was reviewed by the Office of Management and Budget.
II. Changes in the Final Rule
Since we published the proposed rule, the market basket
estimates for hospitals subject to the prospective payment system
and hospitals and units excluded from the system have both risen by
0.3 percentage points. With the exception of these changes, we are
generally implementing the policy and statutory provisions discussed
in the proposed rule.
III. Limitations of Our Analysis
As has been the case in our previously published regulatory
impact analyses, the following quantitative analysis presents the
projected effects of our policy changes, as well as statutory
changes effective for FY 2001, on various hospital groups. We
estimate the effects of individual policy changes by estimating
payments per case while holding all other payment policies constant.
We use the best data available, but we do not attempt to predict
behavioral responses to our policy changes, and we do not make
adjustments for future changes in such variables as admissions,
lengths of stay, or case-mix.
We received no comments on the methodology used for the impact
analysis in the proposed rule.
IV. Hospitals Included In and Excluded From the Prospective Payment
System
The prospective payment systems for hospital inpatient operating
and capital-related costs encompass nearly all general, short-term,
acute care hospitals that participate in the Medicare program. There
were 45 Indian Health Service hospitals in our database, which we
excluded from the analysis due to the special characteristics of the
prospective payment method for these hospitals. Among other short-
term, acute care hospitals, only the 50 such hospitals in Maryland
remain excluded from the prospective payment system under the waiver
at section 1814(b)(3) of the Act. Thus, as of July 2000, we have
included 4,888 hospitals in our analysis. This represents about 80
percent of all Medicare-participating hospitals. The majority of
this impact analysis focuses on this set of hospitals.
The remaining 20 percent are specialty hospitals that are
excluded from the prospective payment system and continue to be paid
on the basis of their reasonable costs (subject to a rate-of-
increase ceiling on their inpatient operating costs per discharge).
These hospitals include psychiatric, rehabilitation, long-term care,
children's, and cancer hospitals. The impacts of our final policy
changes on these hospitals are discussed below.
V. Impact on Excluded Hospitals and Units
As of July 2000, there were 1,068 specialty hospitals excluded
from the prospective payment system and instead paid on a reasonable
cost basis subject to the rate-of-increase ceiling under
Sec. 413.40. Broken down by specialty, there were 529 psychiatric,
196 rehabilitation, 242 long-term care, 74 children's, 17 Christian
Science Sanatoria, and 10 cancer hospitals. In addition, there were
1,468 psychiatric units and 918 rehabilitation units in hospitals
otherwise subject to the prospective payment system. These excluded
units are also paid in accordance with Sec. 413.40. Under
Sec. 413.40(a)(2)(i)(A), the rate-of-increase ceiling is not
applicable to the 36 specialty hospitals and units in Maryland that
are paid in accordance with the waiver at section 1814(b)(3) of the
Act.
As required by section 1886(b)(3)(B) of the Act, the update
factor applicable to the rate-of-increase limit for excluded
hospitals and units for FY 2001 will be between 0 and 3.4 percent,
depending on the hospital's or unit's costs in relation to its limit
for the most recent cost reporting period for which information is
available.
The impact on excluded hospitals and units of the update in the
rate-of-increase limit depends on the cumulative cost increases
experienced by each excluded hospital or unit since its applicable
base period. For excluded hospitals and units that have maintained
their cost increases at a level below the percentage increases in
the rate-of-increase limits since their base period, the major
effect will be on the level of incentive payments these hospitals
and units receive. Conversely, for excluded hospitals and units with
per-case cost increases above the cumulative update in their rate-
of-increase limits, the major effect will be the amount of excess
costs that would not be reimbursed.
We note that, under Sec. 413.40(d)(3), an excluded hospital or
unit whose costs exceed 110 percent of its rate-of-increase limit
receives its rate-of-increase limit plus 50 percent of the
difference between its reasonable costs and 110 percent of the
limit, not to exceed 110 percent of its limit. In addition, under
the various provisions set forth in Sec. 413.40, certain excluded
hospitals and units can obtain payment adjustments for justifiable
increases in operating costs that exceed the limit. At the same
time, however, by generally limiting payment increases, we continue
to provide an incentive for excluded hospitals and units to restrain
the growth in their spending for patient services.
VI. Graduate Medical Education Impact of National Average Per Resident
Amount (PRA)
As discussed in section IV.G. of the preamble, this final rule
implements statutory provisions enacted by section 311 of Public Law
106-113 that establish a methodology for the use of a national
average PRA in computing direct graduate medical education (GME)
payments for cost reporting
[[Page 47190]]
periods beginning on or after October 1, 2000 and on or before
September 30, 2005. The methodology establishes a "floor" and
"ceiling" based on a locality-adjusted, updated national average
PRA. Under section 1886(h)(2)(D)(iii) of the Act, as added by
section 311(a) of Public Law 106-113, the PRA for a hospital for the
cost reporting period beginning during FY 2001 cannot be below 70
percent of the locality-adjusted, updated national average PRA.
Thus, if a hospital's PRA for the cost reporting period beginning
during FY 2001 would otherwise be below the floor, the hospital's
PRA for that cost reporting period is equal to 70 percent of the
locality-adjusted, national average PRA. Under section
1886(h)(2)(D)(iv) of the Act, as added by section 311(a) of Public
Law 106-113, if a hospital's PRA exceeds 140 percent of the
locality-adjusted, updated national average PRA, the hospital's PRA
is frozen (for FYs 2001 and 2002) or subject to a 2-percent
reduction to the otherwise applicable update (for FYs 2003 through
2005). See section IV.G. of the preamble for a fuller explanation of
this policy.
For purposes of the final rule, we have calculated an estimated
impact of this policy on teaching hospitals' PRAs for FY 2001 making
assumptions about update factors and geographic adjustment factors
(GAF) for each hospital. Generally, utilizing FY 1997 data, we
calculated a floor and a ceiling and estimated the impact on
hospitals. This impact was then inflated to FY 2001 to estimate the
total impact on the Medicare program for FY 2001. The estimated
numbers for this impact should not be used by hospitals in
calculating their own individual PRAs; hospitals must use the
methodology stated in section IV.G. of this final rule to revise (if
appropriate) their individual PRAs.
In calculating this impact, we utilized Medicare cost report
data for all cost reports ending in FY 1997. We excluded hospitals
that file manual cost reports because we did not have access to
their Medicare utilization data. We also excluded all teaching
hospitals in Maryland because these hospitals are paid under a
Medicare waiver. For those hospitals that had two cost reporting
periods ending in FY 1997, we used the later of the two periods. A
total of 1,231 teaching hospitals were included in this analysis.
The impact in this final rule differs slightly from the impact
in the proposed rule because we have determined a different weighted
average PRA for this final rule, and we used the most recent CPI-U
update factors to determine the impact for FY 2001. An explanation
of why the weighted average PRA has changed for this final rule may
be found in section IV.G.2 of this preamble.
Utilizing the FY 1997 weighted average PRA of $68,464, we
calculated a FY 1997 70-percent floor of $47,925 and a FY 1997 140-
percent ceiling of $95,850. We then estimated that, for cost
reporting periods ending in FY 1997, 336 hospitals had PRAs that
were below $47,925 (27.3 percent of 1,231 hospitals), and 180
hospitals had PRAs above $95,850 (14.6 percent of 1,231 hospitals).
Thus, for example, to illustrate the extremes in impact for a
hospital with PRAs below the floor, Hospital A had a FY 1997 primary
care PRA of $22,000 and a non-primary care PRA of $20,000. When
these PRAs are replaced by a single PRA of $47,925, the hospital
gains approximately 110 percent in payments per resident. For a
hospital with PRAs above the ceiling, Hospital B had a FY 1997
primary care PRA of $150,000 and a non-primary care PRA of $148,000.
When these PRAs are frozen and not updated for inflation in FY 2001,
the percentage loss in payments per resident that year would be
equal to the CPI-U percentage that would otherwise have been used to
update the PRA.
For the 336 hospitals that had PRAs below the FY 1997 $47,925
floor, we estimated that the total cost to the Medicare program for
FY 2001 of applying the floor would be $33.2 million. For the 180
hospitals that had PRAs above the FY 1997 $95,850 ceiling, we
estimated that the total savings to the Medicare program for FY 2001
would be $16 million. Subtracting the estimated savings of $16
million from the estimated costs of $33.2 million yields an
estimated total net cost to the Medicare program for FY 2001 of
$17.2 million.
VII. Quantitative Impact Analysis of the Policy Changes Under the
Prospective Payment System for Operating Costs
A. Basis and Methodology of Estimates
In this final rule, we are announcing policy changes and payment
rate updates for the prospective payment systems for operating and
capital-related costs. We have prepared separate impact analyses of
the changes to each system. This section deals with changes to the
operating prospective payment system.
The data used in developing the quantitative analyses presented
below are taken from the FY 1999 MedPAR file and the most current
provider-specific file that is used for payment purposes. Although
the analyses of the changes to the operating prospective payment
system do not incorporate cost data, the most recently available
hospital cost report data were used to categorize hospitals. Our
analysis has several qualifications. First, we do not make
adjustments for behavioral changes that hospitals may adopt in
response to these policy changes. Second, due to the interdependent
nature of the prospective payment system, it is very difficult to
precisely quantify the impact associated with each change. Third, we
draw upon various sources for the data used to categorize hospitals
in the tables. In some cases, particularly the number of beds, there
is a fair degree of variation in the data from different sources. We
have attempted to construct these variables with the best available
source overall. For individual hospitals, however, some
miscategorizations are possible.
Using cases in the FY 1999 MedPAR file, we simulated payments
under the operating prospective payment system given various
combinations of payment parameters. Any short-term, acute care
hospitals not paid under the general prospective payment systems
(Indian Health Service hospitals and hospitals in Maryland) are
excluded from the simulations. Payments under the capital
prospective payment system, or payments for costs other than
inpatient operating costs, are not analyzed here. Estimated payment
impacts of FY 2001 changes to the capital prospective payment system
are discussed in section IX of this Appendix.
The final changes discussed separately below are the following:
The effects of the annual reclassification of diagnoses
and procedures and the recalibration of the diagnosis-related group
(DRG) relative weights required by section 1886(d)(4)(C) of the Act.
The effects of changes in hospitals' wage index values
reflecting the wage index update (FY 1997 data).
The effects of removing from the wage index the costs
and hours associated with teaching physicians paid under Medicare
Part A, residents, and certified registered nurse anesthetists
(CRNAs) during the second year of a 5-year phase-out, by calculating
a wage index based on 40 percent of hospitals' average hourly wages
after removing these costs and hours, and 60 percent of hospitals'
average hourly wages with these costs included.
The effects of geographic reclassifications by the
Medicare Geographic Classification Review Board (MGCRB) that will be
effective in FY 2001.
The total change in payments based on FY 2001 policies
relative to payments based on FY 2000 policies.
