[Federal Register: May 4, 2001 (Volume 66, Number 87)] [Proposed Rules] [Page 22845-22891] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr04my01-38] [[pp. 22845-22891]] Medicare Program; Changes to the Hospital Inpatient Prospective Payment Systems and Fiscal Year 2002 Rates [[Continued from page 22844]] [[Page 22843]] 306............. 11 SURG PROSTATECTOMY W CC......... 1.3006 4.3 6.2 307............. 11 SURG PROSTATECTOMY W/O CC....... .6054 1.9 2.3 308............. 11 SURG MINOR BLADDER PROCEDURES W 1.6788 4.8 6.9 CC. 309............. 11 SURG MINOR BLADDER PROCEDURES W/ .8935 1.8 2.3 O CC. 310............. 11 SURG TRANSURETHRAL PROCEDURES W 1.1342 3.3 4.7 CC. 311............. 11 SURG TRANSURETHRAL PROCEDURES W/ .5952 1.5 1.8 O CC. 312............. 11 SURG URETHRAL PROCEDURES, AGE 1.0749 3.3 4.8 >17 W CC. 313............. 11 SURG URETHRAL PROCEDURES, AGE .6598 1.8 2.3 >17 W/O CC. 314............. 11 SURG * URETHRAL PROCEDURES, AGE .4927 2.3 2.3 0-17. 315............. 11 SURG OTHER KIDNEY & URINARY 2.1396 4.8 8.2 TRACT O.R. PROCEDURES. 316............. 11 MED RENAL FAILURE.............. 1.3732 5.6 7.3 317............. 11 MED ADMIT FOR RENAL DIALYSIS... .6157 2.0 2.9 318............. 11 MED KIDNEY & URINARY TRACT 1.1710 5.0 6.5 NEOPLASMS W CC. 319............. 11 MED KIDNEY & URINARY TRACT .5918 2.1 2.8 NEOPLASMS W/O CC. 320............. 11 MED KIDNEY & URINARY TRACT .8610 4.6 5.6 INFECTIONS AGE >17 W CC. 321............. 11 MED KIDNEY & URINARY TRACT .5592 3.3 3.9 INFECTIONS AGE >17 W/O CC. 322............. 11 MED KIDNEY & URINARY TRACT .5234 3.6 4.3 INFECTIONS AGE 0-17. 323............. 11 MED URINARY STONES W CC, &/OR .7969 2.5 3.3 ESW LITHOTRIPSY. 324............. 11 MED URINARY STONES W/O CC...... .4447 1.6 1.9 325............. 11 MED KIDNEY & URINARY TRACT .6332 3.1 4.0 SIGNS & SYMPTOMS AGE >17 W CC. 326............. 11 MED KIDNEY & URINARY TRACT .4118 2.1 2.7 SIGNS & SYMPTOMS AGE >17 W/ O CC. 327............. 11 MED KIDNEY & URINARY TRACT .3741 2.8 3.2 SIGNS & SYMPTOMS AGE 0-17. 328............. 11 MED URETHRAL STRICTURE AGE >17 .7216 2.9 3.8 W CC. 329............. 11 MED URETHRAL STRICTURE AGE >17 .4388 1.6 2.0 W/O CC. 330............. 11 MED * URETHRAL STRICTURE AGE 0- .3174 1.6 1.6 17. 331............. 11 MED OTHER KIDNEY & URINARY 1.0625 4.6 6.0 TRACT DIAGNOSES AGE >17 W CC. 332............. 11 MED OTHER KIDNEY & URINARY .6057 2.6 3.4 TRACT DIAGNOSES AGE >17 W/ O CC. 333............. 11 MED OTHER KIDNEY & URINARY .8056 4.0 5.4 TRACT DIAGNOSES AGE 0-17. 334............. 12 SURG MAJOR MALE PELVIC 1.4761 4.0 4.5 PROCEDURES W CC. 335............. 12 SURG MAJOR MALE PELVIC 1.1081 3.0 3.2 PROCEDURES W/O CC. 336............. 12 SURG TRANSURETHRAL PROSTATECTOMY .9149 2.9 3.9 W CC. 337............. 12 SURG TRANSURETHRAL PROSTATECTOMY .5769 1.9 2.2 W/O CC. 338............. 12 SURG TESTES PROCEDURES, FOR 1.2150 3.7 5.6 MALIGNANCY. 339............. 12 SURG TESTES PROCEDURES, NON- 1.2384 3.5 5.5 MALIGNANCY AGE >17. 340............. 12 SURG * TESTES PROCEDURES, NON- .2820 2.4 2.4 MALIGNANCY AGE 0-17. 341............. 12 SURG PENIS PROCEDURES........... 1.2740 1.9 3.1 342............. 12 SURG CIRCUMCISION AGE >17....... .7866 2.6 3.6 343............. 12 SURG * CIRCUMCISION AGE 0-17.... .1533 1.7 1.7 344............. 12 SURG OTHER MALE REPRODUCTIVE 1.1746 1.6 2.4 SYSTEM O.R. PROCEDURES FOR MALIGNANCY. 345............. 12 SURG OTHER MALE REPRODUCTIVE 1.2518 3.9 5.6 SYSTEM O.R. PROC EXCEPT FOR MALIGNANCY. 346............. 12 MED MALIGNANCY, MALE 1.0311 4.9 6.4 REPRODUCTIVE SYSTEM, W CC. 347............. 12 MED MALIGNANCY, MALE .5701 2.3 3.0 REPRODUCTIVE SYSTEM, W/O CC. 348............. 12 MED * BENIGN PROSTATIC .7105 6.2 6.2 HYPERTROPHY W CC. 349............. 12 MED * BENIGN PROSTATIC .4357 4.9 4.9 HYPERTROPHY W/O CC. 350............. 12 MED INFLAMMATION OF THE MALE .7173 3.8 4.6 REPRODUCTIVE SYSTEM. 351............. 12 MED * STERILIZATION, MALE...... .2352 1.3 1.3 352............. 12 MED OTHER MALE REPRODUCTIVE .6878 3.0 4.2 SYSTEM DIAGNOSES. 353............. 13 SURG PELVIC EVISCERATION, 1.8386 5.4 6.8 RADICAL HYSTERECTOMY & RADICAL VULVECTOMY. 354............. 13 SURG UTERINE,ADNEXA PROC FOR NON- 1.5275 5.1 6.1 OVARIAN/ADNEXAL MALIG W CC. 355............. 13 SURG UTERINE,ADNEXA PROC FOR NON- .9039 3.1 3.3 OVARIAN/ADNEXAL MALIG W/O CC. 356............. 13 SURG FEMALE REPRODUCTIVE SYSTEM .7469 2.0 2.3 RECONSTRUCTIVE PROCEDURES. 357............. 13 SURG UTERINE & ADNEXA PROC FOR 2.4424 7.5 9.2 OVARIAN OR ADNEXAL MALIGNANCY. 358............. 13 SURG UTERINE & ADNEXA PROC FOR 1.1910 3.7 4.4 NON-MALIGNANCY W CC. 359............. 13 SURG UTERINE & ADNEXA PROC FOR .8191 2.6 2.8 NON-MALIGNANCY W/O CC. 360............. 13 SURG VAGINA, CERVIX & VULVA .8530 2.4 2.9 PROCEDURES. 361............. 13 SURG LAPAROSCOPY & INCISIONAL 1.0927 2.2 3.0 TUBAL INTERRUPTION. 362............. 13 SURG * ENDOSCOPIC TUBAL .3006 1.4 1.4 INTERRUPTION. 363............. 13 SURG D&C, CONIZATION & RADIO- .8149 2.6 3.6 IMPLANT, FOR MALIGNANCY. 364............. 13 SURG D&C, CONIZATION EXCEPT FOR .8190 2.9 4.1 MALIGNANCY. [[Page 22844]] 365............. 13 SURG OTHER FEMALE REPRODUCTIVE 2.0115 5.8 8.1 SYSTEM O.R. PROCEDURES. 366............. 13 MED MALIGNANCY, FEMALE 1.2739 5.6 7.4 REPRODUCTIVE SYSTEM W CC. 367............. 13 MED MALIGNANCY, FEMALE .5582 2.4 3.2 REPRODUCTIVE SYSTEM W/O CC. 368............. 13 MED INFECTIONS, FEMALE 1.1384 5.6 7.0 REPRODUCTIVE SYSTEM. 369............. 13 MED MENSTRUAL & OTHER FEMALE .5584 2.5 3.4 REPRODUCTIVE SYSTEM DISORDERS. 370............. 14 SURG CESAREAN SECTION W CC...... 1.0417 4.6 6.1 371............. 14 SURG CESAREAN SECTION W/O CC.... .6848 3.3 3.7 372............. 14 MED VAGINAL DELIVERY W .5578 2.6 3.3 COMPLICATING DIAGNOSES. 373............. 14 MED VAGINAL DELIVERY W/O .3764 2.0 2.3 COMPLICATING DIAGNOSES. 374............. 14 SURG VAGINAL DELIVERY W .7103 2.6 3.2 STERILIZATION &/OR D&C. 375............. 14 SURG VAGINAL DELIVERY W O.R. .6081 2.1 2.3 PROC EXCEPT STERIL &/OR D&C. 376............. 14 MED POSTPARTUM & POST ABORTION .4954 2.5 3.2 DIAGNOSES W/O O.R. PROCEDURE. 377............. 14 SURG POSTPARTUM & POST ABORTION 1.6465 3.7 5.6 DIAGNOSES W O.R. PROCEDURE. 378............. 14 MED ECTOPIC PREGNANCY.......... .7984 2.0 2.4 379............. 14 MED THREATENED ABORTION........ .4502 2.4 3.5 380............. 14 MED ABORTION W/O D&C........... .4196 1.6 2.1 381............. 14 SURG ABORTION W D&C, ASPIRATION .6654 1.8 2.5 CURETTAGE OR HYSTEROTOMY. 382............. 14 MED FALSE LABOR................ .1607 1.2 1.3 383............. 14 MED OTHER ANTEPARTUM DIAGNOSES .4856 2.8 3.8 W MEDICAL COMPLICATIONS. 384............. 14 MED OTHER ANTEPARTUM DIAGNOSES .3412 1.6 2.2 W/O MEDICAL COMPLICATIONS. 385............. 15 MED * NEONATES, DIED OR 1.3696 1.8 1.8 TRANSFERRED TO ANOTHER ACUTE CARE FACILITY. 386............. 15 MED * EXTREME IMMATURITY OR 4.5165 17.9 17.9 RESPIRATORY DISTRESS SYNDROME, NEONATE. 387............. 15 MED * PREMATURITY W MAJOR 3.0846 13.3 13.3 PROBLEMS. 388............. 15 MED * PREMATURITY W/O MAJOR 1.8612 8.6 8.6 PROBLEMS. 389............. 15 MED FULL TERM NEONATE W MAJOR 2.0857 7.9 13.7 PROBLEMS. 390............. 15 MED NEONATE W OTHER SIGNIFICANT 1.1337 3.5 4.3 PROBLEMS. 391............. 15 MED * NORMAL NEWBORN........... .1519 3.1 3.1 392............. 16 SURG SPLENECTOMY AGE >17........ 3.3890 8.3 10.8 393............. 16 SURG * SPLENECTOMY AGE 0-17..... 1.3416 9.1 9.1 394............. 16 SURG OTHER O.R. PROCEDURES OF 1.8266 5.1 8.1 THE BLOOD AND BLOOD FORMING ORGANS. 395............. 16 MED RED BLOOD CELL DISORDERS .8194 3.5 4.7 AGE >17. 396............. 16 MED RED BLOOD CELL DISORDERS 1.0480 3.9 5.0 AGE 0-17. 