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OCR for page 199
Index
[Page numbers followed by b, f, n, or t, refer to boxed Administrative staff of physician practice, 130
text, figures, footnotes, or tables, respectively.] Advanced practice nurses, 148
Affordable Health Care for America Act, 17, 29, 30
Agency for Healthcare Research and Quality, 21
A Ambulatory surgical centers, 9, 79–81, 83
American Community Survey
Access to care
access to data, 128
adjustments to address provider shortages, 29,
commuting data, 94
56–57, 117, 147
employee compensation data, 132
hospital wage index policy adjustment add-ons to
for GPCI calculation, 125, 126–127t, 128–129
improve, 62
limitations, 128–129
Phase 2 study goals, 147
physician work adjustment data, 11–12
research needs, 113–114
scope of, 128
Accountability
American Housing Survey, 13
of data providers, 4
American Medical Association, 23, 118
integration of care and, 58
Average hourly wage
Accountable Care Act, 58
accuracy, 72, 81
Accuracy of data
health care practitioners, 54–55, 54t
for creation of payment areas, 45–46
health care sectors, 54–55, 54t
current system, 4, 31, 70–72
hospital wage index computations, 62–65, 81
definition, 4, 16n, 31
inputs and weighting, 73, 78–79
for hospital wage index calculation, 70
Occupational Employment Statistics for calculation
Occupational Employment Statistics, 74–77
of, 74, 81
proxy data for physician income, 117, 124–125
relative value units, 118
strategies for improving, 4 B
study goals, 2, 16–17, 18b, 29, 146
Accuracy of payments to facilities, 2, 15–16 Balanced Budget Act, 22, 87
Administrative burden of geographic adjustment Basic Allowance for Housing, 13
current hospital cost reporting and review, 73 Beneficiaries of Medicare
labor market segmentation and, 55–56, 58 age distribution, 17
use of Bureau of Labor Statistics data and, 77, 82 current coverage, 1, 17
199
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200 GEOGRAPHIC ADJUSTMENT IN MEDICARE PAYMENT
economic status, 17 shortcomings, 109
geographic distribution, 17 technical development, 89
health status, 17 Contract wages
impact of geographic adjustment determinations, 2 in hospital wage index, 72, 75–76
nonelderly, 1, 17 as percent of hospital personnel expenses, 75–76
Benefits valuation Conversion factor, 115
in Bureau of Labor Statistics data, 75, 82 Core-based statistical areas, 44b, 85, 93–94
in hospital wage index, 71–72, 75, 82 Cost-share weights, 10, 25, 118–119, 139
Blum, Jonathan, 19b Cost Survey for Single Specialty Practices, 135
Braley, Bruce, 28b Critical access hospitals, 62
Budget neutrality adjustments, 29, 89, 90b Current Procedural Terminology, 23, 25, 114
GPCI, 115–117 Customary, prevailing, and reasonable, 118
Bureau of Labor Statistics, 12
health care sector data, recommendations for use
D
of, 8, 12, 58–59, 81–82, 141
labor market smoothing with data from, 89
Dartmouth Atlas Project, 30, 52
See also Occupational Employment Statistics
Data sources
access to, 12, 117, 128
commuting patterns, 94
C
current concerns and criticisms, 4, 16, 31
Capital as factor of production in health care system, for geographic variation in physician income,
37–38, 81 121–122
Care transitions, 58 for GPCI cost-share weights, 119
Center for Studying Health System Change, 122 for input price determinations, 2, 4
Centers for Medicare and Medicaid Services on labor market conditions, 4–5, 32
administrative costs, 55–56, 58, 73, 77, 82 for labor market smoothing, 89
perception of geographic adjustment policy physician office rent, 13, 132–135, 136t, 141–142
recommendations and implementation, 19b physician salary, 11–12
recommendations for, 8, 9, 10, 12, 13, 82, 83, for physician work adjustment, 4, 124–129
139–140, 141 for practice expenses GPCI adjustments, 130, 132
use of statistical areas, 43–45, 44b professional liability insurance premiums, 137–138
See also Medicare proxies for physician income calculation, 10–11
Combined statistical areas, 44b quality of current hospital wage index data, 70–74
Commuting, 7 recommendations for CMS access to BLS data, 12,
