Federal Analyses – DataGen Reports

Federal Analyses

NCHA contracts with the Hospital Association of New York State (HANYS) to offer DataGen reports to members. DataGen reports:

Interpret changes in healthcare payment policy.

Model the impact of healthcare payment changes on revenue, quality, and profitability.

Help members to act on insight to drive organizational change.

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Update: HHS announced the distribution of $10 billion in CARES Act Provider Relief Funds to certain Safety Net hospitals that serve a disproportionate number of Medicaid patients or provide large amounts of uncompensated care. According to the HHS announcement, hospitals qualifying for this funding pool will have:

· a Medicare Disproportionate Payment Percentage of 20.2% or greater;
· average uncompensated care of $25,000 or more per bed — for example, a hospital with 100 beds would need to provide $2,500,000 in uncompensated care in a
year to meet this requirement; and
· profitability of 3% or less, as reported to CMS in the hospital’s most recently filed cost report.

Updated June 11, 2020

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Update: Health and Human Services began distribution of the $10 billion COVID-19 relief to rural providers. Hospitals and Rural Health Clinics will each receive a minimum base payment plus a percent of their annual operating expenses. This expense-based method accounts for operating cost and lost revenue incurred by rural hospitals for both inpatient and outpatient services. The base payment will account for RHCs with no reported Medicare claims, such as pediatric RHCs, and Community Health Centers lacking expense data, by ensuring that all clinical, non-hospital sites receive a minimum level of support no less than $100,000, with additional payment based on operating expenses. Rural acute care general hospitals and CAHs will receive a minimum level of support of no less than $1,000,000, with additional payment based on operating expenses.

Updated May 11, 2020.

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Update: Health and Human Services began distribution to providers of the remaining $20 billion of the $50 billion general allocation on April 24. Payment to providers from this $20 billion are calculated so that a provider’s allocation from the entire $50 billion general distribution is a portion of such provider’s 2018 net patient revenue. Total revenues of Medicare facilities and providers is estimated to be approximately $2.5 trillion. Providers can estimate their expected combined general revenue distribution through the following formula: Individual Provider Revenues/$2.5 Trillion) X $50 Billion = Expected Combined General Distribution.

Updated April 26, 2020.

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Please Note: Several payment changes adopted in the CARES Act are not included due to lack of data and/or full detail on implementation. For other impacts, such as Medicaid DSH, please contact Anthony Okunak (aokunak@ncha.org).

On March 27, 2020, Congress responded to the COVID-19 emergency by adopting the Coronavirus Aid, Relief, and Economic Security Act (CARES Act). The act provides financial relief and resources to hospitals impacted by the public health emergency. This analysis indicates how existing Medicare provider payments will be affected by the CARES Act legislation.

Updated April 2020.

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Critical Access Hospital and Small Rural PPS Utilization

The Critical Access Hospital (CAH) and Small Rural Prospective Payment System (PPS) Utilization Analysis is intended to provide hospitals with a comprehensive and comparative review of Medicare fee-for-service (FFS) inpatient utilization and Medicare FFS outpatient utilization.

In each section, U.S. and State critical access and small rural hospital benchmark comparisons are provided. In this analysis, small rural hospitals are defined as Prospective Payment System (PPS) hospitals with less than 6,000 adjusted discharges or critical access hospitals (CAHs) with less than 800 adjusted discharges.

Updated November 2021.

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Critical Access Hospitals Payment Comparison
The Critical Access Hospital (CAH) Payment Comparison is intended for advocacy purposes and shows how existing Medicare payments for inpatient, outpatient, and swing bed patients may be affected if providers currently reimbursed based on cost were to instead be paid prospectively.
Updated August 2021.

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Critical Access and Small and Rural Hospitals PPS Databook

The Critical Access and Small Rural Prospective Payment System (PPS) Hospitals DataBook is intended to provide hospitals with a comprehensive and comparative review of:

  • Medicare inpatient utilization
  • Medicare outpatient utilization
  • Financial indicator performance
  • Quality performance.

Updated November 2020.

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Medicare VBP Estimates for Critical Access Hospitals

This analysis is intended to provide CAHs with an estimate of their performance potential under a scenario for the CAH VBP program that closely resembles the one currently in place for IPPS hospitals.  The reports in this analysis estimate VBP scores and impacts for CAHs, and provide full detail on how the points and scores for each quality measure and quality domain are calculated.

Updated September 2020.