397............. 16 MED COAGULATION DISORDERS...... 1.2664 4.2 5.6 398............. 16 MED RETICULOENDOTHELIAL & 1.3049 5.1 6.4 IMMUNITY DISORDERS W CC. 399............. 16 MED RETICULOENDOTHELIAL & .6690 3.0 3.7 IMMUNITY DISORDERS W/O CC. 400............. 17 SURG LYMPHOMA & LEUKEMIA W MAJOR 2.9273 7.4 10.5 O.R. PROCEDURE. 401............. 17 SURG LYMPHOMA & NON-ACUTE 2.9814 9.9 12.8 LEUKEMIA W OTHER O.R. PROC W CC. 402............. 17 SURG LYMPHOMA & NON-ACUTE 1.1619 3.1 4.4 LEUKEMIA W OTHER O.R. PROC W/O CC. 403............. 17 MED LYMPHOMA & NON-ACUTE 1.8486 6.8 9.0 LEUKEMIA W CC. 404............. 17 MED LYMPHOMA & NON-ACUTE .8711 3.4 4.6 LEUKEMIA W/O CC. 405............. 17 MED * ACUTE LEUKEMIA W/O MAJOR 1.9021 4.9 4.9 O.R. PROCEDURE AGE 0-17. 406............. 17 SURG MYELOPROLIF DISORD OR 2.9692 8.4 11.0 POORLY DIFF NEOPL W MAJ O.R.PROC W CC. 407............. 17 SURG MYELOPROLIF DISORD OR 1.2484 3.8 4.7 POORLY DIFF NEOPL W MAJ O.R.PROC W/O CC. 408............. 17 SURG MYELOPROLIF DISORD OR 2.2150 6.0 9.2 POORLY DIFF NEOPL W OTHER O.R.PROC. 409............. 17 MED RADIOTHERAPY............... 1.1469 4.9 6.3 410............. 17 MED CHEMOTHERAPY W/O ACUTE .9972 3.3 4.1 LEUKEMIA AS SECONDARY DIAGNOSIS. 411............. 17 MED HISTORY OF MALIGNANCY W/O .4401 1.8 2.3 ENDOSCOPY. 412............. 17 MED HISTORY OF MALIGNANCY W .6073 1.9 2.4 ENDOSCOPY. 413............. 17 MED OTHER MYELOPROLIF DIS OR 1.3898 6.1 7.8 POORLY DIFF NEOPL DIAG W CC. 414............. 17 MED OTHER MYELOPROLIF DIS OR .7422 3.5 4.5 POORLY DIFF NEOPL DIAG W/O CC. 415............. 18 SURG O.R. PROCEDURE FOR 3.8811 12.6 16.2 INFECTIOUS & PARASITIC DISEASES. 416............. 18 MED SEPTICEMIA AGE >17......... 1.6209 6.4 8.1 417............. 18 MED SEPTICEMIA AGE 0-17........ .8498 4.5 5.3 418............. 18 MED POSTOPERATIVE & POST- 1.0452 5.3 6.6 TRAUMATIC INFECTIONS. [[Page 22845]] 419............. 18 MED FEVER OF UNKNOWN ORIGIN AGE .8617 4.0 5.0 >17 W CC. 420............. 18 MED FEVER OF UNKNOWN ORIGIN AGE .6114 3.0 3.6 >17 W/O CC. 421............. 18 MED VIRAL ILLNESS AGE >17...... .6646 3.2 3.9 422............. 18 MED VIRAL ILLNESS & FEVER OF .4800 2.6 3.2 UNKNOWN ORIGIN AGE 0-17. 423............. 18 MED OTHER INFECTIOUS & 1.8405 6.7 9.0 PARASITIC DISEASES DIAGNOSES. 424............. 19 SURG O.R. PROCEDURE W PRINCIPAL 2.4350 10.7 15.6 DIAGNOSES OF MENTAL ILLNESS. 425............. 19 MED ACUTE ADJUSTMENT REACTION & .6799 3.2 4.2 PSYCHOSOCIAL DYSFUNCTION. 426............. 19 MED DEPRESSIVE NEUROSES........ .5276 3.5 4.7 427............. 19 MED NEUROSES EXCEPT DEPRESSIVE. .5438 3.6 5.0 428............. 19 MED DISORDERS OF PERSONALITY & .7200 5.0 7.6 IMPULSE CONTROL. 429............. 19 MED ORGANIC DISTURBANCES & .8357 5.2 6.8 MENTAL RETARDATION. 430............. 19 MED PSYCHOSES.................. .7653 6.7 8.9 431............. 19 MED CHILDHOOD MENTAL DISORDERS. .6309 5.0 6.8 432............. 19 MED OTHER MENTAL DISORDER .7068 3.4 5.1 DIAGNOSES. 433............. 20 MED ALCOHOL/DRUG ABUSE OR .2852 2.3 3.2 DEPENDENCE, LEFT AMA. 434............. 20 MED NO LONGER VALID............ .0000 .0 .0 435............. 20 MED NO LONGER VALID............ .0000 .0 .0 436............. 20 MED NO LONGER VALID............ .0000 .0 .0 437............. 20 MED NO LONGER VALID............ .0000 .0 .0 438............. 20 ................... NO LONGER VALID............ .0000 .0 .0 439............. 21 SURG SKIN GRAFTS FOR INJURIES... 1.9350 6.7 9.5 440............. 21 SURG WOUND DEBRIDEMENTS FOR 2.0732 7.1 10.3 INJURIES. 441............. 21 SURG HAND PROCEDURES FOR .9273 2.3 3.3 INJURIES. 442............. 21 SURG OTHER O.R. PROCEDURES FOR 2.5349 6.8 9.6 INJURIES W CC. 443............. 21 SURG OTHER O.R. PROCEDURES FOR .9896 2.7 3.6 INJURIES W/O CC. 444............. 21 MED TRAUMATIC INJURY AGE >17 W .7244 3.4 4.4 CC. 445............. 21 MED TRAUMATIC INJURY AGE >17 W/ .4713 2.4 3.0 O CC. 446............. 21 MED * TRAUMATIC INJURY AGE 0-17 .2949 2.4 2.4 447............. 21 MED ALLERGIC REACTIONS AGE >17. .4851 1.9 2.5 448............. 21 MED * ALLERGIC REACTIONS AGE 0- .0970 2.9 2.9 17. 449............. 21 MED POISONING & TOXIC EFFECTS .8306 2.8 3.9 OF DRUGS AGE >17 W CC. 450............. 21 MED POISONING & TOXIC EFFECTS .4161 1.6 2.0 OF DRUGS AGE >17 W/O CC. 451............. 21 MED * POISONING & TOXIC EFFECTS .2618 2.1 2.1 OF DRUGS AGE 0-17. 452............. 21 MED COMPLICATIONS OF TREATMENT 1.0125 3.8 5.2 W CC. 453............. 21 MED COMPLICATIONS OF TREATMENT .4997 2.2 2.8 W/O CC. 454............. 21 MED OTHER INJURY, POISONING & .8713 3.4 4.9 TOXIC EFFECT DIAG W CC. 455............. 21 MED OTHER INJURY, POISONING & .4617 1.9 2.6 TOXIC EFFECT DIAG W/O CC. 456............. 22 ................... NO LONGER VALID............ .0000 .0 .0 457............. 22 MED NO LONGER VALID............ .0000 .0 .0 458............. 22 SURG NO LONGER VALID............ .0000 .0 .0 459............. 22 SURG NO LONGER VALID............ .0000 .0 .0 460............. 22 MED NO LONGER VALID............ .0000 .0 .0 461............. 23 SURG O.R. PROC W DIAGNOSES OF 1.1994 2.5 4.6 OTHER CONTACT W HEALTH SERVICES. 462............. 23 MED REHABILITATION............. 1.2033 10.4 12.3 463............. 23 MED SIGNS & SYMPTOMS W CC...... .6818 3.4 4.3 464............. 23 MED SIGNS & SYMPTOMS W/O CC.... .4630 2.5 3.1 465............. 23 MED AFTERCARE W HISTORY OF .6065 2.5 3.6 MALIGNANCY AS SECONDARY DIAGNOSIS. 466............. 23 MED AFTERCARE W/O HISTORY OF .6630 2.5 4.2 MALIGNANCY AS SECONDARY DIAGNOSIS. 467............. 23 MED OTHER FACTORS INFLUENCING .5762 2.7 4.1 HEALTH STATUS. 468............. ....... ................... EXTENSIVE O.R. PROCEDURE 3.8458 11.3 14.5 UNRELATED TO PRINCIPAL DIAGNOSIS. 469............. ....... ................... ** PRINCIPAL DIAGNOSIS .0000 .0 .0 INVALID AS DISCHARGE DIAGNOSIS. 470............. ....... ................... ** UNGROUPABLE............. .0000 .0 .0 471............. 08 SURG BILATERAL OR MULTIPLE MAJOR 2.9929 5.0 5.7 JOINT PROCS OF LOWER EXTREMITY. 472............. 22 SURG NO LONGER VALID............ .0000 .0 .0 473............. 17 SURG ACUTE LEUKEMIA W/O MAJOR 3.9044 9.7 15.0 O.R. PROCEDURE AGE >17. 474............. 04 SURG NO LONGER VALID............ .0000 .0 .0 475............. 04 MED RESPIRATORY SYSTEM 3.9155 10.0 12.7 DIAGNOSIS WITH VENTILATOR SUPPORT. 476............. ....... SURG PROSTATIC O.R. PROCEDURE 2.2902 10.0 12.3 UNRELATED TO PRINCIPAL DIAGNOSIS. [[Page 22846]] 477............. ....... SURG NON-EXTENSIVE O.R. 1.9571 6.7 9.3 PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS. 478............. 05 SURG OTHER VASCULAR PROCEDURES W 2.4276 5.9 8.2 CC. 479............. 05 SURG OTHER VASCULAR PROCEDURES W/ 1.4024 2.8 3.7 O CC. 480............. PRE SURG LIVER TRANSPLANT........... 10.6132 17.7 22.8 481............. PRE SURG BONE MARROW TRANSPLANT..... 7.8889 23.4 25.6 482............. PRE SURG TRACHEOSTOMY FOR FACE, 3.8343 11.4 14.3 MOUTH & NECK DIAGNOSES. 483............. PRE SURG TRACHEOSTOMY EXCEPT FOR 15.2827 34.0 41.0 FACE, MOUTH & NECK DIAGNOSES. 484............. 24 SURG CRANIOTOMY FOR MULTIPLE 5.1265 11.5 14.5 SIGNIFICANT TRAUMA. 485............. 24 SURG LIMB REATTACHMENT, HIP AND 3.1094 8.5 10.3 FEMUR PROC FOR MULTIPLE SIGNIFICANT TRA. 486............. 24 SURG OTHER O.R. PROCEDURES FOR 5.2547 11.0 14.3 MULTIPLE SIGNIFICANT TRAUMA. 487............. 24 MED OTHER MULTIPLE SIGNIFICANT 1.9199 6.3 8.2 TRAUMA. 488............. 25 SURG HIV W EXTENSIVE O.R. 5.1474 15.0 19.8 PROCEDURE. 489............. 25 MED HIV W MAJOR RELATED 1.8802 7.0 9.4 CONDITION. 490............. 25 MED HIV W OR W/O OTHER RELATED 1.0475 4.3 5.8 CONDITION. 491............. 