To illustrate the impacts of the FY 2001 final changes, our
analysis begins with a FY 2000 baseline simulation model using: the
FY 2000 DRG GROUPER (version 17.0); the FY 2000 wage index; and no
MGCRB reclassifications. Outlier payments are set at 5.1 percent of
total DRG plus outlier payments.
Each final and statutory policy change is then added
incrementally to this baseline model, finally arriving at an FY 2001
model incorporating all of the changes. This allows us to isolate
the effects of each change.
Our final comparison illustrates the percent change in payments
per case from FY 2000 to FY 2001. Five factors have significant
impacts here. The first is the update to the standardized amounts.
In accordance with section 1886(d)(3)(A)(iv) of the Act, we are
updating the large urban and the other areas average standardized
amounts for FY 2001 using the most recently forecasted hospital
market basket increase for FY 2001 of 3.4 percent minus 1.1
percentage points (for an update of 2.3 percent).
Under section 1886(b)(3) of the Act, as amended by section 406
of Public Law 106-113, the updates to the average standardized
amounts and the hospital-specific amounts for sole community
hospitals (SCHs) will be equal to the full market basket increase
for FY 2001. Consequently, the update factor used for SCHs in this
impact analysis is 3.4 percent. Under section 1886(b)(3)(D) of the
Act, the update factor for the hospital-specific amounts for MDHs is
equal to the market basket increase of 3.4 percent minus 1.1
percentage points (for an update of 2.3 percent).
A second significant factor that impacts changes in hospitals'
payments per case from FY 2000 to FY 2001 is a change in MGCRB
reclassification status from one year to the next. That is,
hospitals reclassified in FY 2000 that are no longer reclassified in
FY
[[Page 47191]]
2001 may have a negative payment impact going from FY 2000 to FY
2001; conversely, hospitals not reclassified in FY 2000 that are
reclassified in FY 2001 may have a positive impact. In some cases,
these impacts can be quite substantial, so if a relatively small
number of hospitals in a particular category lose their
reclassification status, the percentage change in payments for the
category may be below the national mean.
A third significant factor is that we currently estimate that
actual outlier payments during FY 2000 will be 6.2 percent of actual
total DRG payments. When the FY 2000 final rule was published, we
projected FY 2000 outlier payments would be 5.1 percent of total DRG
payments; the standardized amounts were offset correspondingly. The
effects of the higher than expected outlier payments during FY 2000
(as discussed in the Addendum to this final rule) are reflected in
the analyses below comparing our current estimates of FY 2000
payments per case to estimated FY 2001 payments per case.
Fourth, section 111 of Public Law 106-113 revised section
1886(d)(5)(B)(ii) of the Act so that the IME adjustment changes from
FY 2000 to FY 2001 from approximately a 6.5 percent increase for
every 10 percent increase in a hospital's resident-to-bed ratio
during FY 2000 to approximately a 6.2 percent increase in FY 2001.
Similarly, section 112 of Public Law 106-113 revised section
1886(d)(5)(F)(ix) of the Act so that the DSH adjustment for FY 2001
is reduced by 3 percent from what would otherwise have been paid
(this is the same percentage reduction that was applied in FY 2000).
Additionally, the January 20, 2000 interim final rule with comment
revised policy, effective with discharges occurring on or after
January 20, 2000, to allow hospitals to include the patient days of
all populations eligible for Title XIX matching payments in a
State's section 1115 waiver in calculating the hospital's Medicare
DSH adjustment.
Finally, section 405 of Public Law 106-113 provided that certain
SCHs may elect to receive payment on the basis of their costs per
case during their cost reporting period that began during FY 1996.
To be eligible, a SCH must have received payment on the basis of its
hospital-specific rate for its cost reporting period beginning
during 1999. For FY 2001, eligible SCHs that elect rebasing receive
a hospital-specific rate comprised of 75-percent of the higher of
their FY 1982 or FY 1987 hospital-specific rate, and 25-percent of
their FY 1996 hospital-specific rate.
Table I demonstrates the results of our analysis. The table
categorizes hospitals by various geographic and special payment
consideration groups to illustrate the varying impacts on different
types of hospitals. The top row of the table shows the overall
impact on the 4,888 hospitals included in the analysis. This number
is 34 fewer hospitals than were included in the impact analysis in
the FY 2000 final rule (64 FR 41624).
The next four rows of Table I contain hospitals categorized
according to their geographic location (all urban, which is further
divided into large urban and other urban, or rural). There are 2,752
hospitals located in urban areas (MSAs or NECMAs) included in our
analysis. Among these, there are 1,571 hospitals located in large
urban areas (populations over 1 million), and 1,181 hospitals in
other urban areas (populations of 1 million or fewer). In addition,
there are 2,136 hospitals in rural areas. The next two groupings are
by bed-size categories, shown separately for urban and rural
hospitals. The final groupings by geographic location are by census
divisions, also shown separately for urban and rural hospitals.
The second part of Table I shows hospital groups based on
hospitals' FY 2001 payment classifications, including any
reclassifications under section 1886(d)(10) of the Act. For example,
the rows labeled urban, large urban, other urban, and rural show
that the number of hospitals paid based on these categorizations
(after consideration of geographic reclassifications) are 2,833,
1,665, 1,168, and 2,055, respectively.
The next three groupings examine the impacts of the final
changes on hospitals grouped by whether or not they have residency
programs (teaching hospitals that receive an IME adjustment) or
receive DSH payments, or some combination of these two adjustments.
There are 3,770 nonteaching hospitals in our analysis, 876 teaching
hospitals with fewer than 100 residents, and 242 teaching hospitals
with 100 or more residents.
In the DSH categories, hospitals are grouped according to their
DSH payment status, and whether they are considered urban or rural
after MGCRB reclassifications. Hospitals in the rural DSH
categories, therefore, represent hospitals that were not
reclassified for purposes of the standardized amount or for purposes
of the DSH adjustment. (They may, however, have been reclassified
for purposes of the wage index.) The next category groups hospitals
considered urban after geographic reclassification, in terms of
whether they receive the IME adjustment, the DSH adjustment, both,
or neither.
The next five rows examine the impacts of the final changes on
rural hospitals by special payment groups (SCHs, rural referral
centers (RRCs), and MDHs), as well as rural hospitals not receiving
a special payment designation. The RRCs (150), SCHs (661), MDHs
(352), and SCH and RRCs (57) shown here were not reclassified for
purposes of the standardized amount. There are 26 RRCs, 1 MDH, 4
SCHs and 3 SCH and RRCs that will be reclassified as urban for the
standardized amount in FY 2001 and, therefore, are not included in
these rows.
The next two groupings are based on type of ownership and the
hospital's Medicare utilization expressed as a percent of total
patient days. These data are taken primarily from the FY 1998
Medicare cost report files, if available (otherwise FY 1997 data are
used). Data needed to determine ownership status or Medicare
utilization percentages were unavailable for 2 and 85 hospitals,
respectively. For the most part, these are new hospitals.
The next series of groupings concern the geographic
reclassification status of hospitals. The first three groupings
display hospitals that were reclassified by the MGCRB for both FY
2000 and FY 2001, or for only one of those 2 years, by urban and
rural status. The next rows illustrate the overall number of FY 2001
reclassifications, as well as the numbers of reclassified hospitals
grouped by urban and rural location. The final row in Table I
contains hospitals located in rural counties but deemed to be urban
under section 1886(d)(8)(B) of the Act.
Table I.--Impact Analysis of Changes for FY 2001 Operating Prospective Payment System
[Percent changes in payments per case)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Phase out
Number of DRG New wage of GME and DRG and WI MGCRB All FY
hosps.\1\ recalib.\2\ data \3\ CRNA costs changes reclassification 2001
\4\ \5\ \6\ changes
(0) (1) (2) (3) (4) (5) (6)
--------------------------------------------------------------------------------------------------------------------------------------------------------
(BY GEOGRAPHIC LOCATION):
ALL HOSPITALS......................................... 4,888 0.0 0.2 0.1 0.0 0.0 1.5
URBAN HOSPITALS....................................... 2,752 0.0 0.1 0.0 -0.1 -0.4 1.4
LARGE URBAN AREAS..................................... 1,571 0.0 0.1 0.0 -0.1 -0.5 1.3
OTHER URBAN AREAS..................................... 1,181 0.0 0.1 0.1 0.0 -0.3 1.5
RURAL HOSPITALS....................................... 2,136 0.2 0.6 0.1 0.6 2.5 2.5
BED SIZE (URBAN):
0-99 BEDS............................................. 716 0.2 0.1 0.1 0.3 -0.6 1.6
100-199 BEDS.......................................... 944 0.1 0.1 0.1 0.1 -0.5 1.5
200-299 BEDS.......................................... 548 0.1 0.1 0.1 -0.1 -0.4 1.3
300-499 BEDS.......................................... 401 0.0 0.0 0.1 -0.2 -0.4 1.1
[[Page 47192]]
500 OR MORE BEDS...................................... 143 -0.1 0.4 0.0 0.0 -0.4 1.6
BED SIZE (RURAL):
0-49 BEDS............................................. 1,233 0.2 0.6 0.1 0.6 0.2 3.1
50-99 BEDS............................................ 535 0.2 0.6 0.1 0.6 0.8 2.6
100-149 BEDS.......................................... 219 0.2 0.6 0.1 0.6 3.4 2.1
150-199 BEDS.......................................... 81 0.2 0.7 0.1 0.6 5.2 2.6
200 OR MORE BEDS...................................... 68 0.1 0.6 0.1 0.5 4.5 2.2
URBAN BY CENSUS DIVISION:
NEW ENGLAND........................................... 146 0.0 -0.9 0.1 -0.3 -0.2 0.9
MIDDLE ATLANTIC....................................... 421 0.1 0.1 -0.1 -0.2 -0.3 1.2
SOUTH ATLANTIC........................................ 404 0.0 0.0 0.1 -0.2 -0.6 1.1
EAST NORTH CENTRAL.................................... 463 0.0 0.5 0.0 0.2 -0.3 2.0
EAST SOUTH CENTRAL.................................... 161 0.0 -0.1 0.0 -0.5 -0.6 0.8
WEST NORTH CENTRAL.................................... 188 -0.1 0.3 0.0 -0.1 -0.6 1.4