consideration of, in current adjustment and 141
classification system, 93–94 recommendations for GPCI construction, 8, 12–13,
data sources, 94 58–59, 141–142
hospital wage index adjustments, 22, 86–87 recommendations for hospital wage index
labor market smoothing based on, 88, 93–102, construction, 8, 58–59, 81–82
107–109 research framework, 2–3, 33–34
modeling techniques, 9 strategies for improving hospital data, 73–74
patterns, 95, 96t study goals, 2, 4, 16–17, 18b, 31, 147
recommendations for smoothing labor market See also Accuracy of data
borders and payment areas, 9–10, 109–110 Department of Defense, 13
Section 505 adjustment for, 87 Department of Health and Human Services, 2, 8, 13, 16
significance of, in setting labor market boundaries,
42
E
wage index smoothing, 53
Congress, U.S., 2, 16, 29–30
Employee compensation
recommendations for, 8, 81–82
data sources, 130, 132
Contiguous-county smoothing
geographic adjustment rationale, 1–2
implementation, 91b
health sector-level wages, 130
results of simulations, 91–93, 92t, 93t
occupational mix, 130
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INDEX
End-stage renal disease, 1, 17 hospital wage index and, 5–6, 32–33
Energy costs, 81 implementation of recommendations for, 13–14
Equity issues, 17 nonclinical labor-related expenses, 13, 25
office rent component, 13
one-quarter adjustments, 11, 140
F payment areas, 117–118
price and cost distinctions, 85, 115
Factors of production
quality of current data sources, 4, 5, 31, 32, 117,
definition, 37
138–139
scope of, in health care system, 37–38
recommendations for cost-share-weight calculations,
scope of geographic variation in costs, 38
10, 139
See also Input prices, health care
recommendations for data sources for construction
Frontier states, 22, 22n, 24f, 50b, 88, 92, 110, 115
of, 8, 12, 58–59, 141–142
recommendations for labor market and payment
area definition, 7–8, 57–58, 118
G
recommendations for occupational inputs, 12,
141–142
General Services Administration, 13, 132, 142
recommendations for setting percentage of work
Geographic adjustment, generally
adjustment, 11–12, 140
budget neutrality in, 29, 89, 90b, 115, 117
recommendations for smoothing labor market
consistent criteria for, 5, 32
borders and payment areas, 9, 109–110
current concerns and criticisms, 2, 15–16
recommendations for use of physician income
definitional issues, 2, 48
proxies, 10–11, 139–140
policy adjustment and, 6, 10, 33
relative value units, 25–26
price and cost distinctions in methodology for,
strategies for improving geographic adjustment
19–21, 38–39, 59
system, 5–6, 32–33
rationale, 1, 15, 17–18, 31, 37, 113
study goals, 2, 3b, 18b, 138–139
study goals, 2, 16–17, 18b, 29–30, 146
update schedule, 115, 132
See also Geographic adjustment factors; Geographic
See also Physician payment areas; Physician work
practice cost indexes (GPCIs); Hospital wage
adjustment
index; Research on geographic adjustment
Geospatial smoothing, 88
Geographic adjustment factors
with inverse distance weighting, 105–107
component adjusters, 25, 113, 118
nearest neighbor model, 102–105
county-level versus payment area, 51, 55
Grassley, Charles, 28b
criticisms of, 29
effects of, in health care system, 3b, 17
for hospitals, 39b
H
for practitioners, 39b, 43–45
purpose and application, 1–2, 15, 17–18, 39b,
Health Care and Education Reconciliation Act, 29
45–46
Health care practitioners
study goals, 3b, 18b
average wages, 54–55, 54t
variation within payment areas, 51
consideration of all economic sectors in labor
See also Geographic practice cost indexes (GPCIs);
market definition, 4–5, 32, 39, 42, 48–50, 59
Hospital wage index
definition of, 1n, 15n, 113n
Geographical information systems, 105
distribution, Medicare payment system and, 2, 3b,
Geographic practice cost indexes (GPCIs)
147
budget neutrality, 115–117
distribution of employment shares by region and
components, 7, 25, 39b, 113, 114, 118. See also
statistical areas, 79t
specific components
employee compensation in physician practices, 130,
cost share weight calculations, 118–119, 119t
132
current concerns and criticisms, 2, 51, 115–117,