08 SURG MAJOR JOINT & LIMB 1.6364 3.0 3.5 REATTACHMENT PROCEDURES OF UPPER EXTREMITY. 492............. 17 MED CHEMOTHERAPY W ACUTE 4.8853 13.6 19.0 LEUKEMIA AS SECONDARY DIAGNOSIS. 493............. 07 SURG LAPAROSCOPIC 1.8468 4.9 6.3 CHOLECYSTECTOMY W/O C.D.E. W CC. 494............. 07 SURG LAPAROSCOPIC .9800 1.9 2.5 CHOLECYSTECTOMY W/O C.D.E. W/O CC. 495............. PRE SURG LUNG TRANSPLANT............ 8.8879 13.8 16.2 496............. 08 SURG COMBINED ANTERIOR/POSTERIOR 5.6865 8.5 10.3 SPINAL FUSION. 497............. 08 SURG SPINAL FUSION EXCEPT 3.1996 5.8 6.8 CERVICAL W CC. 498............. 08 SURG SPINAL FUSION EXCEPT 2.2996 3.9 4.3 CERVICAL W/O CC. 499............. 08 SURG BACK & NECK PROCEDURES 1.4471 3.8 5.0 EXCEPT SPINAL FUSION W CC. 500............. 08 SURG BACK & NECK PROCEDURES .9375 2.2 2.6 EXCEPT SPINAL FUSION W/O CC. 501............. 08 SURG KNEE PROCEDURES W PDX OF 2.7466 9.8 12.0 INFECTION W CC. 502............. 08 SURG KNEE PROCEDURES W PDX OF 1.5591 5.9 6.9 INFECTION W/O CC. 503............. 08 SURG KNEE PROCEDURES W/O PDX OF 1.2336 3.3 4.2 INFECTION. 504............. 22 SURG EXTENSIVE 3RD DEGREE BURNS 13.8097 28.2 33.6 W SKIN GRAFT. 505............. 22 MED EXTENSIVE 3RD DEGREE BURNS 1.4893 2.0 3.4 W/O SKIN GRAFT. 506............. 22 SURG FULL THICKNESS BURN W SKIN 4.9149 15.7 19.9 GRAFT OR INHAL INJ W CC OR SIG TRAUMA. 507............. 22 SURG FULL THICKNESS BURN W SKIN 1.8331 7.2 9.2 GRFT OR INHAL INJ W/O CC OR SIG TRAUMA. 508............. 22 MED FULL THICKNESS BURN W/O 1.2966 6.0 8.3 SKIN GRFT OR INHAL INJ W CC OR SIG TRAUMA. 509............. 22 MED FULL THICKNESS BURN W/O .7323 3.7 4.9 SKIN GRFT OR INH INJ W/O CC OR SIG TRAUMA. 510............. 22 MED NON-EXTENSIVE BURNS W CC OR 1.3509 5.8 8.0 SIGNIFICANT TRAUMA. 511............. 22 MED NON-EXTENSIVE BURNS W/O CC .7558 3.6 5.1 OR SIGNIFICANT TRAUMA. 512............. PRE SURG SIMULTANEOUS PANCREAS/ 6.6413 13.4 16.5 KIDNEY TRANSPLANT. 513............. PRE SURG PANCREAS TRANSPLANT........ 6.6497 10.3 13.4 514............. 05 SURG CARDIAC DEFIBRILLATOR 6.4169 6.8 9.0 IMPLANT W CARDIAC CATH. 515............. 05 SURG CARDIAC DEFIBRILLATOR 5.0652 4.3 6.8 IMPLANT W/O CARDIAC CATH. 516............. 05 SURG PERCUTANEOUS CARDIOVASC 2.7250 4.1 5.0 PROC W AMI. 517............. 05 SURG PERC CARDIO PROC W CORONARY 2.1497 1.9 2.7 ARTERY STENT W/O AMI. 518............. 05 SURG PERC CARDIO PROC W/O 1.6673 2.5 3.6 CORONARY ARTERY STENT OR AMI. 519............. 08 SURG CERVICAL SPINAL FUSION W CC 2.2654 3.4 5.1 520............. 08 SURG CERVICAL SPINAL FUSION W/O 1.5709 2.0 2.8 CC. 521............. 20 MED ALCOHOL/DRUG ABUSE OR .7354 4.2 5.4 DEPENDENCE W CC. 522............. 20 MED ALC/DRUG ABUSE OR DEPEND W .6631 9.0 10.7 REHABILITATION THERAPY W/O CC. 523............. 20 MED ALC/DRUG ABUSE OR DEPEND W/ .3983 3.5 4.3 O REHABILITATION THERAPY W/ O CC. ---------------------------------------------------------------------------------------------------------------- * MEDICARE DATA HAVE BEEN SUPPLEMENTED BY DATA FROM 19 STATES FOR LOW VOLUME DRGS. ** DRGS 469 AND 470 CONTAIN CASES WHICH COULD NOT BE ASSIGNED TO VALID DRGS. NOTE: GEOMETRIC MEAN IS USED ONLY TO DETERMINE PAYMENT FOR TRANSFER CASES. NOTE: ARITHMETIC MEAN IS PRESENTED FOR INFORMATIONAL PURPOSES ONLY. NOTE: RELATIVE WEIGHTS ARE BASED ON MEDICARE PATIENT DATA AND MAY NOT BE APPROPRIATE FOR OTHER PATIENTS. [[Page 22847]] Table 6A.--New Diagnosis Codes ---------------------------------------------------------------------------------------------------------------- Diagnosis code Description CC MDC DRG ---------------------------------------------------------------------------------------------------------------- 256.31 Premature menopause.......... N 13 358, 359, 369 256.39 Other ovarian failure........ N 13 358, 359, 369 277.7 Dysmetabolic Syndrome X...... N 10 299 464.00 Acute laryngitis, without N 3 68, 69, 70 mention of obstruction. pre 482 464.01 Acute laryngitis, with N 3 68, 69, 70 obstruction. pre 482 464.50 Unspecified supraglottis, N 3 68, 69, 70 without mention of pre 482 obstruction. 464.51 Unspecified supraglottis, N 3 68, 69, 70 with obstruction. pre 482 521.00 Unspecified dental caries.... N 3 185, 186, 187 pre 482 521.01 Dental caries limited to N 3 185, 186, 187 enamel. pre 482 521.02 Dental caries extending into N 3 185, 186, 187 dentine. pre 482 521.03 Dental caries extending into N 3 185, 186, 187 pulp. pre 482 521.04 Arrested dental caries....... N 3 185, 186, 187 pre 482 521.05 Odontoclasia................. N 3 185, 186, 187 pre 482 521.09 Other dental caries.......... N 3 185, 186, 187 pre 482 525.10 Unspecified acquired absence N 3 185, 186, 187 of teeth. pre 482 525.11 Loss of teeth due to trauma.. N 3 185, 186, 187 pre 482 525.12 Loss of teeth due to N 3 182, 183, 184 periodontal disease. pre 482 525.13 Loss of teeth due to caries.. N 3 185, 186, 187 pre 482 525.19 Other loss of teeth.......... N 3 185, 186, 187 pre 482 530.12 Acute esophagitis............ N 6 182, 183, 184 564.00 Unspecified constipation..... N 6 182, 183, 184 564.01 Slow transit constipation.... N 6 182, 183, 184 564.02 Outlet dysfunction N 6 182, 183, 184 constipation. 564.09 Other constipation........... N 6 182, 183, 184 602.3 Dysplasia of prostate........ N 12 352 608.82 Hematospermia................ N 12 352 608.87 Retrograde ejaculation....... N 12 352 692.76 Sunburn of second degree..... N 9 283, 284 692.77 Sunburn of third degree...... N 9 283, 284 718.70 Developmental dislocation of N 8 256 joint, site unspecified. 718.71 Developmental dislocation of N 8 256 joint, shoulder region. 718.72 Developmental dislocation of N 8 256 joint, upper arm. 718.73 Developmental dislocation of N 8 256 joint, forearm. 718.74 Developmental dislocation of N 8 256 joint, hand. 718.75 Developmental dislocation of N 8 256 joint, pelvic region and thigh. 718.76 Developmental dislocation of N 8 256 joint, lower leg. 718.77 Developmental dislocation of N 8 256 joint, ankle and foot. 718.78 Developmental dislocation of N 8 256 joint, other specified sites. 718.79 Developmental dislocation of N 8 256 joint, multiple sites. 733.93 Stress fracture of tibia or Y 8 239 fibula. 733.94 Stress fracture of the Y 8 239 metatarsals. 733.95 Stress fracture of other bone Y 8 239 772.10 Intraventricular hemorrhage, Y 15 387, 389 unspecified grade. 772.11 Intraventricular hemorrhage, Y 15 387, 389 Grade I. 772.12 Intraventricular hemorrhage, Y 15 387, 389 Grade II. 772.13 Intraventricular hemorrhage, Y 15 387, 389 Grade III. 772.14 Intraventricular hemorrhage, Y 15 387, 389 Grade IV. 779.7 Perventricular leukomalacia.. Y 15 387, 389 793.80 Unspecified abnormal N 9 276 mammogram. 793.81 Mammographic N 9 276 microcalcification. 793.89 Other abnormal findings on N 9 276 radiological examination breast. 840.7 Superior glenoid labrum N 8 253, 254, 255 lesions (SLAP). 24 487 [[Page 22848]] 997.71 Vascular complications of Y 6 188, 189, 190 mesenteric artery. 15 387,\1\ 389 \1\ 997.72 Vascular complications of Y 11 331, 332, 333 renal artery. 15 387,\1\ 389 \1\ 997.79 Vascular complications of Y 5 130, 131 other vessels. 15 387,\1\ 389 \1\ V10.53 Personal history of malignant N 17 411, 412 neoplasm, renal pelvis. V45.84 Dental restoration status.... N 23 467 V49.82 Dental sealant status........ N 23 467 V83.01 Asymptomatic hemophilia A N 23 467 carrier. V83.02 Symptomatic hemophilia A N 23 467 carrier. ---------------------------------------------------------------------------------------------------------------- Table 6B.--New Procedure Codes ---------------------------------------------------------------------------------------------------------------- Procedure code Description OR MDC DRG ---------------------------------------------------------------------------------------------------------------- 37.28 Intracardiac echocardiography N 44.32 Percutaneous [endoscopic] Y 6 154-156 gastrojejunostomy. 