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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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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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 October 2019.

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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:

Updated July 2019.

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Critical Access Hospital Payment Model

Impact of changes to Medicare payments for Critical Access Hospitals if their reimbursement changes from the current cost-based model to prospective payment.

Updated January 2019.

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The Medicare Cost Report provides hospital associations/systems with commonly sought after data elements from the CMS Healthcare Cost Report Information System (HCRIS) database. The model highlights hospital utilization, inpatient, outpatient, overall hospital statistics, and uncompensated care data.

Updated March 2020.

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Enacted Medicare Cuts Analysis indicates scale of Medicare provider payment cuts enacted to achieve policy or deficit reduction goals.

Updated February 2020.

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Potential Medicare Cuts Analysis (President’s Budget Update) is intended for advocacy purposes only, and indicates how existing Medicare provider payments would be affected by additional changes that Congress may consider to achieve Medicare payment policy and/or long-term deficit reduction goals.

Updated March 2020.

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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 July 2019.

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The calendar year (CY) 2020 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 2019 to CY 2020 based on the policies set forth in the CY 2020 HH PPS final rule.

Updated March 2020.

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The calendar year (CY) 2020 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 2019 to CY 2020 based on the policies set forth in the CY 2020 HH PPS proposed rule.

Updated August 2019.

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Shows Potential Impact of the Medicare Inpatient HAC Reduction Program.

Updated March 2020.

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Final Rule Analysis

The federal fiscal year (FFY) 2020 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments will change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 IPF PPS final rule.

Updated September 2019.

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Proposed Rule Analysis

The federal fiscal year (FFY) 2020 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 2019 to FFY 2020 based on the policies set forth in the FFY 2020 IPF PPS proposed rule.

Updated June 2019.

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Final Rule Analysis
The FFY 2020 Medicare IRF PPS Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments will change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 IRF PPS final rule.

Updated August 2019.

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Proposed Rule Analysis
The FFY 2020 Medicare IRF PPS Proposed Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments will change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 IRF PPS proposed rule.

Updated June 2019.

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The federal fiscal year (FFY) 2020 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 2019 to FFY 2020 based on the policies set forth in the FFY 2020 LTCH PPS final rule.

Updated September 2019.

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Medicare Inpatient Prospective Payment System Final Rule Analysis
The federal fiscal year (FFY) 2020 Medicare Inpatient Prospective Payment System (IPPS) Final Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments will change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 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;
  • quality-based payment adjustments;
  • Disproportionate Share Hospital (DSH) uncompensated care (UCC) payments; and
  • CMS’ use of solely FFY 2015 Medicare Cost Report Worksheet S-10 for FFY 2020 UCC payments.

Updated August 2019.

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Medicare Inpatient Prospective Payment System Proposed Rule Analysis

The federal fiscal year (FFY) 2020 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments will change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 IPPS proposed rule. The analysis compares the year-over-year change in operating, capital, and uncompensated care.

Updated May 2019.

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Estimated Impact due to Removal of MA Days from the DSH Percentage Calculation (Azar v. Allina Health Services)

Analysis is intended to show providers how traditional Medicare inpatient fee-for-service (FFS) operating and capital DSH payments may change on an annual basis based on the Supreme Court’s June 3, 2019 decision in ‘Azar v. Allina Health Services’ (https://www.supremecourt.gov/opinions/18pdf/17-1484_4f57.pdf) that CMS did not follow proper notice-and-comment period procedure when including Medicare Advantage days in the calculation of the Medicare DSH percentage.

Updated July 2019.

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This analysis shows the trends in Medicare margins over the most recent ten-year period. 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 March 2020.

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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.

Updated March 2020.

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Occupational Mix FY 2021 – Revised

The Medicare Hospital Occupational Mix Data Analysis – Revised Data (January 31, 2020 Release) is intended to provide hospitals with a comparative review of the occupational mix data that will be used to develop the federal fiscal year (FFY) 2021 Medicare hospital wage index.

Updated March 2020.

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Occupational Mix FY 2021 – Preliminary

Reviews occupational mix data that will be used to develop the FFY 2021 Medicare hospital wage index.

Updated August 2019

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The calendar year (CY) 2020 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 2019 to CY 2020 based on the policies set forth in the CY 2020 OPPS final rule correction notice.

Updated January 2020.

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The calendar year (CY) 2020 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule Analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments may change from CY 2019 to CY 2020 based on the policies set forth in the CY 2020 OPPS proposed rule, using the FFY 2020 IPPS final rule wage index.

Updated August 2019.

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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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Performance overview in the Medicare quality programs: Value Based Purchasing, Readmissions Reduction, Hospital Acquired Conditions, and Comprehensive Care for Joint Replacement.

Updated March 2020.

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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) 2019 and 2020 programs. The analysis also projects potential exposure under the FFY 2021 Program based on data utilized for the FFY 2020 Program.

Updated October 2019.

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Provides hospitals with comparative data to ascertain if reporting improvement is needed on Worksheet S-10, as well as to show how inpatient revenue may be impacted as the Centers for Medicare and Medicaid Services (CMS) continues its transition to using Worksheet S-10 as the basis for distribution of funds from the Medicare Disproportionate Share Hospital (DSH) Uncompensated Care (UCC) Pool.

Updated March 2020.

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Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule Impact Analysis Federal Fiscal Year (FFY) 2020

The analysis of the FFY 2020 proposed rule for SNFs is intended to show providers how Medicare PPS payments may change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 SNF PPS proposed rule.
Updated August 2019.

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Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Final Rule Impact Analysis Federal Fiscal Year (FFY) 2020 for Freestanding SNFs

Updated August 2019.

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Medicare Skilled Nursing Facility (SNF) Prospective Payment System (PPS) Proposed Rule Impact Analysis Federal Fiscal Year (FFY) 2020

The analysis of the FFY 2020 final rule for SNFs is intended to show providers how Medicare PPS payments may change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 SNF PPS final rule.

Updated June 2019.

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Estimated Change in Medicare Payments to Free Standing SNFs

The analysis of the FFY 2020 proposed rule for Free Standing SNFs is intended to show providers how Medicare PPS payments may change from FFY 2019 to FFY 2020 based on the policies set forth in the FFY 2020 SNF PPS proposed rule.

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Provides a preview of the potential impact of the Medicare inpatient hospital VBP program based on publicly available data and program rules established by CMS.

Updated March 2020.

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Comparative review of the wage data that will be used to develop the federal fiscal year (FFY) 2021 Medicare hospital wage index.

Updated February 2020.

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Wage Index FY 2021

Comparative review of the wage data that will be used to develop the federal fiscal year (FFY) 2021 Medicare hospital wage index.

Updated August 2019

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