WEST SOUTH CENTRAL.................................... 351 0.0 1.3 0.1 1.0 -0.6 2.3
MOUNTAIN.............................................. 133 0.0 0.3 0.1 0.0 -0.5 1.6
PACIFIC............................................... 440 0.0 -0.5 0.2 -0.6 -0.5 0.7
PUERTO RICO........................................... 45 0.1 -0.1 0.0 -0.1 -0.6 1.7
RURAL BY CENSUS DIVISION:
NEW ENGLAND........................................... 52 0.1 -0.1 0.0 -0.3 2.8 2.2
MIDDLE ATLANTIC....................................... 80 0.2 -0.1 0.0 -0.2 2.5 2.2
SOUTH ATLANTIC........................................ 277 0.2 1.0 0.1 1.0 2.9 2.8
EAST NORTH CENTRAL.................................... 283 0.2 0.6 0.1 0.5 2.2 2.6
EAST SOUTH CENTRAL.................................... 266 0.2 0.6 0.1 0.5 2.8 2.6
WEST NORTH CENTRAL.................................... 492 0.1 0.5 0.1 0.4 2.3 2.5
WEST SOUTH CENTRAL.................................... 340 0.2 1.0 0.1 1.0 3.0 2.1
MOUNTAIN.............................................. 201 0.2 0.4 0.1 0.3 1.6 2.7
PACIFIC............................................... 140 0.2 0.3 0.1 0.3 1.9 2.3
PUERTO RICO........................................... 5 0.2 0.3 -0.2 0.1 -0.7 0.2
(BY PAYMENT CATEGORIES):
URBAN HOSPITALS....................................... 2,833 0.0 0.1 0.0 -0.1 -0.4 1.4
LARGE URBAN........................................... 1,665 0.0 0.1 0.0 -0.1 -0.3 1.4
OTHER URBAN........................................... 1,168 0.0 0.2 0.1 0.0 -0.4 1.3
RURAL HOSPITALS....................................... 2,055 0.2 0.6 0.1 0.6 2.2 2.6
TEACHING STATUS:
NON-TEACHING.......................................... 3,770 0.1 0.2 0.1 0.2 0.3 1.6
FEWER THAN 100 RESIDENTS.............................. 876 0.0 0.2 0.0 -0.1 -0.3 1.4
100 OR MORE RESIDENTS................................. 242 -0.1 0.2 0.0 -0.2 -0.3 1.6
DISPROPORTIONATE SHARE HOSPITALS (DSH):
NON-DSH............................................... 3,070 0.1 0.1 0.1 -0.1 0.3 1.5
URBAN DSH
100 BEDS OR MORE.................................. 1,390 0.0 0.2 0.0 0.0 -0.4 1.5
FEWER THAN 100 BEDS............................... 72 0.1 0.4 0.1 0.4 -0.5 1.9
RURAL DSH
SOLE COMMUNITY (SCH).................................. 149 0.3 0.9 0.1 0.9 0.2 3.6
REFERRAL CENTERS (RRC)................................ 56 0.2 0.8 0.1 0.8 5.2 2.4
OTHER RURAL DSH HOSPITALS
100 BEDS OR MORE.................................. 48 0.3 1.1 0.1 1.1 1.4 2.9
FEWER THAN 100 BEDS................................... 103 0.3 0.9 0.1 1.0 0.3 2.3
URBAN TEACHING AND DSH:
BOTH TEACHING AND DSH................................. 726 0.0 0.2 0.0 0.0 -0.5 1.6
TEACHING AND NO DSH................................... 327 0.0 0.0 0.0 -0.4 -0.2 1.2
NO TEACHING AND DSH................................... 736 0.1 0.2 0.1 0.2 -0.3 1.3
NO TEACHING AND NO DSH................................ 1,044 0.1 0.0 0.1 -0.1 -0.3 1.0
RURAL HOSPITAL TYPES:
NONSPECIAL STATUS HOSPITALS........................... 835 0.2 0.9 0.1 0.9 1.0 2.4
RRC................................................... 150 0.2 0.8 0.1 0.7 6.1 2.4
SCH................................................... 661 0.2 0.4 0.1 0.3 0.2 3.3
MDH................................................... 352 0.2 0.7 0.1 0.6 0.3 2.7
SCH AND RRC........................................... 57 0.1 0.3 0.0 0.1 1.6 2.2
TYPE OF OWNERSHIP:
VOLUNTARY............................................. 2,840 0.0 0.2 0.0 0.0 -0.1 1.5
PROPRIETARY........................................... 745 0.1 0.2 0.1 0.1 -0.1 1.3
GOVERNMENT............................................ 1,301 0.1 0.2 0.1 0.0 0.2 1.8
UNKNOWN............................................... 2 0.0 0.5 0.1 0.3 -0.4 2.7
[[Page 47193]]
MEDICARE UTILIZATION AS A PERCENT OF INPATIENT DAYS:
0--25................................................. 381 0.0 0.2 0.1 .......... -0.3 1.8
25--50................................................ 1,830 0.0 0.1 0.0 -0.1 -0.3 1.4
50--65................................................ 1,893 0.1 0.3 0.1 0.2 0.2 1.6
OVER 65............................................... 699 0.1 0.2 0.1 0.1 0.3 1.4
UNKNOWN............................................... 85 -0.1 0.5 -0.1 0.1 -0.6 1.2
HOSPITALS RECLASSIFIED BY THE MEDICARE GEOGRAPHIC REVIEW
BOARD:
RECLASSIFICATION STATUS DURING FY 2000 AND FY 2001
RECLASSIFIED DURING BOTH FY 2000 AND FY 2001.......... 377 0.1 0.4 0.1 0.4 6.0 1.8
URBAN................................................. 53 0.0 -0.1 0.1 0.1 5.8 1.7
RURAL................................................. 324 0.1 0.6 0.1 0.5 6.2 1.9
RECLASSIFIED DURING FY 2001 ONLY...................... 149 0.1 0.4 0.1 0.3 4.8 7.1
URBAN................................................. 35 0.1 0.1 0.1 -0.1 4.7 6.6
RURAL................................................. 114 0.2 0.8 0.1 0.7 4.9 7.6
RECLASSIFIED DURING FY 2000 ONLY...................... 172 0.1 0.5 0.1 0.3 -0.9 -1.7
URBAN................................................. 70 0.0 0.4 0.1 0.1 -1.1 -0.8
RURAL................................................. 102 0.2 0.7 0.1 0.7 -0.5 -3.1
FY 2000 RECLASSIFICATIONS:
ALL RECLASSIFIED HOSPITALS............................ 527 0.1 0.4 0.1 0.4 5.8 3.0
STANDARDIZED AMOUNT ONLY.............................. 66 0.2 0.6 0.1 0.6 4.1 4.1
WAGE INDEX ONLY....................................... 386 0.1 0.5 0.1 0.4 4.8 0.6
BOTH.................................................. 46 0.2 0.1 0.1 0.0 4.3 2.6
NONRECLASSIFIED....................................... 4,364 0.0 0.2 0.0 0.0 -0.5 1.6
ALL URBAN RECLASSIFIED................................ 88 0.0 0.0 0.1 0.1 5.4 3.2
STANDARDIZED AMOUNT ONLY.............................. 17 0.2 0.0 0.0 -0.1 0.7 0.9
WAGE INDEX ONLY....................................... 38 0.0 -0.1 0.1 0.2 5.8 2.5
BOTH.................................................. 33 0.0 0.1 0.1 -0.1 6.2 5.1
NONRECLASSIFIED....................................... 2,638 0.0 0.1 0.0 -0.1 -0.7 1.3
ALL RURAL RECLASSIFIED................................ 439 0.1 0.6 0.1 0.5 5.9 2.9
STANDARDIZED AMOUNT ONLY.............................. 54 0.1 0.6 0.1 0.5 4.2 -0.1
WAGE INDEX ONLY....................................... 358 0.2 0.6 0.1 0.6 5.8 3.2
BOTH.................................................. 27 0.1 0.3 0.1 0.1 9.4 2.9
NONRECLASSIFIED....................................... 1,697 0.2 0.6 0.1 0.6 -0.5 2.2
OTHER RECLASSIFIED HOSPITALS (SECTION 1886(d)(8)(B)).. 26 0.2 -0.4 0.0 -0.4 1.0 1.3
--------------------------------------------------------------------------------------------------------------------------------------------------------
\1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the
national total. Discharge data are from FY 1999, and hospital cost report data are from reporting periods beginning in FY 1997 and FY 1998.
\2\ This column displays the payment impact of the recalibration of the DRG weights based on FY 1999 MedPAR data and the DRG reclassification changes,
in accordance with section 1886(d)(4)(C) of the Act.
\3\ This column shows the payment effects of updating the data used to calculate the wage index with data from the FY 1997 cost reports.
\4\ This column displays the impact of removing 60 percent of the costs and hours associated with teaching physicians Part A, residents, and CRNAs from
the wage index calculation.
\5\ This column displays the combined impact of the reclassification and recalibration of the DRGs, the updated and revised wage data used to calculate
the wage index, and the budget neutrality adjustment factor for these two changes, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of
the Act. Thus, it represents the combined impacts shown in columns 1, 2 and 3, and the FY 2001 budget neutrality factor of .997225.
\6\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate
the FY 2001 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2001. Reclassification for
prior years has no bearing on the payment impacts shown here.
\7\ This column shows changes in payments from FY 2000 to FY 2001. It incorporates all of the changes displayed in columns 4 and 5 (the changes
displayed in columns 1, 2, and 3 are included in column 4). It also displays the impact of the FY 2001 update (including the higher update for SCHs),
changes in hospitals' reclassification status in FY 2001 compared to FY 2000, the difference in outlier payments from FY 2000 to FY 2001, and the
reductions to payments through the IME adjustment taking effect during FY 2001. It also reflects section 405 of Public law 106-113, which permitted
certain SCHs to rebase for a 1996 hospital-specific rate. The sum of these columns may be different from the percentage changes shown here due to
rounding and interactive effects.
B. Impact of the Changes to the DRG Reclassifications and
Recalibration of Relative Weights (Column 1)
In column 1 of Table I, we present the combined effects of the
DRG reclassifications and recalibration, as discussed in section II
of the preamble to this final rule. Section 1886(d)(4)(C)(i) of the
Act requires us to annually make appropriate classification changes
and to recalibrate the DRG weights in order to reflect changes in
treatment patterns, technology, and any other factors that may
change the relative use of hospital resources.
We compared aggregate payments using the FY 2000 DRG relative
weights (GROUPER version 17) to aggregate payments using the
[[Page 47194]]
FY 2001 DRG relative weights (GROUPER version 18). Overall payments
are unaffected by the DRG reclassification and recalibration.
Consistent with the minor changes we made in the FY 2001 GROUPER,
the redistributional impacts of DRG reclassifications and
recalibration across hospital groups are very small (a 0.0 percent
impact for large and other urban hospitals; a 0.2 percent increase
for rural hospitals). Within hospital categories, the net effects
for urban hospitals are small positive changes for small hospitals
(a 0.2 percent increase for hospitals with fewer than 100 beds), and
small decreases for larger hospitals (a 0.1 percent decrease for
hospitals with more than 500 beds). Among rural hospitals, most
hospital categories experienced small positive changes, 0.2 percent
increases for hospitals with fewer than 200 beds and 0.1 percent
increases for hospitals with more than 200 beds.
The breakdown by urban census division shows that the small
decrease among urban hospitals is confined to the West North Central
region. Payments to urban hospitals in most other regions are
unchanged, while payments to urban hospitals in the Middle Atlantic
and Puerto Rico regions rise by 0.1 percent. All rural hospital
census divisions experience payment increases ranging from 0.1
percent for hospitals in New England and West North Central regions
to 0.2 percent for hospitals in the South Atlantic, Middle Atlantic,
East North Central, East South Central, West South Central, Pacific,
Mountain, and Puerto Rico regions.