7 201 10 288 17 400, 406, 407 67.51 Transabdominal cerclage of Y 13 360 cervix. 14 372, 373 21 442, 443 24 486 67.59 Other repair of internal Y 13 360 cervical os. 14 372, 373 21 442, 443 24 486 75.38 Fetal pulse oximetry......... N 81.30 Refusion of spine, not Y 1 4 otherwise specified. 8 497, 498 21 442, 443 24 486 81.31 Refusion of Atlas-axis spine. Y 1 4 8 497, 498 21 442, 443 24 486 81.32 Refusion of other cervical Y 1 4 spine, anterior technique. 8 496, 519, 520 21 442, 443 24 486 81.33 Refusion of other cervical Y 1 4 spine, posterior technique. 8 496, 519, 520 21 442, 443 24 486 81.34 Refusion of dorsal and Y 1 4 dorsolumbar spine, anterior 8 496, 497, 498 technique. 21 442, 443 24 486 81.35 Refusion of dorsal and Y 1 4 dorsolumbar spine, posterior 8 496, 497, 498 technique. 21 442, 443 24 486 81.36 Refusion of lumbar and Y 1 4 lumbosacral spine, anterior 8 496, 497, 498 technique. 21 442, 443 24 486 81.37 Refusion of lumbar and Y 1 4 lumbosacral spine, lateral 8 496, 497, 498 transverse process technique. 21 442, 443 24 486 81.38 Refusion of lumbar and Y 1 4 lumbosacral spine, posterior 8 496, 497, 498 technique. 21 442, 443 24 486 [[Page 22849]] 81.39 Refusion of spine, not Y 1 4 elsewhere classified. 8 497, 498 21 442, 443 24 486 97.44 Nonoperative removal of heart N assist system. ---------------------------------------------------------------------------------------------------------------- Table 6C.--Invalid Diagnosis Codes ---------------------------------------------------------------------------------------------------------------- Diagnosis code Description CC MDC DRG ---------------------------------------------------------------------------------------------------------------- 256.3 Other ovarian failure........ N 13 358, 359, 369 464.0 Acute laryngitis............. N 3 68, 69, 70 pre 482 521.0 Dental caries................ N 3 185, 186, 187 pre 482 525.1 Loss of teeth due to N 3 185, 186, 187 accident, extraction, or pre 482 local periodontal disease. 564.0 Constipation................. N 6 182, 183, 184 772.1 Intraventricular hemorrhage.. Y 15 387,389 793.8 Nonspecific abnormal findings N 9 276 on radiological and other examinations of body structure, breast. ---------------------------------------------------------------------------------------------------------------- Table 6D.--Invalid Procedure Codes ---------------------------------------------------------------------------------------------------------------- Procedure code Description OR MDC DRG ---------------------------------------------------------------------------------------------------------------- 67.5 Repair of internal cervical Y 13 360 os. 14 372, 373 21 442, 442 24 486 81.09 Refusion of spine, any level Y 1 4 or technique. 8 497, 498 21 442, 443 24 486 ---------------------------------------------------------------------------------------------------------------- Table 6E.--Revised Diagnosis Code Titles ---------------------------------------------------------------------------------------------------------------- Diagnosis code Description CC MDC DRG ---------------------------------------------------------------------------------------------------------------- 411.81 Acute coronary occlusion Y 5 124, 140 without myocardial infarction. 493.00 Extrinsic asthma without N 4 96, 97, 98 mention of status asthmaticus or acute exacerbation or unspecified. 493.10 Intrinsic asthma without N 4 96, 97, 98 mention of status asthmaticus or acute exacerbation or unspecified. 493.20 Chronic obstructive asthma Y 4 88 without mention of status asthmaticus or acute exacerbation or unspecified. 493.90 Asthma, unspecified without N 4 96, 97, 98 mention of status asthmaticus or acute exacerbation or unspecified. V70.7 Examination of participant in N 23 467 clinical trial. ---------------------------------------------------------------------------------------------------------------- Table 6F.--Revised Procedure Codes ---------------------------------------------------------------------------------------------------------------- Procedure code Description OR MDC DRG ---------------------------------------------------------------------------------------------------------------- 75.34 Other fetal monitoring....... N ---------------------------------------------------------------------------------------------------------------- [[Page 22850]] Table 6G.--Additions to the CC Exclusions List CCs that are added to the list are in Table 6F-Additions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis. ------------------------------------------------------------------------ ------------------------------------------------------------------------ *25631 80600 82010 80637 80606 82021 77212 77210 2580 80601 82011 80638 80607 82022 77213 77211 2581 80602 82012 80639 80608 82030 77214 77212 2588 80603 82013 8064 80609 82031 7797 77213 2589 80604 82019 8065 80610 82032 *7729 77214 *25639 80605 82020 80660 80611 8208 77210 7797 2580 80606 82021 80661 80612 8209 77211 *7769 2581 80607 82022 80662 80613 82100 77212 77210 2588 80608 82030 80669 80614 82101 77213 77211 2589 80609 82031 80670 80615 82110 77214 77212 *6023 80610 82032 80671 80616 82111 7797 77213 5960 80611 8208 80672 80617 *7720 *7760 77214 5996 80612 8209 80679 80618 77210 77210 7797 6010 80613 82100 8068 80619 77211 77211 *7797 6012 80614 82101 8069 80620 77212 77212 7722 6013 80615 82110 8080 80621 77213 77213 7797 6021 80616 82111 8082 80622 77214 77214 *7798 78820 80617 *73394 8083 80623 7797 7797 77210 78829 80618 73310 80843 80624 *77210 *7761 77211 *60887 80619 73311 80849 80625 77210 77210 77212 5970 80620 73312 80851 80626 77211 77211 77213 5994 80621 73313 80852 80627 77212 77212 77214 *73310 80622 73314 80853 80628 77213 77213 7797 73393 80623 73315 80859 80629 77214 77214 *9972 73394 80624 73316 8088 80630 7722 7797 99771 73395 80625 73319 8089 80631 7797 *7762 99772 *73311 80626 73393 82000 80632 *77211 77210 99779 73393 80627 73394 82001 80633 77210 77211 *99771 73394 80628 73395 82002 80634 77211 77212 53640 73395 80629 8058 82003 80635 77212 77213 53641 *73312 80630 8059 82009 80636 77213 77214 53642 73393 80631 80600 82010 80637 77214 7797 53649 73394 80632 80601 82011 80638 7722 *7763 56962 73395 80633 80602 82012 80639 7797 77210 9974 *73313 80634 80603 82013 8064 *77212 77211 99771 73393 80635 80604 82019 8065 77210 77212 99772 73394 80636 80605 82020 80660 77211 77213 99779 73395 80637 80606 82021 80661 77212 77214 *99772 *73314 80638 80607 82022 80662 77213 7797 9975 73393 80639 80608 82030 80669 77214 *7764 99771 73394 8064 80609 82031 80670 7722 77210 99772 73395 8065 80610 82032 80671 7797 77211 99779 *73315 80660 80611 8208 80672 *77213 77212 *99779 73393 80661 80612 8209 80679 77210 77213 9972 73394 80662 80613 82100 8068 77211 77214 99771 73395 80669 80614 82101 8069 77212 7797 99772 *73316 80670 80615 82110 8080 77213 *7765 99779 73393 80671 80616 82111 8082 77214 77210 *99791 73394 80672 80617 *73395 8083 7722 77211 99771 73395 80679 80618 73310 80843 7797 77212 99772 *73319 8068 80619 73311 80849 *77214 77213 99779 73393 8069 80620 73312 80851 77210 77214 *99799 73394 8080 80621 73313 80852 77211 7797 99771 73395 8082 80622 73314 80853 77212 *7766 99772 *73393 8083 80623 73315 80859 77213 77210 99779 73310 80843 80624 73316 8088 77214 77211 *99881 73311 80849 80625 73319 8089 7722 77212 99771 73312 80851 80626 73393 82000 7797 77213 99772 73313 80852 80627 73394 82001 *7722 77214 99779 73314 80853 80628 73395 82002 77210 7797 *99883 73315 80859 80629 8058 82003 77211 *7767 99771 73316 8088 80630 8059 82009 77212 77210 99772 73319 8089 80631 80600 82010 77213 77211 99779 73393 82000 80632 80601 82011 77214 77212 *99889 73394 82001 80633 80602 82012 7797 77213 99771 73395 82002 80634 80603 82013 *7728 77214 99772 8058 82003 80635 80604 82019 77210 7797 99779 8059 82009 80636 80605 82020 77211 *7768 *9989 99771 99772 99779 ------------------------------------------------------------------------ [[Page 22851]] Table 6H.