Phase 2 study goals, 2, 147
124–125
quality of cost data, 4, 31
current structure and operations, 1, 15, 25, 114–117
study goals, 2, 3b, 17, 18b
future of exceptions, 110
trends, 148
historical evolution, 116b
See also Geographic practice cost indexes (GPCIs)
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Health information technology, 148 purpose, 15, 38, 61
Health technicians, 130 quality of current data sources, 4, 5, 31, 32, 70–74,
Healthcare Common Procedure Coding System, 23, 81
114 recommendations for data sources for construction
Home health agencies of, 7, 8–9, 58–59, 81–82, 83
hospital wage index calculations, 9, 79–81, 83 recommendations for labor market and payment
study goals, 2, 18b area definition, 7–8, 57–58, 118
Hospice facilities, 79–81 recommendations for occupational inputs, 9, 82
Hospital cost survey data, 7, 8 recommendations for revision of controlling statute,
Hospital Outpatient Departments, 79–81 8, 81–82
Hospital payment areas recommendations for smoothing labor market
alternative approaches to defining, 52–53 borders and payment areas, 9–10, 109–110
current structure, 42–43 rural floors, 87–88
metropolitan statistical areas and, 46–48 strategies for improving data for, 73–74
physician payment areas and, 7–8, 53–55, 57–58 strategies for improving geographic adjustment
reclassification appeals, 48 system, 5–6, 32–33
Hospital referral regions, 52 study goals, 2, 3b, 18b
Hospital service areas, 52 transparency of cost report data, 72
Hospital wage index types of labor market adjustments and exceptions,
administrative burden of reporting and review, 73, 86, 87t
77 use of all-industry or health sector data in
alternative approaches to defining labor markets for, calculation of, 4–5, 32, 39, 42, 48–50, 59,
52–53 70–71, 74–75, 75t, 76
benefits valuation in, 71–72, 75, 82 volatility, 50, 76
calculation from Occupational Employment wage data for defining, 48–51
Statistics, 74–79 See also Hospital payment areas
case mix adjustment, 62 Housing costs, 41
circularity problem in data, 50–51, 71
comparative effects of adjustments in different
I
geographic areas, 62, 63t
contract wages in, 72, 75–76
Index floors, 10
current data sources and calculation methodology,
Indexes, defined, 1n, 15, 16b
1, 2, 4, 5, 7, 8, 18–21, 31, 32, 39b, 42–43,
Inflation, 118–119
61–67, 81
Inpatient Prospective Payment System (IPPS)
current geographic distribution, 22, 23f
current methodology, 18–19
data needs for calculating, 70
current reclassifications and exceptions, 24f
exceptions and reclassifications, 22, 86–88, 109,
geographic adjustment in, 1–2, 15, 38–39
110
hospital wage index calculation, 61–62, 86
for facilities other than acute care hospitals, 9,
number of hospitals by labor market, 71t
79–81, 83
Inpatient psychiatric facilities, 79–81
future of exceptions, 110
Inpatient rehabilitation facilities, 79–81
GPCI and, 5–6, 32–33
Input prices, health care
historical evolution, 68–69b
concerns about current geographic adjustment
hospital-specific, 52–53
system determinations, 2
implementation of recommendations for, 13–14
geographic adjustment rationale, 1, 37
inputs and weighting, 9, 73, 78–79, 82–83
for GPCI calculations, 10
objectives for smoothing labor market borders,
GPCI cost-share weights, 118–119
88–89
inflationary changes over time, 118–119
occupational mix in calculation of, 9, 21, 39–40,
major factors of production, 37–38
78–79
price and cost distinctions in methodology for
origins, 61
geographic adjustment, 19–21, 38–39, 51, 59
policy adjustment add-ons, 62
quality of data, 4, 31
pre-classified, pre-floor, 79, 80n, 86
recommendations for GPCI calculation, 12, 13,
price and cost distinctions, 19–21, 61, 85
141–142
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INDEX
recommendations for hospital wage index Medical equipment, 38
calculation, 9, 82–83 Medical Group Management Association, 11–12, 13,
source data for determination of, 2, 117 120, 125, 129, 135, 140, 142, 148
study goals, 2, 17, 18b Medicare
variation within payment areas, 117–118 coverage, 1, 17
Inverse distance weighting function, 105–107 current payment system, 18–28, 20f, 26f, 114–118