C. Impact of Updating the Wage Data (Column 2)
Section 1886(d)(3)(E) of the Act requires that, beginning
October 1, 1993, we annually update the wage data used to calculate
the wage index. In accordance with this requirement, the wage index
for FY 2001 is based on data submitted for hospital cost reporting
periods beginning on or after October 1, 1996 and before October 1,
1997. As with the previous column, the impact of the new data on
hospital payments is isolated by holding the other payment
parameters constant in the two simulations. That is, column 2 shows
the percentage changes in payments when going from a model using the
FY 2000 wage index (based on FY 1996 wage data before geographic
reclassifications to a model using the FY 2001 prereclassification
wage index based on FY 1997 wage data). Section 152 of Public Law
106-113 reclassified certain hospitals for purposes of the wage
index and the standardized amounts. For purposes of this column,
these hospitals are located in their prereclassification geographic
location. The impacts of these statutory reclassifications are shown
in column 5, when examining the impacts of geographic
reclassification.
The wage data collected on the FY 1997 cost reports are similar
to the data used in the calculation of the FY 2000 wage index. For a
thorough discussion of the data used to calculate the wage index,
see section III.B. of this final rule.
The results indicate that the new wage data have an overall
impact of a 0.2 percent increase in hospital payments (prior to
applying the budget neutrality factor, see column 5). Rural
hospitals appear to benefit from the update as their payments
increase by 0.6 percent. These increases are attributable to
positive increases in the wage index values for the rural areas of
several States; California, Illinois, Indiana, Ohio, Texas and
Minnesota all had increases of approximately 3 percent in their
prereclassification wage index values.
Urban hospitals as a group are not significantly affected by the
updated wage data. Hospitals in both other urban areas and large
urban areas experienced a small positive increase (0.1 percent).
Urban hospitals in New England experienced a 0.9 percent decrease
from the updated wage data due to declines ranging from 5 to 1
percent in the wage index values for several MSAs in Connecticut and
Massachusetts. Urban hospitals in the Pacific census region
experience a 0.5 percent decline due to several MSAs in California
with prereclassified FY 2001 wage indexes that fall by 5 percent or
less.
The largest increases are seen in the rural census divisions.
Rural South Atlantic and West South Central regions experience the
greatest positive impact, 1.0 percent. Hospitals in five other
census divisions receive positive impacts of 0.5 or greater: East
North Central at 0.6, East South Central at 0.6, and West North
Central at 0.5. The following chart compares the shifts in wage
index values for labor market areas for FY 2000 relative to FY 2001.
This chart demonstrates the impact of the changes for the FY 2001
wage index relative to the FY 2000 wage index. The majority of labor
market areas (339) experience less than a 5 percent change. A total
of 21 labor market areas experience an increase of more than 5
percent with only 1 having an increase greater than 10 percent. A
total of 15 areas experience decreases of more than 5 percent. Of
those, only 1 decline by 10 percent or more.
------------------------------------------------------------------------
Number of labor market
areas
Percentage change in area wage index values -------------------------
FY 2000 FY 2001
------------------------------------------------------------------------
Increase more than 10 percent................. 8 1
Increase more than 5 percent and less than 10 22 20
percent......................................
Increase or decrease less than 5 percent...... 318 339
Decrease more than 5 percent and less than 10 17 14
percent......................................
Decrease more than 10 percent................. 5 1
------------------------------------------------------------------------
Among urban hospitals, 96 would experience an increase of
between 5 and 10 percent and 2 more than 10 percent. No rural
hospitals have increases greater than 5 percent. On the negative
side, 106 urban hospitals have decreases in their wage index values
of at least 5 percent but less than 10 percent. One urban hospital
has a decrease in their wage index value that is greater than 10
percent. Two rural hospitals have decreases in their wage index
values that are greater than 5 percent but less than 10 percent. The
following chart shows the projected impact for urban and rural
hospitals.
------------------------------------------------------------------------
Number of hospitals
Percentage change in area wage index values -------------------------
Urban Rural
------------------------------------------------------------------------
Increase more than 10 percent................. 2 0
Increase more than 5 percent and less than 10 96 0
percent......................................
Increase or decrease less than 5 percent...... 2547 2134
Decrease more than 5 percent and less than 10 106 2
percent......................................
Decrease more than 10 percent................. 1 0
------------------------------------------------------------------------
D. Impact of 5-Year Phase-Out of Teaching Physicians', Residents',
and CRNAs' Costs (Column 3)
As described in section III.C. of this preamble, the FY 2001
wage index is calculated by blending 60 percent of hospitals'
average hourly wages calculated without removing teaching physician
(paid under Medicare Part A), residents, or CRNA costs (and hours)
and 40 percent of average hourly wages calculated after removing
these costs (and hours). This constitutes the second year of a 5-
year phase-out of these costs and hours, where the proportion of the
calculation based upon average hourly wages after removing these
costs increases by 20 percentage points per year.
In order to determine the impact of moving from the 80/20 blend
percentage to the 60/40 blend percentage, we first estimated the
payments for FY 2001 using the FY 2001 prereclassified wage index
calculated using the 80/20 blend percentage (Column 2). We then
estimated what the payments for FY 2001 would have been if the 60/40
blend percentage was applied to the FY 2001 prereclassified wage
index. Column 3 compares the differences in these payment estimates
and shows that the 60/40 blend percentage does not significantly
impact overall payments (0.0 percent change). Although there were
165 labor market areas that experience a small percent decrease in
their wage index, most of the decreases were less than 3 percent.
E. Combined Impact of DRG and Wage Index Changes-- Including Budget
Neutrality Adjustment (Column 4)
The impact of DRG reclassifications and recalibration on
aggregate payments is required by section 1886(d)(4)(C)(iii) of the
Act to be budget neutral. In addition, section
[[Page 47195]]
1886(d)(3)(E) of the Act specifies that any updates or adjustments
to the wage index are to be budget neutral. As noted in the Addendum
to this final rule, we compared simulated aggregate payments using
the FY 2000 DRG relative weights and wage index to simulated
aggregate payments using the FY 2001 DRG relative weights and
blended wage index. Based on this comparison, we computed a wage and
recalibration budget neutrality factor of 0.997225. In Table I, the
combined overall impacts of the effects of both the DRG
reclassifications and recalibration and the updated wage index are
shown in column 4. The 0.0 percent impact for all hospitals
demonstrates that these changes, in combination with the budget
neutrality factor, are budget neutral.
For the most part, the changes in this column are the sum of the
changes in columns 1, 2, and 3, minus approximately 0.3 percent
attributable to the budget neutrality factor. There may be some
variation of plus or minus 0.1 percent due to rounding.
F. Impact of MGCRB Reclassifications (Column 5)
Our impact analysis to this point has assumed hospitals are paid
on the basis of their actual geographic location (with the exception
of ongoing policies that provide that certain hospitals receive
payments on bases other than where they are geographically located,
such as hospitals in rural counties that are deemed urban under
section 1886(d)(8)(B) of the Act). The changes in column 5 reflect
the per case payment impact of moving from this baseline to a
simulation incorporating the MGCRB decisions for FY 2001. As noted
below, these decisions affect hospitals' standardized amount and
wage index area assignments.
Beginning in 1998, by February 28 of each year, the MGCRB makes
reclassification determinations that will be effective for the next
fiscal year, which begins on October 1. The MGCRB may approve a
hospital's reclassification request for the purpose of using the
other area's standardized amount, wage index value, or both, or for
FYs 1999 through 2001, for purposes of qualifying for a DSH
adjustment or to receive a higher DSH payment.
The FY 2001 wage index values incorporate all of the MGCRB's
reclassification decisions for FY 2001. The wage index values also
reflect any decisions made by the HCFA Administrator through the
appeals and review process. Additional changes that resulted from
the Administrator's review of MGCRB decisions or a request by a
hospital to withdraw its application are reflected in this final
rule for FY 2001.
Section 152 of Public Law 106-113 reclassified certain hospitals
for purposes of the wage index and the standardized amounts. The
impacts of these statutory reclassifications are included in this
column.
The overall effect of geographic reclassification is required by
section 1886(d)(8)(D) of the Act to be budget neutral. Therefore, we
applied an adjustment of 0.993187 to ensure that the effects of
reclassification are budget neutral. (See section II.A.4.b. of the
Addendum to this final rule.)
As a group, rural hospitals benefit from geographic
reclassification. Their payments rise 2.5 percent, while payments to
urban hospitals decline 0.4 percent. Hospitals in other urban areas
see a decrease in payments of 0.3 percent, while large urban
hospitals lose 0.5 percent. Among urban hospital groups (that is,
bed size, census division, and special payment status), payments
generally decline.
A positive impact is evident among most of the rural hospital
groups. The largest decrease among the rural census divisions is 0.7
percent for Puerto Rico. The largest increases are in rural West
South Central and South Atlantic. These regions receive increases of
3.0 and 2.9 percent, respectively.
Among rural hospitals designated as RRCs, 179 hospitals are
reclassified for purposes of the wage index only, leading to the 6.1
percent increase in payments among RRCs overall. This positive
impact on RRCs is also reflected in the category of rural hospitals
with 150-199 beds, which has a 5.2 percent increase in payments.
Rural hospitals reclassified for FY 2000 and FY 2001 experience
a 6.2 percent increase in payments. This may be due to the fact that
these hospitals have the most to gain from reclassification and have
been reclassified for a period of years. Rural hospitals
reclassified for FY 2001 only experience a 4.9 percent increase in
payments, while rural hospitals reclassified for FY 2000 only
experience a 0.5 percent decrease in payments. Urban hospitals
reclassified for FY 2001 but not FY 2000 experience a 4.7 percent
increase in payments overall. Urban hospitals reclassified for FY
2000 but not for FY 2001 experience a 1.1 percent decline in
payments.
The FY 2001 Reclassification rows of Table I show the changes in
payments per case for all FY 2001 reclassified and nonreclassified
hospitals in urban and rural locations for each of the three
reclassification categories (standardized amount only, wage index
only, or both). The table illustrates that the largest impact for
reclassified rural hospitals is for those hospitals reclassified for
both the standardized amount and the wage index. These hospitals
receive a 9.4 percent increase in payments. In addition, rural
hospitals reclassified just for the wage index receive a 5.8 percent
payment increase. The overall impact on reclassified hospitals is to
increase their payments per case by an average of 5.9 percent for FY
2001.
The reclassification of hospitals primarily affects payment to
nonreclassified hospitals through changes in the wage index and the
geographic reclassification budget neutrality adjustment required by
section 1886(d)(8)(D) of the Act. Among hospitals that are not
reclassified, the overall impact of hospital reclassifications is an
average decrease in payments per case of about 0.5 percent. Rural
nonreclassified hospitals decrease by 0.5 percent, and urban
nonreclassified hospitals lose 0.7 percent (the amount of the budget
neutrality offset).