--Deletions to the CC Exclusions List CCs that are deleted from the list are in Table 6G--Deletions to the CC Exclusions List. Each of the principal diagnoses is shown with an asterisk, and the revisions to the CC Exclusions List are provided in an indented column immediately following the affected principal diagnosis. ------------------------------------------------------------------------ ------------------------------------------------------------------------ *2563 2580 2581 2588 2589 *7720 7721 *7721 7721 7722 *7722 7721 *7728 7721 *7729 7721 *7760 7721 *7761 7721 *7762 7721 *7763 7721 *7764 7721 *7765 7721 *7766 7721 *7767 7721 *7768 7721 *7769 7721 *7798 7721 ------------------------------------------------------------------------ [[Page 22852]] Table 7A.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay [FY2000 MEDPAR update 12/00 Grouper V18.0] -------------------------------------------------------------------------------------------------------------------------------------------------------- Number Arithmetic 10th 25th 50th 75th 90th DRG discharges mean LOS percentile percentile percentile percentile percentile -------------------------------------------------------------------------------------------------------------------------------------------------------- 1....................................... 33822 8.9935 2 3 6 12 19 2....................................... 6772 9.9778 3 5 8 13 20 3....................................... 2 43.5000 35 35 52 52 52 4....................................... 6035 7.1639 1 2 5 9 15 5....................................... 93311 3.1649 1 1 2 3 7 6....................................... 366 2.9672 1 1 2 4 6 7....................................... 12470 9.9739 2 4 7 12 20 8....................................... 4164 3.2759 1 1 2 4 7 9....................................... 1610 6.3491 1 3 5 8 13 10...................................... 17577 6.5503 2 3 5 8 13 11...................................... 3128 4.0767 1 2 3 5 8 12...................................... 46758 5.8962 2 3 4 7 11 13...................................... 6415 5.2011 2 3 4 6 9 14...................................... 319523 5.8762 2 3 5 7 11 15...................................... 145366 3.5498 1 2 3 4 7 16...................................... 11155 6.0293 2 3 5 7 12 17...................................... 3519 3.3231 1 2 3 4 6 18...................................... 25961 5.4162 2 3 4 7 10 19...................................... 8638 3.6972 1 2 3 5 7 20...................................... 5629 10.1482 3 5 8 13 20 21...................................... 1309 6.5516 2 3 5 8 13 22...................................... 2535 4.8174 1 2 4 6 9 23...................................... 9464 4.1855 1 2 3 5 8 24...................................... 52753 4.9830 1 2 4 6 10 25...................................... 25370 3.2236 1 2 3 4 6 26...................................... 31 2.7097 1 1 2 3 6 27...................................... 3441 5.0584 1 1 3 6 11 28...................................... 11316 6.2100 1 3 5 8 13 29...................................... 4486 3.6097 1 2 3 5 7 30...................................... 1 1.0000 1 1 1 1 1 31...................................... 3488 4.4903 1 2 3 5 8 32...................................... 1738 2.5621 1 1 2 3 5 33...................................... 1 1.0000 1 1 1 1 1 34...................................... 20249 5.0786 1 2 4 6 10 35...................................... 5728 3.3959 1 2 3 4 6 36...................................... 3190 1.4649 1 1 1 1 2 37...................................... 1452 4.0296 1 1 2 5 9 38...................................... 102 2.6569 1 1 2 3 5 39...................................... 912 1.9079 1 1 1 2 4 40...................................... 1545 3.4252 1 1 2 4 7 42...................................... 2223 2.2852 1 1 1 3 5 43...................................... 85 3.1882 1 2 3 4 6 44...................................... 1238 4.9548 2 3 4 6 9 45...................................... 2444 3.1678 1 2 3 4 6 46...................................... 3051 4.6834 1 2 4 6 9 47...................................... 1281 3.2560 1 1 3 4 6 49...................................... 2241 4.8104 1 2 3 6 9 50...................................... 2488 1.9425 1 1 1 2 3 51...................................... 203 2.6995 1 1 1 2 6 52...................................... 220 1.9318 1 1 1 2 3 53...................................... 2478 3.5557 1 1 2 4 8 54...................................... 2 1.5000 1 1 2 2 2 55...................................... 1505 2.7442 1 1 1 3 6 56...................................... 503 2.7256 1 1 2 3 5 57...................................... 708 3.9492 1 1 2 5 9 59...................................... 107 2.7850 1 1 2 3 5 60...................................... 2 3.5000 2 2 5 5 5 61...................................... 231 5.0996 1 1 2 6 12 62...................................... 3 1.3333 1 1 1 2 2 63...................................... 2934 4.3889 1 2 3 5 8 64...................................... 3033 6.1800 1 2 4 8 13 65...................................... 34466 2.8420 1 1 2 4 5 66...................................... 6978 3.1635 1 1 2 4 6 67...................................... 495 3.5960 1 2 3 4 7 68...................................... 16724 4.1158 1 2 3 5 7 69...................................... 5435 3.2736 1 2 3 4 6 70...................................... 24 2.9167 1 2 2 4 5 71...................................... 82 3.8049 1 2 3 4 7 72...................................... 883 3.5663 1 2 3 4 6 73...................................... 6630 4.4065 1 2 3 6 9 [[Page 22853]] 75...................................... 39010 9.9124 3 5 7 12 19 76...................................... 38998 11.2677 3 5 9 14 21 77...................................... 2352 4.9184 1 2 4 7 10 78...................................... 32087 6.7848 3 4 6 8 11 79...................................... 169783 8.4892 3 4 7 11 16 80...................................... 9018 5.6618 2 3 5 7 10 81...................................... 4 18.2500 3 3 4 8 58 82...................................... 61883 6.9447 2 3 5 9 14 83...................................... 6446 5.5496 2 3 4 7 10 84...................................... 1508 3.3455 1 2 3 4 6 85...................................... 20572 6.3122 2 3 5 8 12 86...................................... 2118 3.6643 1 2 3 5 7 87...................................... 60110 6.2840 1 3 5 8 12 88...................................... 389694 5.1207 2 3 4 6 9 89...................................... 525838 5.9470 2 3 5 7 11 90...................................... 53895 4.1549 2 3 4 5 7 91...................................... 54 4.5185 2 2 3 5 10 92...................................... 13774 6.3499 2 3 5 8 12 93...................................... 1672 4.0353 1 2 3 5 7 94...................................... 12030 6.2988 2 3 5 8 12 95...................................... 1595 3.7179 1 2 3 5 7 96...................................... 61986 4.6292 2 3 4 6 8 97...................................... 