IPPS. See Inpatient Prospective Payment System policy adjustments, 6
scope of geographic adjustment in, 1–2, 15
spending, 1, 17
L See also Beneficiaries of Medicare; Geographic
adjustment, generally
Labor market areas, 53
Medicare dependent hospitals, 23f
Labor markets
Medicare Economic Index, 10, 118–119, 129
alternative approaches to defining, 52–57
Medicare Geographic Classification Review Board, 22n,
average wages, 54–55, 54t
24f, 48, 50b, 86–87
as basis for geographic adjustment, 37, 40
Medicare Modernization Act, 22, 50b, 87, 123
boundary setting, 41–42, 85
Medicare Part B, 2, 12, 26f, 30, 115n, 141, 147
conceptual framework, 6, 33
Medicare Payment Advisory Commission, 78, 80f, 89
consideration of all economic sectors in definition
Medicare Severity-Diagnosis Related Group, 19, 62, 67
of, 4–5, 32, 39, 42, 48–50, 59
Metropolitan statistical areas (MSAs)
defined by geopolitical units, 52–53
in construction of hospital payment areas, 42
definition of, in geographic adjustment
geographic distribution, 43f
methodology, 2, 21, 38, 85
number of, 5, 7, 21, 32, 42–43, 43n, 46, 55, 56
determinants of wage differentials, 40–41
wage variation within, 53, 55
as factor of production in health care system, 37–38
See also MSA/statewide non-MSA system
geographic variation in costs, 38, 40–41
Micropolitan statistical areas, 42
hospital wage index exceptions and reclassifications,
definition and characteristics, 44b
22, 23f
geographic distribution, 43f
number of, 5, 32
MSAs. See Metropolitan statistical areas
occupational mix in, 9, 12, 21, 27–28, 39–40
MSA/statewide non-MSA system
quality of data, 4–5, 32
advantages, 58
recommendations for defining, 7–8, 57–58, 85, 118
commuting behavior considerations in, 93
recommendations for smoothing borders of
distribution of employment shares by health care
payment areas and, 109–110
occupation, 79t
types of adjustments and exceptions, 86, 87t
hospital payment areas, 42, 46–49, 53
updates, 58
hospital wage index reclassifications, 86–87
wage data for defining, 48–51
to influence provider distribution, 29, 56–57, 117
See also Hospital payment areas; Payment areas;
iterated approach, 56–57
Physician payment areas; Smoothing labor
as labor market proxy, 46, 53, 85
market borders and payment areas
origins of, 44b
Land
physician income variation within, 121–122
as factor of production in health care system, 37–38
physician payment areas, 55–56
See also Rent
recommendations for labor market definition based
Licensed practical nurses, 39–40, 130
on, 7–8, 57–58, 118
Long-term care hospitals, 79–81
rural floor adjustments, 87–88
Low-income communities
separation of high-cost MSAs, 56
cost of providing health care services in, 121
See also Metropolitan statistical areas (MSAs);
hospital wage index adjustments, 62
Micropolitan statistical areas; Statewide non-MSA
Lugar County reclassifications, 24f, 50b, 86, 94
statistical areas
M N
Malpractice. See Professional liability insurance
National Compensation Survey, 75, 82
Medicaid and Medicare Extension Act, 123
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O hospital wage index exceptions and reclassifications,
22
Occupational Employment Statistics for hospitals, construction of, 42–43
access to data, 77, 82 need for consistent criteria in geographic
accuracy, 74–77 adjustment, 5, 32
administrative burden of using, 77 practice cost variation within, 27, 51, 117–118
employee compensation data, 130 recommendations for definition of, 7–8, 57–58, 118
for GPCI calculation, 124–125, 126–127t, 128 recommendations for smoothing borders of labor
inputs and weighting, 78–79 markets and, 109–110
labor market smoothing with data from, 89 statewide consolidation, 45
limitations, 128 study goals, 2, 18b
purpose, 74 wage data for defining, 48–51
recommendations for use of, 8, 10, 82 See also Hospital payment areas; Physician payment
scope of survey, 74, 128 areas; Smoothing labor market borders and
timeliness of data, 77 payment areas
Occupational mix Physician Assistants, 148
in Bureau of Labor Statistics data, 78–79 Physician Compensation and Production Survey, 125,