G. All Changes (Column 6)
Column 6 compares our estimate of payments per case,
incorporating all changes reflected in this final rule for FY 2001
(including statutory changes), to our estimate of payments per case
in FY 2000. It includes the effects of the 2.3 percent update to the
standardized amounts and the hospital-specific rates for MDHs and
the 3.4 percent update for SCHs. It also reflects the 1.1 percentage
point difference between the projected outlier payments in FY 2000
(5.1 percent of total DRG payments) and the current estimate of the
percentage of actual outlier payments in FY 2000 (6.2 percent), as
described in the introduction to this Appendix and the Addendum to
this final rule.
Another change affecting the difference between FY 2000 and FY
2001 payments arises from section 1886(d)(5)(B) of the Act, as
amended by Public Law 106-113. As noted in the introduction to this
impact analysis, for FY 2001, the IME adjustment is decreased from
last year (6.5 percent in FY 2000 and 6.2 percent in FY 2001).
We also note that column 6 includes the impacts of FY 2001 MGCRB
reclassifications compared to the payment impacts of FY 2000
reclassifications. Therefore, when comparing FY 2001 payments to FY
2000, the percent changes due to FY 2001 reclassifications shown in
column 5 need to be offset by the effects of reclassification on
hospitals' FY 2000 payments(column 7 of Table 1, July 30, 1999 final
rule (64 FR 41625)). For example, the impact of MGCRB
reclassifications on rural hospitals' FY 2001 payments was
approximately a 2.5 percent increase, offsetting most of the 2.6
percent increase in column 7 for FY 2000. Therefore, the net change
in FY 2001 payments due to reclassification for rural hospitals is
actually a decrease of 0.1 percent relative to FY 2000. However,
last year's analysis contained a somewhat different set of
hospitals, so this might affect the numbers slightly.
Finally, section 405 of Public Law 106-113 provided that certain
SCHs may elect to receive payment on the basis of their costs per
case during their cost reporting period that began during 1996. To
be eligible, a SCH must have received payment for cost reporting
periods beginning during 1999 on the basis of its hospital-specific
rate. For FY 2001, eligible SCHs that elect rebasing receive a
hospital-specific rate comprised of 75 percent of the higher of
their FY 1982 or FY 1987 hospital-specific rate, and 25 percent of
their 1996 hospital-specific rate. The impact of this provision is
modeled in column 6 as well.
There might also be interactive effects among the various
factors comprising the payment system that we are not able to
isolate. For these reasons, the values in column 6 may not equal the
sum of the changes in columns 4 and 5, plus the other impacts that
we are able to identify.
The overall payment change from FY 2000 to FY 2001 for all
hospitals is a 1.5 percent increase. This reflects the 2.3 percent
update for FY 2001 (3.4 percent for SCHs), the 1.0 percent lower
outlier payments in FY 2001 compared to FY 2000 (5.1 percent
compared to 6.2 percent); the change in the IME
[[Page 47196]]
adjustment (6.5 in FY 2000 to 6.2 in FY 2001); and the rebasing of
certain SCHs to their 1996 hospital-specific rate.
Hospitals in urban areas experience a 1.4 percent increase in
payments per case compared to FY 2000. The 0.4 percent negative
impact due to reclassification is offset by an identical negative
impact for FY 2000. Hospitals in rural areas, meanwhile, experience
a 2.5 percent payment increase. As discussed previously, this is
primarily due to the positive effect of the wage index and DRG
changes and reclassifications.
Among urban census divisions, payments increased between 0.7 and
2.3 percent between FY 2000 and FY 2001. The rural census division
experiencing the smallest increase in payments was Puerto Rico (0.2
percent). The largest increases by rural hospitals are in the South
Atlantic and Mountain regions, 2.8 and 2.7 percent, respectively.
Among other rural census divisions, the largest increases are in the
East South Central and the East North Central, both with 2.6.
Among special categories of rural hospitals, those hospitals
receiving payment under the hospital-specific methodology (SCHs,
MDHs, and SCH/RRCs) experience payment increases of 3.3 percent, 2.7
percent, and 2.2 percent, respectively. This outcome is primarily
related to the fact that, for hospitals receiving payments under the
hospital-specific methodology, there are no outlier payments.
Therefore, these hospitals do not experience negative payment
impacts from the decline in the percentage of outlier payments from
FY 2000 to FY 2001 (from 6.2 of total DRG payments to 5.1 percent)
as do hospitals paid based on the national standardized amounts.
The largest negative payment impacts from FY 2000 to FY 2001 are
among hospitals that were reclassified for FY 2000 and are not
reclassified for FY 2001. Overall, these hospitals lose 1.7 percent.
The urban hospitals in this category lose 0.8 percent, while the
rural hospitals lose 3.1 percent. On the other hand, hospitals
reclassified for FY 2001 that were not reclassified for FY 2000
would experience the greatest payment increases: 7.1 percent
overall; 7.6 percent for 114 rural hospitals in this category and
6.6 percent for 35 urban hospitals.
Table II.--Impact Analysis of Changes for FY 2000; Operating Prospective Payment System
[Payments per case]
----------------------------------------------------------------------------------------------------------------
Average FY Average FY
Number of 2000 2001 All
hospitals payment payment changes
(1) per case per case (4)
(2)\1\ (3)\1\
----------------------------------------------------------------------------------------------------------------
(BY GEOGRAPHIC LOCATION):
ALL HOSPITALS............................................... 4,888 6,783 6,885 1.5
URBAN HOSPITALS............................................. 2,752 7,354 7,454 1.4
LARGE URBAN AREAS........................................... 1,571 7,895 7,996 1.3
OTHER URBAN AREAS........................................... 1,181 6,650 6,747 1.5
RURAL HOSPITALS............................................. 2,136 4,544 4,658 2.5
BED SIZE (URBAN):
0-99 BEDS................................................... 716 4,947 5,025 1.6
100-199 BEDS................................................ 944 6,202 6,294 1.5
200-299 BEDS................................................ 548 7,042 7,132 1.3
300-499 BEDS................................................ 401 7,885 7,974 1.1
500 OR MORE BEDS............................................ 143 9,547 9,703 1.6
BED SIZE (RURAL):
0-49 BEDS................................................... 1,233 3,784 3,901 3.1
50-99 BEDS.................................................. 535 4,248 4,358 2.6
100-149 BEDS................................................ 219 4,648 4,746 2.1
150-199 BEDS................................................ 81 5,090 5,220 2.6
200 OR MORE BEDS............................................ 68 5,710 5,838 2.2
URBAN BY CENSUS DIVISION:
NEW ENGLAND................................................. 146 7,815 7,888 0.9
MIDDLE ATLANTIC............................................. 421 8,296 8,396 1.2
SOUTH ATLANTIC.............................................. 404 7,022 7,098 1.1
EAST NORTH CENTRAL.......................................... 463 7,006 7,144 2
EAST SOUTH CENTRAL.......................................... 161 6,627 6,683 0.8
WEST NORTH CENTRAL.......................................... 188 7,105 7,203 1.4
WEST SOUTH CENTRAL.......................................... 351 6,760 6,917 2.3
MOUNTAIN.................................................... 133 7,044 7,156 1.6
PACIFIC..................................................... 440 8,572 8,633 0.7
PUERTO RICO................................................. 45 3,156 3,209 1.7
RURAL BY CENSUS DIVISION:
NEW ENGLAND................................................. 52 5,468 5,586 2.2
MIDDLE ATLANTIC............................................. 80 4,910 5,016 2.2
SOUTH ATLANTIC.............................................. 277 4,680 4,813 2.8
EAST NORTH CENTRAL.......................................... 283 4,591 4,710 2.6
EAST SOUTH CENTRAL.......................................... 266 4,209 4,317 2.6
WEST NORTH CENTRAL.......................................... 492 4,348 4,458 2.5
WEST SOUTH CENTRAL.......................................... 340 4,061 4,144 2.1
MOUNTAIN.................................................... 201 4,863 4,995 2.7
PACIFIC..................................................... 140 5,583 5,712 2.3
PUERTO RICO................................................. 5 2,447 2,453 0.2
(BY PAYMENT CATEGORIES):
URBAN HOSPITALS............................................. 2,833 7,312 7,411 1.4
LARGE URBAN................................................. 1,665 7,797 7,905 1.4
OTHER URBAN................................................. 1,168 6,637 6,724 1.3
RURAL HOSPITALS............................................. 2,055 4,509 4,627 2.6
TEACHING STATUS:
NON-TEACHING................................................ 3,770 5,464 5,550 1.6
FEWER THAN 100 RESIDENTS.................................... 876 7,125 7,223 1.4
[[Page 47197]]
100 OR MORE RESIDENTS....................................... 242 10,828 11,001 1.6
DISPROPORTIONATE SHARE HOSPITALS (DSH):
NON-DSH..................................................... 3,070 5,810 5,895 1.5
URBAN DSH:
100 BEDS OR MORE........................................ 1,390 7,919 8,037 1.5
FEWER THAN 100 BEDS..................................... 72 4,927 5,019 1.9
RURAL DSH:
SOLE COMMUNITY (SCH).................................... 149 4,140 4,290 3.6
REFERRAL CENTERS (RRC).................................. 56 5,415 5,543 2.4
OTHER RURAL DSH HOSPITALS:
100 BEDS OR MORE........................................ 48 4,097 4,218 2.9
FEWER THAN 100 BEDS..................................... 103 3,714 3,798 2.3
URBAN TEACHING AND DSH:
BOTH TEACHING AND DSH................................... 726 8,826 8,962 1.6
TEACHING AND NO DSH..................................... 327 7,322 7,409 1.2
NO TEACHING AND DSH..................................... 736 6,311 6,395 1.3
NO TEACHING AND NO DSH.................................. 1,044 5,668 5,727 1
RURAL HOSPITAL TYPES:
NONSPECIAL STATUS HOSPITALS................................. 835 3,922 4,017 2.4
RRC......................................................... 150 5,257 5,382 2.4
SCH......................................................... 661 4,502 4,650 3.3
MDH......................................................... 352 3,784 3,885 2.7
SCH AND RRC................................................. 57 5,500 5,620 2.2
TYPE OF OWNERSHIP:
VOLUNTARY................................................... 2,840 6,945 7,079 1.5
PROPRIETARY................................................. 745 6,300 6,384 1.3
GOVERNMENT.................................................. 1,301 6,400 6,512 1.8
UNKNOWN..................................................... 2 3,406 3,499 2.7
MEDICARE UTILIZATION AS A PERCENT OF INPATIENT DAYS:
0--25....................................................... 381 9,013 9,172 1.8
25--50...................................................... 1,830 7,858 7,968 1.4
50--65...................................................... 1,893 5,910 6,007 1.6
OVER 65..................................................... 699 5,260 5,336 1.4
UNKNOWN..................................................... 85 9,997 10,116 1.2
HOSPITALS RECLASSIFIED BY THE MEDICARE GEOGRAPHIC REVIEW BOARD:
RECLASSIFICATION STATUS DURING FY 2000 AND FY 2001:
RECLASSIFIED DURING BOTH FY 2000 AND FY 2001................ 377 5,851 5,958 1.8
URBAN....................................................... 53 8,027 8,161 1.7
RURAL....................................................... 324 5,249 5,348 1.9
RECLASSIFIED DURING FY 2001 ONLY............................ 149 5,537 5,930 7.1
URBAN....................................................... 35 6,971 7,428 6.6
RURAL....................................................... 114 4,623 4,975 7.6
RECLASSIFIED DURING FY 2000 ONLY............................ 172 6,011 5,909 -1.7
URBAN....................................................... 70 7,454 7,394 -0.8
RURAL....................................................... 102 4,620 4,476 -3.1
FY 2000 RECLASSIFICATIONS:
ALL RECLASSIFIED HOSPITALS.................................. 527 5,776 5,948 3
STANDARDIZED AMOUNT ONLY.................................... 66 4,697 4,888 4.1
WAGE INDEX ONLY............................................. 386 5,878 5,913 0.6
BOTH........................................................ 46 6,295 6,457 2.6
NONRECLASSIFIED............................................. 4,364 6,912 7,019 1.6
ALL URBAN RECLASSIFIED...................................... 88 7,660 7,906 3.2
STANDARDIZED AMOUNT ONLY.................................... 17 5,333 5,379 0.9
WAGE INDEX ONLY............................................. 38 8,718 8,934 2.5
BOTH........................................................ 33 7,217 7,584 5.1
NONRECLASSIFIED............................................. 2,638 7,355 7,449 1.3
ALL RURAL RECLASSIFIED...................................... 439 5,128 5,275 2.9
STANDARDIZED AMOUNT ONLY.................................... 54 4,785 4,779 -0.1
WAGE INDEX ONLY............................................. 358 5,153 5,316 3.2
BOTH........................................................ 27 5,258 5,410 2.9
NONRECLASSIFIED............................................. 1,697 4,114 4,204 2.2
OTHER RECLASSIFIED HOSPITALS (SECTION 1886(d)(8)(B))........ 26 4,713 4,775 1.3
----------------------------------------------------------------------------------------------------------------
\1\ These payment amounts per case do not reflect any estimates of annual case-mix increase.