31444 3.6560 1 2 3 5 7 98...................................... 18 4.2222 1 2 2 4 6 99...................................... 18996 3.1991 1 1 2 4 6 100..................................... 7619 2.1869 1 1 2 3 4 101..................................... 19997 4.3938 1 2 3 5 9 102..................................... 5146 2.6570 1 1 2 3 5 103..................................... 475 46.6021 9 13 25 60 98 104..................................... 36578 11.3165 7 11 28 60 98 105..................................... 29726 9.2831 5 6 8 15 98 106..................................... 3401 11.4963 5 7 10 14 20 107..................................... 87868 10.3783 5 7 9 12 17 108..................................... 6048 10.2116 3 5 8 13 19 109..................................... 60265 7.6926 4 5 6 9 12 110..................................... 52595 9.2013 2 5 7 11 18 111..................................... 8545 4.7604 1 2 5 6 8 113..................................... 42250 12.1885 3 6 9 15 24 114..................................... 8712 8.3768 2 4 7 10 16 115..................................... 14329 8.1687 1 4 7 11 16 116..................................... 330888 3.6061 2 9 7 11 16 117..................................... 3717 4.1512 1 1 2 5 9 118..................................... 7667 2.6849 1 1 1 3 6 119..................................... 1307 4.8829 1 1 3 6 12 120..................................... 35929 8.1178 1 2 5 10 16 121..................................... 162112 6.3821 2 3 5 8 12 122..................................... 78969 3.7027 1 2 3 5 7 123..................................... 40659 4.5833 1 1 3 6 11 124..................................... 132801 4.3427 1 2 3 5 8 125..................................... 80169 2.7657 1 1 2 4 5 126..................................... 5150 11.6882 3 6 9 14 22 127..................................... 678903 5.2745 2 3 4 7 10 128..................................... 9424 5.6175 2 4 5 7 9 129..................................... 4140 2.7621 1 1 1 3 6 130..................................... 86009 5.6760 2 3 5 7 10 131..................................... 28236 4.2426 1 2 4 6 7 132..................................... 147648 3.0002 1 1 2 4 6 133..................................... 8321 2.3367 1 1 2 3 4 134..................................... 36118 3.2406 1 2 3 4 6 135..................................... 7266 4.5531 1 2 3 6 9 136..................................... 1221 2.7158 1 1 2 3 5 138..................................... 194087 3.9932 1 2 3 5 8 139..................................... 82604 2.5072 1 1 2 3 5 140..................................... 69724 2.6533 1 1 2 3 5 141..................................... 90403 3.6691 1 2 3 5 7 142..................................... 45776 2.6508 1 1 2 3 5 143..................................... 203918 2.1253 1 1 2 3 4 144..................................... 81577 5.3196 1 2 4 7 11 145..................................... 7224 2.7460 1 1 2 3 5 146..................................... 10683 10.2826 5 7 9 12 17 [[Page 22854]] 147..................................... 2629 6.4196 3 5 6 8 9 148..................................... 129247 12.1904 5 7 10 15 22 149..................................... 18462 6.5184 4 5 6 8 9 150..................................... 19795 11.2770 4 7 10 14 20 151..................................... 4814 5.8286 2 3 5 8 10 152..................................... 4381 8.1438 3 5 7 9 14 153..................................... 2083 5.3711 3 4 5 7 8 154..................................... 28660 13.1491 4 7 10 16 25 155..................................... 6596 4.2179 1 2 3 6 8 156..................................... 4 7.5000 1 1 5 6 18 157..................................... 7903 5.3790 1 2 4 7 11 158..................................... 4630 2.5395 1 1 2 3 5 159..................................... 16309 4.9926 1 2 4 6 10 160..................................... 11655 2.6619 1 1 2 3 5 161..................................... 11119 4.2027 1 1 3 5 9 162..................................... 7199 1.9267 1 1 1 2 4 163..................................... 5 4.4000 1 1 3 4 13 164..................................... 4824 8.4279 4 5 7 10 15 165..................................... 2066 4.8049 2 3 5 6 8 166..................................... 3532 5.0337 2 2 4 6 10 167..................................... 3269 2.5990 1 2 2 3 5 168..................................... 1327 4.7641 1 2 3 6 10 169..................................... 834 2.3405 1 1 2 3 5 170..................................... 10975 11.1690 2 5 8 14 22 171..................................... 1284 4.6597 1 2 4 6 9 172..................................... 30412 6.9363 2 3 5 9 14 173..................................... 2685 3.6648 1 1 3 5 7 174..................................... 240400 4.7974 2 3 4 6 9 175..................................... 32375 2.9414 1 2 3 4 5 176..................................... 15101 5.2286 2 3 4 6 10 177..................................... 9190 4.5348 2 2 4 6 8 178..................................... 3597 3.0703 1 2 3 4 6 179..................................... 12291 5.9729 2 3 5 7 11 180..................................... 85599 5.3567 2 3 4 7 10 181..................................... 26315 3.4185 1 2 3 4 6 182..................................... 243506 4.3356 1 2 3 5 8 183..................................... 83969 2.9155 1 1 2 4 5 184..................................... 79 2.9620 1 2 2 4 6 185..................................... 4760 4.5210 1 2 3 6 9 186..................................... 3 9.3333 1 1 9 18 18 187..................................... 646 3.9164 1 1 3 5 8 188..................................... 75558 5.5580 1 2 4 7 11 189..................................... 11984 3.1542 1 1 2 4 6 190..................................... 49 7.0204 2 3 4 5 8 191..................................... 8889 13.7967 4 6 10 17 28 192..................................... 1105 6.5122 2 4 6 8 11 193..................................... 5258 12.5369 5 7 10 16 22 194..................................... 718 6.7869 2 4 6 8 12 195..................................... 4327 10.1470 4 6 9 12 17 196..................................... 1162 5.7212 2 4 5 7 10 197..................................... 18754 8.9335 3 5 7 11 16 198..................................... 5751 4.5416 2 3 4 6 8 199..................................... 1704 9.5827 2 4 7 13 20 200..................................... 1063 10.3518 1 3 7 13 22 201..................................... 1398 13.7790 3 6 11 17 25 202..................................... 25975 6.4045 2 3 5 8 13 203..................................... 29017 6.6364 2 3 5 9 13 204..................................... 57319 5.7964 2 3 4 7 11 205..................................... 22900 6.1735 2 3 5 8 12 206..................................... 1948 3.9168 1 2 3 5 7 207..................................... 30817 5.0832 1 2 4 6 10 208..................................... 10061 2.8946 1 1 2 4 6 209..................................... 343375 5.0786 3 3 4 6 8 210..................................... 120891 6.8189 3 4 6 8 11 211..................................... 31665 4.9325 3 4 4 6 7 212..................................... 6 13.5000 1 4 4 29 29 213..................................... 9144 8.9604 2 4 7 11 18 216..................................... 5956 9.6949 2 4 8 12 20 217..................................... 16333 13.1971 3 5 9 16 28 218..................................... 21296 5.4123 2 3 4 7 10 [[Page 22855]] 219..................................... 