in calculation of occupational mix adjustment, 65–67 126–127t, 129
in employee compensation data sources, 130 Physician Cost Survey, 13
employment shares by geographic region and Physician Fee Schedules, 23–25
statistical areas, 79t basis for, 114
in hospitals, 21, 39–40 components, 113
physician payment area variations, 27–28, 39 in geographic adjustment system, 1–2, 15, 23–25
in physician practice, 131t recommendations for future update methodology,
recommendations for calculation of hospital wage 10, 139
index, 9, 82–83 Physician payment areas
recommendations for GPCI calculation, 12, 141–142 administrative costs to Centers for Medicare and
required staffing levels, 78 Medicaid Services, 55–56, 58
similarities between needs of physician offices and alternative strategies for defining, 53–57
hospitals, 53–54, 54t construction of, 43–45
Occupational mix adjustment current concerns and criticisms, 27–28, 51, 57–58
average hourly wage computations, 73 current structure, 27, 27f, 43–45
hospital wage index calculations, 64–67, 81 in GPCI, 39b
Occupational mix survey, 67, 70 hospital payment areas and, 7–8, 53–55, 57–58
Office of Management and Budget, 42 metropolitan statistical areas and, 55, 56–57, 56t
Office visits, 118 number of, 55–56, 56t, 118
Omnibus Budget Reconciliation Act, 23, 115, 137 recommendations for, 7–8, 57–58
Omnibus Reconciliation Act, 86 role in distribution of providers, 56–57
Outmigration adjustment Physician Practice Information Survey, 119, 125,
commuting pattern-based smoothing, 93–102 126–127t, 129
purpose, 22, 87 Physician work adjustment, 39b
recommendations for smoothing, 9, 110 choices in level and scope of, 120–124
See also Commuting; Section 505 reclassifications cost-share weight calculations, 118–119, 119t
current concerns and criticisms, 28
data sources for, 124–129, 140
P definition, 25, 114
non-geographic factors, 11
Patient Protection and Affordable Care Act, 19b, 22,
office rent component, 13, 132–135, 136t, 141–142
88, 115
proxy professions, 10–11, 123–125, 139–140
Payment areas
purpose, 120
conceptual framework, 6, 33, 38
recommendations for, 10–12, 139–140
creation of new, 45–46
statistical modeling, 11–12, 140
current concerns and criticisms, 2, 16
unique challenges in calculation of, 120
in current geographic adjustment system, 2, 7, 38
See also Geographic practice cost indexes (GPCIs)
GPCI, 117–118
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INDEX
R
Policy adjustments
geographic adjustments to address provider
Reclassification
shortages, 29, 56–57, 117, 147
current IPPS hospitals, 24f
hospital wage index adjustments, 62, 86
hospital labor market adjustments, 48, 86–87
Phase 2 study goals, 10, 17, 18, 33, 110, 147
smoothing of labor market borders and payment
purpose, 6, 18, 110
areas to replace, 7, 10, 22, 110
study goals and, 113–114
strategies to minimize wage cliffs, 50b
Population health, 2, 3b, 17
Recommendations
Poverty among Medicare beneficiaries, 17
for Centers for Medicare and Medicaid Services, 8,
Practice expenses
9, 10, 82, 83, 139–140, 141
adjustment goals, 129
for Congress, 8, 81–82
cost-share weight calculations, 10, 118–119, 119t,
for determining nonclinical labor-related expenses,
139
13, 142
data sources, 4, 16, 31
for determining office rent costs, 13, 141–142
definition, 25, 114
for geographic practice index calculation, 7–8, 12,
employee compensation component, 13, 130–132,
57–59, 141
142
for hospital wage index calculation, 7–9, 57–59,
occupational mix, 2, 12, 130, 132, 141
81–83
office rent component, 13, 132–135, 142
implementation, 13–14, 19b, 145, 147–148
recommendations for GPCI calculations, 10, 12, 13,
for labor market definition, 7–8, 57–58
139, 141, 142
research framework for, 2–3, 33–34
as share of GPCI, 129
for smoothing labor market borders and payment
variation within payment areas, 27, 51
areas, 9–10, 109–110
See also Physician work adjustment; Professional
for use of proxies for physician income calculations,
liability insurance
10–11, 139–140
Primary Care Service Area, 52
Registered nurses
Professional liability insurance, 7, 39b
average wages, 54, 54t