[[Page 47198]]
Table II presents the projected impact of the changes for FY
2001 for urban and rural hospitals and for the different categories
of hospitals shown in Table I. It compares the estimated payments
per case for FY 2000 with the average estimated per case payments
for FY 2001, as calculated under our models. Thus, this table
presents, in terms of the average dollar amounts paid per discharge,
the combined effects of the changes presented in Table I. The
percentage changes shown in the last column of Table II equal the
percentage changes in average payments from column 6 of Table I.
VIII. Impact of Organ, Tissue and Eye Procurement Condition of
Participation on CAHs
In this final rule, we are adding a CoP for organ, tissue and
eye procurement for CAHs. We estimate that the procurement costs for
organ, eyes, and tissue for CAHs is negligible. This estimate is
based on the following projections. There are several provisions in
this condition that will impact CAHs to a greater or lesser degree.
Specifically, CAHs are required to have written protocols; have
agreements with an OPO, a tissue bank, and an eye bank; refer all
deaths that occur in the CAH to the OPO or a third party designated
by the OPO; ensure that CAH employees who initiate a request for
donation to the family of a potential donor have been trained as a
designated requestor; and work cooperatively with the OPO, tissue
bank, and eye bank in educating CAH staff, reviewing death records,
and maintaining potential donors. It is important to note that
because of the inherent flexibility of this condition, the extent of
its economic impact is dependent upon decisions that will be made
either by the CAH or by the CAH in conjunction with the OPO or the
tissue and eye banks. Thus, the impact on individual CAHs will vary
and is subject in large part to their decision making. The impact
will also vary based on whether a CAH currently has an organ
donation protocol and its level of compliance with existing law and
regulations. For example, if a CAH was a Medicare hospital in
compliance with the hospital CoP for organ, tissue, and eye
procurement prior to converting to a CAH, there will be no
additional impact.
The first requirement in the CoP is that CAHs have and implement
written protocols that reflect the various other requirements of the
CoP. Currently, under section 1138 of the Act, CAHs must have
written protocols for organ donation. Most CAHs will need to rewrite
their existing protocols to conform with this regulation; however,
this is clearly not a requirement that imposes a significant
economic burden.
In addition, a CAH must have an agreement with its designated
OPO and with at least one tissue bank and at least one eye bank.
CAHs are required under section 1138 of the Act to refer all
potential donors to an OPO. Also, the OPO regulation at 42 CFR
486.306 requires, as a qualification for designation as an OPO, that
the OPO have a working relationship with at least 75 percent of the
hospitals in its service area that participate in the Medicare and
Medicaid programs and that have an operating room and the equipment
and personnel for retrieving organs. Therefore, some CAHs may
already have an agreement with their designated OPO. Although CAHs
may need to modify those existing agreements, the need to make
modifications would not impose a significant economic burden.
Although there is no statutory or regulatory requirement for a CAH
to have agreements with tissue and eye banks, we must assume some
CAHs have agreements with tissue and eye banks, since hospitals are
the source for virtually all tissues and eyes.
The CoP requires CAHs to notify the OPO about every death that
occurs in the CAH. The average Medicare hospital has approximately
165 beds and 200 deaths per year. However, by statute and
regulation, CAHs may use no more than 15 beds for acute care
services. Assuming that the number of deaths in a hospital is
related to the number of acute care beds, there should be
approximately 18 deaths per year in the average CAH. Thus, the
economic impact for a CAH of referring all deaths would be small.
Under the CoP, a CAH may agree to have the OPO determine medical
suitability for tissue and eye donation or may have alternative
arrangements with a tissue bank and an eye bank. These alternative
arrangements could include the CAH's direct notification of the
tissue and eye bank of potential tissue and eye donors or direct
notification of all deaths. Again, the impact is small, and the
regulation permits the CAH to decide how this process will take
place. We recognize that many communities already have a one-phone-
call system in place. In addition, some OPOs are also tissue banks
or eye banks or both. A CAH that chose to use the OPO's tissue and
eye bank services in these localities would need to make only one
telephone call on every death.
This CoP requires that the individual who initiates a request
for donation to the family of a potential donor must be an OPO
representative or a designated requestor. A designated requestor is
an individual who has taken a course offered or approved by the OPO
in the methodology for approaching families of potential donors and
requesting donation. The CAH would need to arrange for designated
requestor training. Most OPOs have trained designated requestors as
part of the hospital CoP for organ, tissue, and eye procurement.
Even if the CAH wants to have a sufficient number of designated
requestors to ensure that all shifts are covered, this provision of
the regulation would not have a significant economic impact on CAHs.
In addition, the CAH may be able to choose to have donation requests
initiated by the OPO, the tissue bank, or the eye bank staff rather
than CAH staff, in which case there is no economic impact.
The regulation requires a CAH to work cooperatively with the
OPO, a tissue bank, and an eye bank in educating CAH staff. We do
not believe education of CAH staff will demand a significant amount
of staff time. In addition, most OPOs already give educational
presentations for the staff in their hospitals.
The regulation requires a CAH to work cooperatively with the
OPO, a tissue bank, and an eye bank in reviewing death records. Most
OPOs currently conduct extensive CAH death record reviews. The CAH's
assistance is required only to provide lists of CAH deaths and
facilitate access to records.
Finally, the regulation requires a CAH to work cooperatively
with the OPO, a tissue bank, and an eye bank in maintaining
potential donors while necessary testing and placement of potential
donated organs and tissues take place. It is possible that because
of the CoP, some CAHs may have their first organ donors. Therefore,
we considered the impact on a CAH of maintaining a brain dead
potential donor on a ventilator until the organs can be placed. CAHs
with full ventilator capability should have no trouble maintaining a
potential donor until the organs are placed. However, some CAHs have
ventilator capability only so that a patient can be maintained until
he or she is transferred to a larger facility for treatment. These
CAHs would have the equipment and staffing to maintain a potential
donor until transfer to another facility occurs. Some CAHs do not
have ventilator capability and would be unable to maintain a
potential donor. However, CAHs without ventilator capability would
still be obligated to notify the OPO, or a third party designated by
the OPO, of all individuals whose death is imminent or who have died
in the CAH because there is a potential to obtain a tissue or an eye
donation. We do not believe there will be a significant impact on
CAHs no matter what their situation--full ventilator capability,
ventilator capability only for patients who are to be transferred to
a larger facility, or no ventilator capability.
Although, as stated previously, there are several requirements
in this CoP that will impact CAHs to a greater or lesser degree, we
assert that the potential benefits to beneficiaries exceed the
associated costs of requiring CAHs to comply with this standard. As
stated in the Hospital Conditions of Participation; Identification
of Potential Organ, Tissue, and Eye Donors and Transplant Hospitals'
Provision of Transplant-Related Data regulation published on June
22, 1998 in the Federal Register (63 FR 33872), there were 3.11
organs transplanted for every donor recovered. Further, we do not
believe there will be a significant impact on CAHs no matter what
their situation--full ventilator capability, ventilator capability
only for patients who are to be transferred to a larger facility, or
no ventilator capability. Based on a HCFA actuarial opinion, the
cost for CAHs to implement this requirement is negligible. We
reviewed the comprehensive analysis in the impact section for the
hospital CoP discussed in the above referenced regulation and
determined that the analysis and assumptions made at that time are
valid for this CAH CoP.
We expect that this regulation will increase tissue and eye
donations as well as organ donations. A study of the impact of the
Pennsylvania routine referral legislation on tissue and eye
donations was presented at the Fourth International Society for
Organ Sharing Congress and Transplant Congress in July 1997.
(Nathan, HM, Abrams, J. Sparkman BA, et al. "Comprehensive State
Legislation Increases Organ and Tissue
[[Page 47199]]
Donations") This study used data from the Delaware Valley
Transplant Program, the OPO for Southeastern Pennsylvania, and found
that although the maximum donor age was lowered from 66 to 60,
tissue donations increased 14 percent from 1994 through 1996. The
study also showed that eye donations increased 28 percent during the
same period, despite more restrictive donor criteria. This virtually
eliminated the waiting list for suitable corneas. North Carolina's
routine referral legislation became effective in October 1997. The
Carolina Organ Procurement Agency (one of three North Carolina OPOs)
has seen heart valve donations increase by 109 percent and other
tissue donations increase 114 percent through May 1998.
We did not receive any public comments on the impact of this
provision.
IX. Impact of Medicare Disproportionate Share Hospital (DSH) Adjustment
Calculation Policy Change in the Treatment of Certain Medicaid Patient
Days in States With 1115 Expansion Waivers
As discussed in the January 20, 2000 interim final rule with
comment period, we revised the policy for the Medicare
disproportionate share hospital adjustment provision set forth under
section 1886(d)(5)(F) of the Act to allow hospitals located in
states with section 1115 expansion waivers to include the patient
days of all populations eligible for title XIX matching payments
under a State's section 1115 waiver in calculating the hospital's
Medicare DSH adjustment.