19530 3.2240 1 2 3 4 6 220..................................... 6 4.0000 1 1 3 7 7 223..................................... 13251 2.8497 1 1 2 3 6 224..................................... 11112 1.9343 1 1 2 2 3 225..................................... 5734 4.8575 1 2 3 6 11 226..................................... 5148 6.5874 1 2 4 8 14 227..................................... 4695 2.7242 1 1 2 3 5 228..................................... 2340 3.7970 1 1 2 5 8 229..................................... 1108 2.4838 1 1 2 3 5 230..................................... 2365 5.2592 1 2 3 6 11 231..................................... 11343 4.9395 1 2 3 6 11 232..................................... 807 2.8872 1 1 1 3 7 233..................................... 5059 7.5181 2 3 6 10 15 234..................................... 3168 3.4419 1 1 3 4 7 235..................................... 5036 5.0473 1 2 4 6 9 236..................................... 38265 4.8164 1 3 4 6 9 237..................................... 1687 3.5033 1 2 3 4 6 238..................................... 7930 8.5212 3 4 6 10 16 239..................................... 49088 6.2151 2 3 5 8 12 240..................................... 11318 6.6744 2 3 5 8 13 241..................................... 3168 3.8570 1 2 3 5 7 242..................................... 2434 6.6348 2 3 5 8 13 243..................................... 87407 4.6676 1 2 4 6 9 244..................................... 12162 4.8047 1 2 4 6 9 245..................................... 5130 3.4458 1 2 3 4 6 246..................................... 1386 3.8117 1 2 3 5 7 247..................................... 16832 3.3990 1 1 3 4 7 248..................................... 10529 4.8161 1 2 4 6 9 249..................................... 11336 3.6591 1 1 2 4 8 250..................................... 3456 4.1062 1 2 3 5 7 251..................................... 2406 2.8579 1 1 2 4 5 253..................................... 19677 4.7732 1 3 4 6 9 254..................................... 10449 3.1906 1 2 3 4 6 255..................................... 1 3.0000 3 3 3 3 3 256..................................... 6054 5.0766 1 2 4 6 10 257..................................... 16333 2.7359 1 1 2 3 5 258..................................... 15978 1.9342 1 1 2 2 3 259..................................... 3773 2.6801 1 1 1 2 6 260..................................... 4896 1.4167 1 1 1 2 2 261..................................... 1844 2.2749 1 1 1 3 5 262..................................... 612 3.9477 1 1 3 5 8 263..................................... 18146 12.0208 3 5 8 14 24 264..................................... 3608 7.4088 2 4 6 9 14 265..................................... 3681 6.8036 1 2 4 8 14 266..................................... 2698 3.3039 1 1 2 4 7 267..................................... 233 4.2060 1 1 3 6 9 268..................................... 878 3.4989 1 1 2 4 7 269..................................... 7390 8.2441 1 3 6 10 17 270..................................... 2623 3.5783 1 1 2 5 8 271..................................... 9621 7.6144 2 4 6 9 14 272..................................... 5459 6.1597 2 3 5 8 12 273..................................... 1286 4.0420 1 2 3 5 8 274..................................... 2334 6.5900 1 3 5 8 13 275..................................... 246 4.3130 1 1 3 5 9 276..................................... 1177 4.6669 1 2 4 6 8 277..................................... 85183 5.7309 2 3 5 7 10 278..................................... 33396 4.4205 2 3 4 6 8 279..................................... 3 2.3333 1 1 2 4 4 280..................................... 15577 4.1954 1 2 3 5 8 281..................................... 7128 3.0464 1 1 3 4 6 282..................................... 3 1.6667 1 1 2 2 2 283..................................... 5629 4.5756 1 2 4 6 9 284..................................... 1868 3.1124 1 1 2 4 6 285..................................... 6195 10.3080 3 5 8 13 20 286..................................... 2070 6.4396 2 3 5 7 13 287..................................... 5676 10.5374 3 5 7 12 21 288..................................... 2639 5.7704 2 3 4 6 9 289..................................... 4765 3.0002 1 1 2 3 7 290..................................... 8753 2.3103 1 1 2 2 4 291..................................... 65 1.8462 1 1 1 2 3 [[Page 22856]] 292..................................... 4702 10.4872 2 4 8 14 22 293..................................... 624 5.5096 1 2 4 7 12 294..................................... 87857 4.6066 1 2 4 6 9 295..................................... 3277 3.7376 1 2 3 5 7 296..................................... 235003 5.1556 2 2 4 6 10 297..................................... 43573 3.4124 1 2 3 4 6 298..................................... 86 2.8256 1 1 2 3 5 299..................................... 1178 5.2199 1 2 4 7 10 300..................................... 15999 6.1363 2 3 5 8 12 301..................................... 3208 3.6234 1 2 3 4 7 302..................................... 8018 9.0636 4 5 7 11 19 303..................................... 19452 8.4231 4 5 7 10 15 304..................................... 11767 8.7339 2 4 6 11 18 305..................................... 2984 3.6384 1 2 3 5 7 306..................................... 7320 5.6291 1 2 3 8 13 307..................................... 2082 2.2517 1 1 2 3 4 308..................................... 7463 6.1733 1 2 4 8 14 309..................................... 4096 2.2954 1 1 2 3 4 310..................................... 23873 4.4002 1 1 3 6 10 311..................................... 7963 1.8339 1 1 1 2 3 312..................................... 1487 4.4654 1 1 3 6 10 313..................................... 591 2.3316 1 1 1 3 5 315..................................... 29749 6.9546 1 1 4 9 15 316..................................... 104601 6.6228 2 3 5 8 13 317..................................... 1507 2.8779 1 1 2 3 6 318..................................... 5584 5.9979 1 3 5 8 12 319..................................... 422 2.7725 1 1 2 3 6 320..................................... 186678 5.3171 2 3 4 6 10 321..................................... 30428 3.7951 1 2 3 5 7 322..................................... 61 4.1475 2 2 3 5 8 323..................................... 17241 3.2172 1 1 2 4 7 324..................................... 7479 1.8826 1 1 1 2 3 325..................................... 8160 3.8241 1 2 3 5 7 326..................................... 2676 2.6648 1 1 2 3 5 327..................................... 11 3.0909 1 1 3 4 5 328..................................... 663 3.6305 1 1 3 5 8 329..................................... 77 2.0130 1 1 1 2 4 331..................................... 46045 5.5426 1 3 4 7 11 332..................................... 4930 3.2917 1 1 2 4 7 333..................................... 281 5.0569 1 2 4 6 10 334..................................... 8654 4.4386 2 3 4 5 7 335..................................... 10721 3.1791 2 2 3 4 5 336..................................... 9563 3.7848 1 2 3 4 8 337..................................... 3041 2.1500 1 1 2 3 3 338..................................... 1226 5.1117 1 2 3 7 11 339..................................... 1344 4.9821 1 1 3 7 12 340..................................... 1 1.0000 1 1 1 1 1 341..................................... 2738 3.1088 1 1 1 3 6 342..................................... 298 3.4094 1 1 2 4 7 344..................................... 3502 2.3829 1 1 1 2 5 345..................................... 410 5.1244 1 2 3 6 10 346..................................... 