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Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy (2012)

Chapter: Appendix G: RTI Analysis Data Sources

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Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
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Appendix G

RTI Analysis Data Sources

To assist with the analysis of data accuracy and methodological questions of the current geographic adjusters and to model the impact analysis, the Institute of Medicine (IOM) engaged RTI International as consultants to the committee. The RTI analyses presented in the report’s tables and figures are primarily computed with Centers for Medicare and Medicaid Services (CMS) and Bureau of Labor Statistics (BLS) Occupational Employment Statistics (OES) data. The CMS data are publically available through the CMS websites.

Please note that many of RTI’s computations used data from multiple CMS public access files. BLS data for most areas are publically available on the BLS website. However, to produce wage index values for all areas, BLS computed wage index values from non-publically available data. Researchers may apply to work on-site at BLS to validate computations using unpublished data.

HOSPITAL WAGE INDEX DATA SOURCES

The CMS wage index data files encompass files for market and provider-level hourly wages, occupation mix adjustments, reclassifications and other adjustment files, outmigration data, and actual wage index data. The term “CMS FY 2011 IPPS files,” used in table source notes, encompass these wage index files, plus the Impact File, DRG files, case mix index files, and standardizing file, among other files. The CMS files used in the report analyses can be found at:

Centers for Medicare and Medicaid Services. FY 2011 Final Rule Data Files.

http://www.cms.gov/AcuteInpatientPPS/IPPS2011/itemdetail.asp?filterType=none&filterByDID=-99&sortByDID=1&sortOrder=ascending&itemID=CMS1237932&intNumPer Page=10.

Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×

The occupational mix data on hospitals was obtained from the BLS OES:

Bureau of Labor Statistics. Occupational employment statistics: May 2009 national industry-specific occupational employment and wage estimates, NAICS 622000 - Hospitals. http://www.bls.gov/oes/current/naics3_622000.htm.

Data on national hourly wage by health sector was obtained from the BLS OES:

Bureau of Labor Statistics. Occupational employment statistics: May 2009 national industry-specific occupational employment and wage estimates, Sector 62 - Health care and Social Assistance.

http://www.bls.gov/oes/current/naics2_62.htm#29-0000.

GEOGRAPHIC PRACTICE COST INDEX DATA SOURCES

The 2010 current locality GAFs incorporating congressionally mandated floors for the work and practice expense GPCIs were obtained from Addendum D (pages 40643-5) of the Proposed Rule:

Centers for Medicare and Medicaid Services. Addendum D: Proposed FY 2011 Geographic Adjustment Factors (GAFs). Federal Register 75(133):40643-40645.

http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=uidDw6/0/2/0&WAISaction=retrieve.

The 2012 current locality GAFs incorporating congressionally mandated floors for the frontier states were obtained from CMS:

Centers for Medicare and Medicaid Services. Addendum E: Final CY 2011 Geographic Practice Cost Indices (GPCIs) by State and Medicare Locality. Federal Register 75(228):73817-73819. http://frwebgate1.access.gpo.gov/cgi-bin/PDFgate.cgi?WAISdocID=PmHLJ6/5/2/0&WAISaction=retrieve.

The county-level, locality-level, and MSA actual GAFs were derived from county-level 2012 fully transitioned GPCIs that were calculated by CMS and Acumen:

Centers for Medicare and Medicaid Services. Physician Fee Schedule: Federal Regulation Notices, 6th GPCI Update County Data File.

http://www.cms.gov/PhysicianFeeSched/PFSFRN/itemdetail.asp?itemID=CMS1240932.

O’Brien-Strain, Margaret, West Addison, Nick Theobald. Preliminary Report on the Sixth Update of the Geographic Practice Cost Index for the Medicare Physician Fee Schedule. June 2010.

http://www.cms.gov/PhysicianFeeSched/downloads/GPCI_Report.pdf.

Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×

The occupational mix data on physician offices were obtained from the BLS OES:

Bureau of Labor Statistics. Occupational employment statistics: May 2009 national industry-specific occupational employment and wage estimates, NAICS 621100 - Offices of Physicians.

http://www.bls.gov/oes/current/naics4_621100.htm.

Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×

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Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×
Page 187
Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×
Page 188
Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×
Page 189
Suggested Citation:"Appendix G: RTI Analysis Data Sources." Institute of Medicine. 2012. Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy. Washington, DC: The National Academies Press. doi: 10.17226/13138.
×
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Medicare is the largest health insurer in the United States, providing coverage for 39 million people aged 65 and older and 8 million people with disabilities, and reaching more than an estimated $500 billion in payments in 2010. Although Medicare is a national program, it adjusts fee-for-service payments according to the geographic location of a practice. While there is widespread agreement about the importance of providing accurate payments to providers, there is disagreement about how best to adjust payment based on geographic location.

At the request of Congress and the Department of Health and Human Services (HHS), the Institute of Medicine (IOM) examined ways to improve the accuracy of data sources and methods used for making the geographic adjustments to payments. The IOM recommends an integrated approach that includes moving to a single source of wage and benefits data; changing to one set of payment areas; and expanding the range of occupations included in the index calculations. The first of two reports, Geographic Adjustment in Medicare Payment: Phase I: Improving Accuracy, assesses existing practices in regards to accuracy, criteria consistency, evidence for adjustment, sound rationale, transparency, and separate policy adjustments to reform the current payment system. Adopting the recommendations outlined in this report will mean a change in the way that the indexes are calculated, and will require a combination of legislative, rule-making, and administrative actions, as well as a period of public comment.

Geographic Adjustment in Medicare Payment will inform the work of government agencies such as HHS, the Centers for Medicare and Medicaid Services, congressional members and staff, the health care industry, national professional organizations and state medical and nursing societies, and Medicare advocacy groups.

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