There are currently eight States with section 1115 expansion
waivers (Delaware, Hawaii, Massachusetts, Missouri, New York,
Oregon, Tennessee, and Vermont). Under the provisions of this final
rule, hospitals in these eight States will be allowed to include in
the Medicaid percentage portion of their Medicare DSH calculation
the inpatient hospital days attributable to patients who are
eligible under the State's section 1115 expansion waiver. Because
our policy was that these days were not allowable prior to January
20, 2000, by allowing hospitals to begin to include these days in
their Medicare DSH calculation, the impact will be to increase the
DSH payments these hospitals will receive compared to what they
would receive absent this change.
We have estimated the impact of this change to be $270 million
in higher FY 2000 prospective payments system payments (total FY
2000 DSH payments are projected to be $4.6 billion), and $370
million in FY 2001 payments. Thus the total impact of this change
for the period from FY 2001 through FY 2005 is estimated to be $2.14
billion.
X. Impact of Changes in the Capital Prospective Payment System
A. General Considerations
We now have cost report data for the 7th year of the capital
prospective payment system (cost reports beginning in FY 1998)
available through the March 2000 update of the HCRIS. We also have
updated information on the projected aggregate amount of obligated
capital approved by the fiscal intermediaries. However, our impact
analysis of payment changes for capital-related costs is still
limited by the lack of hospital-specific data on several items.
These are the hospital's projected new capital costs for each year,
its projected old capital costs for each year, and the actual
amounts of obligated capital that will be put in use for patient
care and recognized as Medicare old capital costs in each year. The
lack of this information affects our impact analysis in the
following ways:
Major investment in hospital capital assets (for
example, in building and major fixed equipment) occurs at irregular
intervals. As a result, there can be significant variation in the
growth rates of Medicare capital-related costs per case among
hospitals. We do not have the necessary hospital-specific budget
data to project the hospital capital growth rate for individual
hospitals.
Our policy of recognizing certain obligated capital as
old capital makes it difficult to project future capital-related
costs for individual hospitals. Under Sec. 412.302(c), a hospital is
required to notify its intermediary that it has obligated capital by
the later of October 1, 1992, or 90 days after the beginning of the
hospital's first cost reporting period under the capital prospective
payment system. The intermediary must then notify the hospital of
its determination whether the criteria for recognition of obligated
capital have been met by the later of the end of the hospital's
first cost reporting period subject to the capital prospective
payment system or 9 months after the receipt of the hospital's
notification. The amount that is recognized as old capital is
limited to the lesser of the actual allowable costs when the asset
is put in use for patient care or the estimated costs of the capital
expenditure at the time it was obligated. We have substantial
information regarding fiscal intermediary determinations of
projected aggregate obligated capital amounts. However, we still do
not know when these projects will actually be put into use for
patient care, the actual amount that will be recognized as obligated
capital when the project is put into use, or the Medicare share of
the recognized costs. Therefore, we do not know actual obligated
capital commitments for purposes of the FY 2001 capital cost
projections. In Appendix B of this final rule, we discuss the
assumptions and computations that we employ to generate the amount
of obligated capital commitments for use in the FY 2001 capital cost
projections.
In Table III of this section, we present the redistributive
effects that are expected to occur between "hold-harmless"
hospitals and "fully prospective" hospitals in FY 2001. In
addition, we have integrated sufficient hospital-specific
information into our actuarial model to project the impact of the FY
2001 capital payment policies by the standard prospective payment
system hospital groupings. While we now have actual information on
the effects of the transition payment methodology and interim
payments under the capital prospective payment system and cost
report data for most hospitals, we still need to randomly generate
numbers for the change in old capital costs, new capital costs for
each year, and obligated amounts that will be put in use for patient
care services and recognized as old capital each year. We continue
to be unable to predict accurately FY 2001 capital costs for
individual hospitals, but with the most recent data on hospitals'
experience under the capital prospective payment system, there is
adequate information to estimate the aggregate impact on most
hospital groupings.
B. Projected Impact Based on the FY 2001 Actuarial Model
1. Assumptions
In this impact analysis, we model dynamically the impact of the
capital prospective payment system from FY 2000 to FY 2001 using a
capital cost model. The FY 2001 model, as described in Appendix B of
this final rule, integrates actual data from individual hospitals
with randomly generated capital cost amounts. We have capital cost
data from cost reports beginning in FY 1989 through FY 1998 as
reported on the March 2000 update of HCRIS, interim payment data for
hospitals already receiving capital prospective payments through
PRICER, and data reported by the intermediaries that include the
hospital-specific rate determinations that have been made through
April 1, 2000 in the provider-specific file. We used these data to
determine the FY 2001 capital rates. However, we do not have
individual hospital data on old capital changes, new capital
formation, and actual obligated capital costs. We have data on costs
for capital in use in FY 1998, and we age that capital by a formula
described in Appendix B. Therefore, we need to randomly generate
only new capital acquisitions for any year after FY 1998. All
Federal rate payment parameters are assigned to the applicable
hospital.
For purposes of this impact analysis, the FY 2001 actuarial
model includes the following assumptions:
Medicare inpatient capital costs per discharge will
change at the following rates during these periods:
Average Percentage Change in Capital Costs Per Discharge
------------------------------------------------------------------------
Percentage
Fiscal year change
------------------------------------------------------------------------
1999....................................................... 3.12
2000....................................................... 3.31
2001....................................................... 2.95
------------------------------------------------------------------------
We estimate that the Medicare case-mix index will
increase by 0.5 percent in FY 2000 and in FY 2001.
The Federal capital rate and the hospital-specific rate
were updated in FY 1996 by an analytical framework that considers
changes in the prices associated with capital-related costs and
adjustments to account for forecast error, changes in the case-mix
index, allowable changes in intensity, and other factors. The FY
2001 update is 0.9 percent (see section IV. of the Addendum to this
final rule).
[[Page 47200]]
2. Results
We have used the actuarial model to estimate the change in
payment for capital-related costs from FY 2000 to FY 2001. Table III
shows the effect of the capital prospective payment system on low
capital cost hospitals and high capital cost hospitals. We consider
a hospital to be a low capital cost hospital if, based on a
comparison of its initial hospital-specific rate and the applicable
Federal rate, it will be paid under the fully prospective payment
methodology. A high capital cost hospital is a hospital that, based
on its initial hospital-specific rate and the applicable Federal
rate, will be paid under the hold-harmless payment methodology.
Based on our actuarial model, the breakdown of hospitals is as
follows:
Capital Transition Payment Methodology for FY 2001
----------------------------------------------------------------------------------------------------------------
Percent of Percent of
Type of hospital Percent of Percent of capital capital
hospitals discharges costs payments
----------------------------------------------------------------------------------------------------------------
Low Cost Hospital........................................... 67 62 56 61
High Cost Hospital.......................................... 33 38 44 39
----------------------------------------------------------------------------------------------------------------
A low capital cost hospital may request to have its hospital-
specific rate redetermined based on old capital costs in the current
year, through the later of the hospital's cost reporting period
beginning in FY 1994 or the first cost reporting period beginning
after obligated capital comes into use (within the limits
established in Sec. 412.302(e) for putting obligated capital into
use for patient care). If the redetermined hospital-specific rate is
greater than the adjusted Federal rate, these hospitals will be paid
under the hold-harmless payment methodology. Regardless of whether
the hospital became a hold-harmless payment hospital as a result of
a redetermination, we continue to show these hospitals as low
capital cost hospitals in Table III.
Assuming no behavioral changes in capital expenditures, Table
III displays the percentage change in payments from FY 2000 to FY
2001 using the above described actuarial model. With the Federal
rate, we estimate aggregate Medicare capital payments will increase
by 5.48 percent in FY 2001. This increase is noticeably higher than
last year's (3.64 percent) due to the combination of the increase in
the number of hospital admissions, the increase in case-mix, and the
increase in the Federal blend percentage from 90 percent to 100
percent and a decrease in the hospital-specific rate percentage from
10 percent to 0 percent for fully prospective payment hospitals.
Table III.--Impact of Proposed Changes for FY 2001 on Payments per Discharge
--------------------------------------------------------------------------------------------------------------------------------------------------------
Percent
Number of Adjusted Average Hopital Hold Exceptions Total change
hospitals Discharges federal federal specific harmless payment payment over FY
payment percent payment payment 2000
--------------------------------------------------------------------------------------------------------------------------------------------------------
FY 2000 Payments per Discharge:
Low Cost Hospitals............................ 3,194 6,723,732 $574.73 90.41 $30.18 $2.95 $7.84 $615.72 .........
Fully Prospective......................... 3,020 6,252,299 571.02 90.00 32.46 ......... 7.45 610.93 .........
100% Federal Rate......................... 159 438,006 635.95 100.00 ......... ......... 3.42 639.38 .........
Hold Harmless............................. 15 33,426 467.66 54.25 ......... 594.40 139.14 1,201.21 .........
High Cost Hospitals........................... 1,598 4,078,374 650.66 97.86 ......... 19.26 13.05 682.97 .........
100% Federal Rate......................... 1,383 3,717,412 665.24 100.00 ......... ......... 6.98 672.22 .........
Hold Harmless............................. 215 360,962 500.42 75.67 ......... 217.62 75.58 793.63 .........
Total Hospitals......................... 4,792 10,802,106 603.40 93.30 18.79 9.11 9.81 641.11 .........
FY 2001 Payments per Discharge:
Low Cost Hospitals............................ 3,194 6,835,654 $637.91 99.74 ......... $2.42 $9.69 $650.02 5.57
Fully Prospective......................... 3,020 6,356,377 638.58 100.00 ......... ......... 9.20 647.78 6.03
100% Federal Rate......................... 159 445,296 638.34 100.00 ......... ......... 4.35 642.69 0.52
Hold Harmless............................. 15 33,981 506.60 60.11 ......... 486.54 170.96 1,164.09 -3.09
High Cost Hospitals........................... 1,598 4,146,181 653.32 98.38 ......... 15.35 21.47 690.15 1.05
100% Federal Rate......................... 1,394 3,793,349 664.47 100.00 ......... ......... 10.65 675.12 0.43
Hold Harmless............................. 204 352,832 533.52 80.86 ......... 180.41 137.76 851.69 7.32
Total Hospitals......................... 4,792 10,981,835 643.73 99.21 ......... 7.30 14.14 665.17 3.75
--------------------------------------------------------------------------------------------------------------------------------------------------------
We project that low capital cost hospitals paid under the fully
prospective payment methodology will experience an average increase
in payments per case of 6.03 percent, and high capital cost
hospitals will experience an average increase of 1.05 percent. These
results are due to the change in the blended percentages to the
payment system to 100 percent adjusted Federal rate and 0 percent
hospital-specific rate.