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The Medicare Cost Report Model is an Excel-based model that provides hospital associations/systems with commonly sought after data elements from the Centers for Medicare and Medicaid’s (CMS) Healthcare Cost Report Information System (HCRIS) database. The model highlights hospital utilization, inpatient, outpatient, overall hospital statistics, and uncompensated care data.

Updated March 2022.

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Enacted Medicare Cuts Analysis

This analysis is intended for advocacy purposes only and indicates to what extent that hospital providers have been impacted by existing Medicare provider payment cuts enacted by Congress to achieve Medicare payment policy and/or long-term deficit reduction goals. The impacts shown in this analysis include the major cuts enacted since 2010.

Updated March 2021.

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Potential Medicare Cuts Analysis

This analysis is intended for advocacy purposes only, and indicates how existing Medicare provider payments would be affected by additional changes that Congress may consider in order to achieve Medicare payment policy and/or long-term deficit reduction goals. The impacts shown in this analysis include several of the major revisions proposed in recent years as well as other potential scenarios. There is no judgment made on the likelihood of these proposals being adopted. Due to the lack of data, some proposals are not included in this analysis.

Updated April 2021.

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Financial Indicators Analysis provides all-payer comparative financial ratios/metrics for hospitals compared to various benchmark groups for twelve financial ratios. The financial ratios shown are calculated using standard accepted formulas, as defined by various ratings agencies. The model includes a dictionary with calculation instructions and data for each of these indicators.

Profitability Indicators: Liquidity Indicators: Capital Structure Indicators:
Total Margin Current Ratio Average Age of Plant
Operating Margin Average Payment Period Capital Expenditures as a % of Depreciation
Earnings Before Interest, Tax, Depreciation and Amortization (EBITDA) Margin Days Cash on Hand – All Sources Debt to Capitalization
Operating Cash Flow Margin Net Days Revenue in Accounts Receivable Debt Service Coverage

 

Updated December 2021.

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The calendar year (CY) 2022 Medicare Home Health (HH) Prospective Payment System (PPS) Proposed Rule Analysis is intended to show HH providers how Medicare fee-for-service (FFS) payments will change from CY 2021 to CY 2022 based on the policies set forth in the CY 2022 HH PPS proposed rule.

Updated August 2021.

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The calendar year (CY) 2022 Medicare Home Health (HH) Prospective Payment System (PPS) Final Rule Analysis is intended to show HH providers how Medicare fee-for-service (FFS) payments will change from CY 2021 to CY 2022 based on the policies set forth in the CY 2021 HH PPS final rule.

Updated December 2021.

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The Hospital-Acquired Condition (HAC) Reduction Program Analysis is intended to provide hospitals with a preview of the potential impact of the FFY 2023 Medicare Inpatient HAC Reduction Program, based on publicly available data and the program rules established by the Centers for Medicare and Medicaid Services (CMS).

The reports included in this analysis evaluate hospital performance under the FFY 2023 program. CMS did not update the Hospital Acquired Infection (HAI) measures in 2Q2021 Care Compare, and therefore this analysis uses the 3Q 2020 update of Care Compare for HAI measures and the 2Q 2021 update of Care Compare for PSI-90. The analysis includes estimates and details on how HAC measures and domain scores are calculated and how payment penalties are determined and applied under the program.

Updated March 2022.

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Proposed Rule Analysis

The federal fiscal year (FFY) 2023 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Proposed Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments would change from FFY 2022 to FFY 2023 based on the policies set forth in the FFY 2023 IPF PPS proposed rule.

Updated May 2022.

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Final Rule Analysis

The federal fiscal year (FFY) 2022 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments would change from FFY 2021 to FFY 2022 based on the policies set forth in the FFY 2022 IPF PPS final rule.

Updated August 2021.

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Proposed Rule Analysis

The FFY 2023 Medicare IRF PPS Proposed Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments may change from FFY 2022 to FFY 2023 based on the policies set forth in the FFY 2023 IRF PPS proposed rule.

Updated May 2022.

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Final Rule Analysis

The Medicare IRF PPS Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments may change from FFY 2021 to FFY 2022 based on the policies set forth in the FFY 2022 IRF PPS final rule.

Updated August 2021.

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LTCH Proposed Rule Analysis

The federal fiscal year (FFY) 2023 Medicare Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule Impact Analysis is intended to show providers how Medicare LTCH fee-for-service (FFS) payments would change from FFY 2022 to FFY 2023 based on the policies set forth in the FFY 2023 LTCH PPS proposed rule.

Updated May 2022.

