Friday, May 18, 2018

Very Brief Blog: CMS's Web-Friendly, Searchable Hospital DRG and Payment Data

CMS has number of web-searchable, big data provider databases.  I've written about the one for physicians and labs.  There's also one for ordering physicians for DME and one for hospitals.

Home page for inpatient hospital data is here.  (For other options, see the column at left on this CMS page).  As of May 2018, the most current data year is 2015.

I briefly explain how to get into the data and download it in a short footnote.[*]

If I've got this right, for Heart Transplant, DRG 001, there were 1,633 cases among 74 institutions.  7 hospitals had 40 or more Medicare heart transplants, the top four being Advocate in Illinois, St Lukes/Baylor in Texas, Barnes in Missouri, and Cedars in Los Angeles.  $360M was paid, for an average of $220,711 per case (standard deviation about $60,000).  

The famous charge:payment ratio ranged from 2:1 for Tufts to 12:1 for Temple.  All sorts of tidbits - e.g. Mother Mayo in Minnesota had 26 cases, but Mayo Arizona had 28.

Recently there have been new calls for more transparent Medicare data, such as hospital charges and drug prices, and admittedly, this is stuff for experts or at least people facile with Excel.  But still, it's publicly available today on open websites and can be accessed in a few seconds as I've shown above.


For a May 16 investigative article in the Houston Chronicle on the #2 volume center, St. Luke's/Baylor, see here.

I believe the physician data is all CPT codes and the DRG data is all DRG codes.  The Outpatient data for some reason lists only 28 of the many APCs, though.

[*]  Home page for hospital data is here.   Click on "Interactive Dataset...FY2015."  At the next page, click on the box "View Data."  You've now got a table-format web view of what's a huge dataset.   Let's filter it.  Click on the "Filter" box.  Click, "Add a new filter condition."  Change DRG Definition to "...Starts With" and type 001.  It now displays all heart transplant DRG utilization by hospital.  Click on "Export" and export as Excel.  Finally, I immediately save the CSV file as XLS.