For hospitals paid under the fully prospective payment
methodology, the Federal rate payment percentage will increase from
90 percent to 100 percent and the hospital-specific rate payment
percentage will decrease from 10 to 0 percent in FY 2001. The
Federal rate payment percentage for hospitals paid under the hold-
harmless payment methodology is based on the hospital's ratio of new
capital costs to total capital costs. The average Federal rate
payment percentage for high cost hospitals receiving a hold-harmless
payment for old capital will increase from 75.67 percent to 80.86
percent. We estimate the percentage of hold-harmless hospitals paid
based on 100 percent of the Federal rate will increase from 86.55
percent to 87.23 percent. We estimate that the few remaining high
cost hold-harmless hospitals (204) will experience an increase in
payments of 7.32 percent from FY 2000 to FY 2001. This increase
reflects our estimate that exception payments per discharge will
increase 82.27 percent from FY 2000 to FY 2001 for high cost hold-
harmless hospitals. While we estimate that this group's regular
hold-harmless payments for old capital will decline by 17.10 percent
due to the retirement of old capital, we estimate that its high
overall capital costs will cause an increase in these hospitals'
exceptions payments from $75.58 per discharge in FY 2000 to $137.76
per discharge in FY 2001. This is primarily due to the estimated
decrease in outlier payments, which will cause an estimated increase
in exceptions payments to cover unmet capital costs.
We estimate that the average hospital-specific rate payment per
discharge will decrease from $32.46 in FY 2000 to $0.00 in FY 2001.
This decrease is due to the decrease in the hospital-specific rate
payment percentage from 10 percent in FY 2000 to 0 percent in FY
2001 for fully prospective payment hospitals.
We have made no changes in our exceptions policies for FY 2001.
As a result, the minimum payment levels would be--
90 percent for sole community hospitals;
80 percent for urban hospitals with 100 or more beds
and a disproportionate share patient percentage of 20.2 percent or
more; or
[[Page 47201]]
70 percent for all other hospitals.
We estimate that exceptions payments will increase from 1.53
percent of total capital payments in FY 2000 to 2.13 percent of
payments in FY 2001. The projected distribution of the exception
payments is shown in the chart below:
Estimated FY 2001 Exceptions Payments
------------------------------------------------------------------------
Percent of
Type of hospital Number of exceptions
hospitals payments
------------------------------------------------------------------------
Low Capital Cost.............................. 201 43
High Capital Cost............................. 214 57
-------------------------
Total..................................... 415 100
------------------------------------------------------------------------
C. Cross-Sectional Comparison of Capital Prospective Payment
Methodologies
Table IV presents a cross-sectional summary of hospital
groupings by capital prospective payment metholology. This
distribution is generated by our acturarial model.
Table IV.--Distribution by Method of Payment (Hold-Harmless/Fully Prospective) of Hospitals Receiving Capital
Payments (Estimated for FY 2001)
----------------------------------------------------------------------------------------------------------------
(2) Hold-harmless
-------------------------- (3)
(1) Total Percentage Percentage
No. of paid hold- Percentage paid fully
Hospitals harmless paid fully prospective
(A) federal (B) rate
----------------------------------------------------------------------------------------------------------------
By Geographic Location:
All hospitals........................................... 4,792 4.6 32.4 63.0
Large urban areas (populations over 1 million).......... 1,524 4.3 41.0 54.7
Other urban areas (populations of 1 million or fewer)... 1,149 5.8 39.5 54.7
Rural areas............................................. 2,119 4.1 22.4 73.5
Urban hospitals......................................... 2,673 4.9 40.4 54.7
0-99 beds........................................... 658 6.2 33.9 59.9
100-199 beds........................................ 929 7.2 45.5 47.3
200-299 beds........................................ 543 3.3 41.4 55.2
300-499 beds........................................ 400 0.8 37.0 62.3
500 or more beds.................................... 143 2.1 42.0 55.9
Rural hospitals......................................... 2,119 4.1 22.4 73.5
0-49 beds........................................... 1,220 2.9 16.6 80.6
50-99 beds.......................................... 531 6.8 26.7 66.5
100-149 beds........................................ 219 5.9 35.2 58.9
150-199 beds........................................ 81 2.5 25.9 71.6
200 or more beds.................................... 68 1.5 47.1 51.5
By Region:
Urban by Region......................................... 2,673 4.9 40.4 54.7
New England......................................... 145 0.7 25.5 73.8
Middle Atlantic..................................... 408 2.9 34.8 62.3
South Atlantic...................................... 398 5.5 51.8 42.7
East North Central.................................. 454 4.2 29.7 66.1
East South Central.................................. 154 8.4 46.1 45.5
West North Central.................................. 182 6.0 36.8 57.1
West South Central.................................. 328 8.8 58.2 32.9
Mountain............................................ 124 4.8 48.4 46.8
Pacific............................................. 435 4.1 36.3 59.5
Puerto Rico......................................... 45 2.2 26.7 71.1
Rural by Region......................................... 2,119 4.1 22.4 73.5
New England......................................... 52 0.0 23.1 76.9
Middle Atlantic..................................... 78 5.1 19.2 75.6
South Atlantic...................................... 276 2.2 33.3 64.5
East North Central.................................. 279 3.9 16.5 79.6
East South Central.................................. 265 3.4 32.8 63.8
West North Central.................................. 491 3.3 14.5 82.3
West South Central.................................. 334 4.5 26.3 69.2
Mountain............................................ 200 9.5 15.0 75.5
Pacific............................................. 139 5.0 23.7 71.2
By Payment Classification:
Large urban areas (populations over 1 million).......... 1,618 4.2 41.3 54.5
Other urban areas (populations of 1 million or fewer)... 1,136 6.0 38.8 55.2
Rural areas............................................. 2,038 4.1 21.8 74.1
Teaching Status:
Non-teaching........................................ 3,682 5.1 31.6 63.3
Fewer than 100 Residents............................ 871 2.9 35.9 61.2
100 or more Residents............................... 239 2.1 32.2 65.7
Disproportionate share hospitals (DSH): 2,988 4.7 28.3 67.0
By Geographic Location:
All hospitals........................................... 4,792 4.6 32.4 63.0
[[Page 47202]]
Non-DSH
Urban DSH:
100 or more beds................................ 1,379 4.6 42.5 52.9
Less than 100 beds.............................. 70 4.3 25.7 70.0
Rural DSH:
Sole Community (SCH/EACH)....................... 149 5.4 20.1 74.5
Referral Center (RRC/EACH)...................... 56 3.6 51.8 44.6
OTHER RURAL:
100 OR MORE BEDS............................ 48 ........... 39.6 60.4
Less than 100 beds.......................... 102 2.0 23.5 74.5
Urban teaching and DSH:
Both teaching and DSH............................... 720 2.5 36.7 60.8
Teaching and no DSH................................. 325 3.1 33.8 63.1
No teaching and DSH................................. 729 6.7 46.6 46.6
No teaching and no DSH.............................. 980 6.0 40.3 53.7
Rural Hospital Types:
Non special status hospitals........................ 819 1.5 24.1 74.5
RRC/EACH............................................ 150 2.7 36.0 61.3
SCH/EACH............................................ 661 8.5 18.2 73.4
Medicare-dependent hospitals (MDH).................. 351 1.4 16.5 82.1
SCH, RRC and EACH................................... 57 10.5 26.3 63.2
Type of Ownership:
Voluntary........................................... 2,520 4.5 32.4 63.1
Proprietary......................................... 655 7.2 57.1 35.7
Government.......................................... 1,093 4.1 19.2 76.7
Medicare Utilization as a Percent of Inpatient Days:
0-25................................................ 369 5.4 27.6 66.9
25-50............................................... 1,820 4.3 35.1 60.7
50-65............................................... 1,882 4.7 31.2 64.1
Over 65............................................. 688 4.8 32.1 63.1
----------------------------------------------------------------------------------------------------------------
As we explain in Appendix B of this final rule, we were not able
to use 96 of the 4,888 hospitals in our database due to insufficient
(missing or unusable) data. Consequently, the payment methodology
distribution is based on 4,792 hospitals. These data should be fully
representative of the payment methodologies that will be applicable
to hospitals.
The cross-sectional distribution of hospital by payment
methodology is presented by: (1) geographic location; (2) region;
and (3) payment classification. This provides an indication of the
percentage of hospitals within a particular hospital grouping that
will be paid under the fully prospective payment methodology and the
hold-harmless payment methodology.
The percentage of hospitals paid fully Federal (100 percent of
the Federal rate) as hold-harmless hospitals is expected to increase
to 32.4 percent in FY 2001.
Table IV indicates that 63.0 percent of hospitals will be paid
under the fully prospective payment methodology. (This figure,
unlike the figure of 67 percent for low cost capital hospitals in
the chart on "Capital Transition Payment Methodology for FY 2001,"
in section VII.B.2. of this impact analysis takes into account the
effects of redeterminations. In other words, this figure does not
include low cost hospitals that, following a hospital-specific rate
redetermination, are now paid under the hold-harmless methodology.)
As expected, a relatively higher percentage of rural and
governmental hospitals (74.1 percent and 76.7 percent, respectively
by payment classification) are being paid under the fully
prospective payment methodology. This is a reflection of their lower
than average capital costs per case. In contrast, only 35.7 percent
of proprietary hospitals are being paid under the fully prospective
methodology. This is a reflection of their higher than average
capital costs per case. (We found at the time of the August 30, 1991
final rule (56 FR 43430) that 62.7 percent of proprietary hospitals
had a capital cost per case above the national average cost per
case.)
D. Cross-Sectional Analysis of Changes in Aggregate Payments
We used our FY 2001 actuarial model to estimate the potential
impact of our changes for FY 2001 on total capital payments per
case, using a universe of 4,792 hospitals. The individual hospital
payment parameters are taken from the best available data,
including: the April 1, 2000 update to the provider-specific file,
cost report data, and audit information supplied by intermediaries.
In Table V we present the results of the cross-sectional analysis
using the results of our actuarial model and the aggregate impact of
the FY 2001 payment policies. Columns 3 and 4 show estimates of
payments per case under our model for FY 2000 and FY 2001. Column 5
shows the total percentage change in payments from FY 2000 to FY
2001. Column 6 presents the percentage change in payments that can
be attributed to Federal rate changes alone.
Federal rate changes represented in Column 6 include the 1.33
percent increase in the Federal rate, a 0.5 percent increase in case
mix, changes in the adjustments to the Federal rate (for example,
the effect of the new hospital wage index on the geographic
adjustment factor), and reclassifications by the MGCRB. Column 5
includes the effects of the Federal rate changes represented in
Column 6. Column 5 also reflects the effects of all other changes,
including the change from 90 percent to 100 percent in the portion
of the Federal rate for fully prospective hospitals, the hospital-
specific rate update, changes in the proportion of new to total
capital for hold-harmless hospitals, changes in old capital (for
example, obligated capital put in use), hospital-specific rate
redeterminations, and exceptions. The comparisons are provided by:
(1) geographic location, (2) region, and (3) payment classification.
The simulation results show that, on average, capital payments
per case can be expected to increase 3.8 percent in FY 2001. The
results show that the effect of the Federal
[[Continued on page 47204]]
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