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LTCH Final Rule Analysis

The federal fiscal year (FFY) 2022 Medicare Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule Impact Analysis is intended to show providers how Medicare LTCH fee-for-service (FFS) payments would change from FFY 2020 to FFY 2022 based on the policies set forth in the FFY 2022 LTCH PPS final rule.

Updated September 2021.

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Medicare Inpatient Prospective Payment System Proposed Rule Analysis

The federal fiscal year (FFY) 2023 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments would change from FFY 2022 to FFY 2023 based on the policies set forth in the FFY 2023 IPPS proposed rule. The analysis compares the year-over-year change in operating, capital, and uncompensated care IPPS payments.

Updated May 2022.

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Medicare Inpatient Prospective Payment System Final Rule Analysis

The federal fiscal year (FFY) 2022 Medicare Inpatient Prospective Payment System (IPPS) Final Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments would change from FFY 2021 to FFY 2022 based on the policies set forth in the FFY 2022 IPPS final rule. The analysis compares the year-over-year change in operating, capital, and uncompensated care IPPS payments and includes breakout sections that provide detailed insight into specific policies that influence IPPS payment changes, including:

  • potential payment penalties under the Inpatient Quality Reporting (IQR) and electronic health record (EHR) Incentive Programs;
  • impact of CMS’ adjustment to the wage index of hospitals in bottom quartile of wage index values nationally to reduce wage disparities;
  • the adopted Core-Based Statistical Area changes updated by the Office of Management and Budget (OMB) Bulletin No. 18-04;
  • quality-based payment adjustments; and
  • Disproportionate Share Hospital (DSH) uncompensated care (UCC) payments.

Updated September 2021.

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The Fee-For-Service Medicare Margins Analysis shows the trends in Medicare margins over the most recent ten-year period (FFY 2010 through FFY 2019). Medicare margins are shown for the following areas/units: inpatient, outpatient, Graduate Medical Education (GME), psychiatric unit (IPF), rehabilitation unit (IRF), skilled nursing unit (SNF), Home Health Agency (HHA), and swing beds.

Updated April 2021.

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Medicare Spending per Beneficiary (MSPB) is a price-standardized, non-risk-adjusted measure designed by the Centers for Medicare and Medicaid Services (CMS) to evaluate a hospital’s efficiency, as measured by program spending.  This report compares the average Medicare spending per beneficiary for the hospital to State and US benchmarks, using the following three time periods:

  • 1 to 3 days prior to the index hospital admission;
  • During the index hospital admission; and
  • 1 through 30 days after discharge from the index hospital admission.

This report also shows a 3-year MSPB trend. The checkboxes can be used to select the data year, the portion of the episode, and the hospital settings shown on the graph and table. These selections do not impact the estimated risk-adjusted MSPB section which only shows the most recent year of data.

Updated April 2022.

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The Most Favored Nation (MFN) Model analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments may change based on the policies set forth in the MFN Interim Final Rule with Comment Period (IFC).

The MFN Model was set to begin on January 1, 2021. However, due to several court orders, the MFN Model was not implemented on January 1, 2021 and will not be implemented while the preliminary injunction remains in place.

Updated January 2021.

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Occupational Mix FY 2023 – Final Data

The Medicare Hospital Wage Index and Occupational Mix Data Analysis – Revised Data (April 29, 2022 release) is intended to provide hospitals with a comparative review of the wage and occupational mix data that will be used to develop the federal fiscal year (FFY) 2023 Medicare hospital wage index.

Updated May 2022.

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The calendar year (CY) 2022 Medicare Outpatient Prospective Payment System (OPPS) Final Rule Analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments will change from CY 2021 to CY 2022 based on the policies set forth in the CY 2022 OPPS final rule.

Updated January 2022.

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The calendar year (CY) 2022 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule Analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments will change from CY 2020 to CY 2021 based on the policies set forth in the CY 2022 OPPS proposed rule.

Updated August 2021.

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Outpatient Prospective Payment System (OPPS) Claims Analysis analyzes Medicare fee-for-service (FFS) claims to aggregate the top Ambulatory Payment Classifications (APCs).

Updated January 2019.

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Outpatient Prospective Payment System (OPPS) Claims Analysis analyzes Medicare fee-for-service (FFS) Emergency Department and Observation Utilization.

Updated February 2019.

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The Medicare FFS Condition Code Utilization Claims Analysis analyzes Medicare fee-for-service (FFS) Inpatient to Outpatient Condition Code Utilization

Updated June 2019.