as component of Physician Fee Schedule, 113, 114
geographic variation in pay, 38
cost-share weight calculations, 10, 118–119, 119t,
occupational mix calculation, 39–40, 130
139
required staffing levels, 78
coverage, 137
REIS, Inc., 13
definition, 25
Relative value units, 11
GPCI data collection and calculation, 137–138
accuracy, 118
perceived need, 137
definition and function, 114–115
premiums, 137
in GPCI calculations, 23, 25, 118
source of geographic variation, 137
importance of, in current payment system, 118
Prospective payment systems
types of, 114
geographic adjustment in, 1–2, 15
Rent
Medicare evolution, 38, 39
data sources, 132–135, 136t
recommendations for hospital wage index
as factor of production in health care system, 37–38
calculation, 9, 83
geographic variation in costs, 38
Provider shortages, 29, 56–57, 117, 147
recommendations for determining prices, 13,
Proxy data, 4, 31, 141
141–142
MSA as labor market proxy, 46
Research on geographic adjustment
for practice inputs, 117, 122, 123–124, 125
challenges, 146–147
recommendations for, 10–11, 12, 139–140
data needs on physician compensation, 122
in smoothing, 92, 107
data sources, 2, 4, 31
Phase 2 report, 2, 114, 118, 139, 145, 146, 147
Q scope of study, 2, 146
study framework, 2–3, 33–34
Quality of care study goals, 2, 3b, 18b, 29–30, 113–114
future research, 2, 17 underlying principles and assumptions for, 4–6,
study goals, 2, 3b, 18b 31–33
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Resource-Based Relative Value Set, 115, 118 Statewide non-MSA statistical areas
Retrospective cost reimbursement, 38 consolidation within, 45
Rural areas, 110 definition, 44b
cost of providing health care services in, 121 distribution, 43f
occupational mix, 76 hospital payment areas and, 42
physician earnings in, 122–123 input price variation within, 47–48, 117–118
Rural floor adjustments, 23f, 50b, 87–88, 92 number of, 5, 7, 21, 27, 32, 42–43, 45
Rural referral center hospitals, 23f, 62, 110 See also MSA/statewide non-MSA system
S T
Schwartz, Allyson, 30b Tax Relief and Healthcare Act, 67
Section 401 reclassifications, 24f Teaching hospitals, 62
Section 505 reclassifications, 19, 50b, 87, 94. See also Timeliness of hospital cost report data, 72, 73–74, 77
Outmigration adjustment Transitions, care. See Care transitions
Section 508 reclassifications, 50b Transparency
Self-employed physicians, 120 Bureau of Labor Statistics data, 77
Services sector, 13, 81 concerns about current geographic adjustment
Short-term and acute care hospitals, 2, 18b system, 2, 16
Skilled nursing facilities of hospital cost report data, 72, 77, 82
hospital wage index calculations, 9, 79–81, 83 to improve data quality, 4, 31
study goals, 2, 18b of process for reviewing geographic adjustment
Smoothing labor market borders and payment areas, 7 system, 6, 33
budget neutrality adjustments in, 89, 90b study goals, 2, 18b
commuting pattern-based, 88, 93–102, 107–109 use of confidential data sources, 12, 82
comparison of current and alternative approaches
to, 107–109, 108t
U
contiguous-county approach, 88, 89–93
design objectives, 88–89
U.S. Postal Service, 13
geospatial methods, 88, 102–109
implementation, 9
need for, 85
V
outmigration adjustment for, 9, 22
policy adjustments and, 110 Value of care
positive and negative adjustments, 89, 91b, 97–99, future research, 2, 17, 148
110 study goals, 2, 3b, 18b
purpose, 9, 10, 22, 53, 85, 88
recommendations for, 9–10, 109–110
W
to replace system of exceptions and reclassifications,
7, 10, 22, 109, 110
Wage cliffs
techniques, 9, 88
commuting pattern-based smoothing adjustments,
thresholds for county eligibility, 109–110
97
use of Bureau of Labor Statistics data for, 89
definition, 42
Smoothing of wage index values, 53
extent of problem, 47–48
Social Security Act, 23, 115
hospital wage index adjustments to reduce, 86, 88
recommendations for revision of hospital wage
inverse distance weighting to smooth, 106, 106t
index provisions, 8, 81–82
strategies for reducing, 50b
Sole community hospital, 23f, 62
Wage comparability criteria, 86–87
Worksheet S-3, 62, 72, 73, 77, 82, 89