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The federal fiscal year (FFY) 2019 Medicare Post-Acute Transfer Adjustment Policy Analysis calculates and compares Medicare inpatient prospective payment system payment impacts of the post-acute transfer adjustment policy based on the FFY 2019 final rule.

Updated July 2019.

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This report is a one page summary of actual hospital quality performance and estimated impacts for each of the Centers for Medicare and Medicaid Services’ (CMS’) three Medicare fee-for-service (FFS) inpatient quality programs: Value-Based Purchasing; Readmissions Reduction Program; and the Hospital Acquired Condition Reduction program, from FFYs 2019 – FFY 2021.

Updated March 2022.

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The Quality Program Measure Trends Analysis (2Q2021 update) is designed to provide hospitals with a comparative review over time of the quality data collected by the Centers for Medicare and Medicaid Services (CMS) and published on the Hospital Compare website at http://www.medicare.gov/hospitalcompare.

The measures analyzed represent those that CMS has finalized for use in a Medicare quality-based payment program (VBP, RRP, HAC, CJR). Measures collected by CMS and included in the Hospital Compare database, but not in one of these four programs, are not evaluated in this analysis.

Updated October 2021.

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The Readmissions Reduction Program (RRP) Analysis is intended to provide detailed performance information on the readmissions measures that are currently evaluated under the Medicare Hospital Readmissions Reduction Program and to provide hospitals with an in-depth review of actual performance under the Federal Fiscal Years (FFYs) 2021 and 2022 programs.

Updated April 2022.

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Rural Emergency Hospital Analysis

On December 21, 2020 the Consolidated Appropriations Act of 2021 established the Rural Emergency Hospital (REH) provider type, effective January 1, 2023. This analysis estimates how Medicare payments to eligible hospitals may be impacted if converted to from their current provider type to an REH.

This analysis is intended to show providers how Medicare fee-for-service (FFS) payments may change for CAH and Small Rural hospitals if their reimbursement changes from the current payment to the new REH payment. This analysis is based on what information is currently available. Assumptions are made, where needed, as all of the information is not yet available.

Updated September 2021.

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In the FFY 2021 IPPS proposed rule, CMS proposed to use one year of audited FFY 2017 S-10 data to calculate DSH payments. This analysis compares DSH payments using Factor 3 values based on FFY 2017 S-10 (Charity Care and Non-Medicare Bad Debt Expense), line 30 from the FFY 2021 proposed rule DSH Supplemental File to a three component average of 3 years (FFYs 2015, 2016, and 2017) of Medicare Cost Report Worksheet S-10, line 30 in the calculation of Factor 3, similar to what was in effect for the S-10 transition period prior to FFY 2020.

Updated July 2020.

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Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule Impact Analysis

The analysis of the FFY 2022 proposed rule for SNFs is intended to show providers how Medicare PPS payments may change from FFY 2021 to FFY 2022 based on the policies set forth in the FFY 2022 SNF PPS final rule.

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Estimated Change in Medicare Payments to Free Standing SNFs

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Updated August 2021.

 

Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule Impact Analysis

The analysis of the FFY 2023 proposed rule for SNFs is intended to show providers how Medicare PPS payments may change from FFY 2022 to FFY 2023 based on the policies set forth in the FFY 2023 SNF PPS proposed rule.

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Estimated Change in Medicare Payments to Free Standing SNFs
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Updated May 2022.

The Value-Based Purchasing (VBP) Impact Analysis is intended to provide hospitals with a preview of the potential impact of the federal fiscal year (FFY) 2023 Medicare inpatient hospital VBP program based on publicly available data and program rules established by the Centers for Medicare and Medicaid Services (CMS).

The reports included in this analysis estimate VBP scores, impacts, and scoring trends and provide full detail on how the points and scores for each VBP measure and domain are calculated.

For FFY 2023 VBP, performance periods are impacted by the extraordinary circumstances exception granted by CMS in response to the public health emergency so no claims data or chart-abstracted data reflecting services provided January 1, 2020- June 30, 2020 will be used in calculations for the VBP Program.

Updated January 2022.

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Medicare Hospital Wage Index Analysis
The Medicare Hospital Wage Index and Occupational Mix Data Analysis – Preliminary Data (May 24, 2021 release) is intended to provide hospitals with a comparative review of the wage and occupational mix data that will be used to develop the federal fiscal year (FFY) 2023 Medicare hospital wage index.

Updated June 2021

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Medicare Hospital Wage Index Reclassification
This analysis is intended to allow hospitals to test their potential ability to obtain a federal fiscal year (FFY) 2023 Medicare hospital wage index reclassification.

Updated September 2021

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