4441 5.8726 1 3 4 7 12 347..................................... 365 2.9479 1 1 2 4 6 350..................................... 6270 4.3933 1 2 4 5 8 352..................................... 756 3.9577 1 2 3 5 8 353..................................... 2533 6.4212 2 3 5 7 12 354..................................... 7562 5.8375 3 3 4 7 11 355..................................... 5504 3.2862 2 3 3 4 5 356..................................... 25128 2.2924 1 1 2 3 4 357..................................... 5548 8.4874 3 4 7 10 16 358..................................... 20294 4.3121 2 3 3 5 7 359..................................... 29890 2.7295 2 2 3 3 4 360..................................... 15941 2.8557 1 2 2 3 5 361..................................... 378 2.9233 1 1 2 3 5 363..................................... 2862 3.4693 1 2 2 3 7 364..................................... 1644 3.8534 1 1 3 5 8 365..................................... 1722 7.2410 1 3 5 9 16 366..................................... 4410 6.7329 1 3 5 8 14 367..................................... 583 3.0617 1 1 2 4 6 368..................................... 3110 6.4810 2 3 5 8 12 [[Page 22857]] 369..................................... 3133 3.2515 1 1 2 4 7 370..................................... 1095 5.8429 3 3 4 5 10 371..................................... 1307 3.6526 2 3 3 4 5 372..................................... 927 3.2891 1 2 2 3 5 373..................................... 3734 2.2499 1 2 2 3 3 374..................................... 120 3.1583 1 2 2 3 4 375..................................... 10 2.3000 1 2 2 3 4 376..................................... 247 3.0931 1 2 2 4 6 377..................................... 48 5.0000 1 1 3 6 12 378..................................... 157 2.4140 1 1 2 3 4 379..................................... 337 3.4303 1 1 2 4 6 380..................................... 58 2.1207 1 1 1 2 5 381..................................... 152 2.5132 1 1 1 3 5 382..................................... 45 1.2889 1 1 1 1 2 383..................................... 1707 3.5817 1 1 2 4 7 384..................................... 114 2.1842 1 1 1 3 5 385..................................... 1 1.0000 1 1 1 1 1 389..................................... 15 11.7333 1 3 6 10 24 390..................................... 14 4.0000 1 2 3 6 7 391..................................... 1 4.0000 4 4 4 4 4 392..................................... 2323 9.6750 3 4 7 12 20 394..................................... 1870 7.1428 1 2 4 8 16 395..................................... 86911 4.4001 1 2 3 6 9 396..................................... 15 4.6667 1 2 4 6 7 397..................................... 17554 5.1878 1 2 4 7 10 398..................................... 17526 5.9417 2 3 5 7 11 399..................................... 1721 3.5758 1 2 3 5 7 400..................................... 6444 9.1189 1 3 6 12 20 401..................................... 5581 11.2575 2 5 9 15 23 402..................................... 1498 4.1128 1 1 3 6 9 403..................................... 31732 8.0627 2 3 6 10 17 404..................................... 4639 4.2720 1 2 3 6 9 406..................................... 2513 9.8607 3 4 7 12 20 407..................................... 720 4.4417 1 2 4 5 8 408..................................... 2178 8.0317 1 2 5 10 18 409..................................... 2822 5.9072 2 3 4 6 12 410..................................... 33412 3.9069 1 2 4 5 6 411..................................... 13 2.3077 1 1 2 2 5 412..................................... 29 2.4483 1 1 2 3 4 413..................................... 6419 7.0662 2 3 5 9 14 414..................................... 767 4.2529 1 2 3 5 9 415..................................... 38683 14.2779 4 6 11 18 28 416..................................... 183557 7.3848 2 4 6 9 14 417..................................... 16 5.0000 2 2 4 6 9 418..................................... 22822 6.1160 2 3 5 7 11 419..................................... 15294 4.7204 2 2 4 6 9 420..................................... 3109 3.5002 1 2 3 4 6 421..................................... 11464 3.7872 1 2 3 5 7 422..................................... 80 3.0625 1 2 3 4 6 423..................................... 7452 8.1162 2 3 6 10 16 424..................................... 1275 13.4204 2 5 9 16 26 425..................................... 15710 3.9945 1 2 3 5 8 426..................................... 4443 4.4510 1 2 3 5 9 427..................................... 1633 4.6418 1 2 3 6 9 428..................................... 835 6.8192 1 2 4 8 14 429..................................... 25967 6.3055 2 3 5 7 12 430..................................... 58669 8.0151 2 3 6 10 16 431..................................... 313 6.2045 1 3 5 7 11 432..................................... 469 4.7271 1 2 3 5 9 433..................................... 5418 3.0945 1 1 2 4 6 439..................................... 1343 8.4080 1 3 5 10 19 440..................................... 5131 9.0209 2 3 6 11 20 441..................................... 601 3.2313 1 1 2 4 7 442..................................... 15366 8.4839 1 3 6 10 18 443..................................... 3730 3.4399 1 1 3 4 7 444..................................... 5185 4.1338 1 2 3 5 8 445..................................... 2427 2.9250 1 1 2 4 5 447..................................... 5451 2.4748 1 1 2 3 5 449..................................... 28048 3.7457 1 1 3 5 8 450..................................... 6867 2.0051 1 1 1 2 4 [[Page 22858]] 451..................................... 3 1.3333 1 1 1 2 2 452..................................... 22666 4.8553 1 2 3 6 10 453..................................... 5068 2.8035 1 1 2 3 6 454..................................... 3940 4.5652 1 2 3 5 9 455..................................... 931 2.5994 1 1 2 3 5 461..................................... 3490 4.3739 1 1 2 5 11 462..................................... 12994 11.2271 4 6 9 14 21 463..................................... 21790 4.1239 1 2 3 5 8 464..................................... 6533 2.9963 1 1 2 4 6 465..................................... 154 3.4481 1 1 2 4 7 466..................................... 1470 3.9925 1 1 2 5 9 467..................................... 534 3.8390 1 1 2 4 8 468..................................... 58990 12.9159 3 6 10 17 30 471..................................... 11639 5.5322 3 4 4 6 9 473..................................... 7599 12.5038 1 3 7 18 32 475..................................... 107089 11.1800 2 5 9 15 22 476..................................... 4126 10.8924 2 5 9 14 21 477..................................... 24823 8.1004 1 3 6 11 17 478..................................... 106999 7.3166 1 3 5 9 15 479..................................... 24939 3.5376 1 1 3 5 7 480..................................... 541 20.4843 7 9 13 25 43 481..................................... 377 23.9310 10 18 22 27 38 482..................................... 5686 12.9474 4 7 10 15 25 483..................................... 42093 39.0315 14 22 33 49 70 484..................................... 313 12.6773 2 6 10 17 26 485..................................... 2880 9.5955 4 5 7 11 18 486..................................... 1856 12.4402 1 5 10 16 25 487..................................... 3339 7.3612 1 3 6 10 15 488..................................... 770 17.0078 3 7 13 22 36 489..................................... 14005 8.4383 2 3 6 10 17 490..................................... 5378 5.3405 1 2 4 6 10 491..................................... 12205 3.4483 2 2 3 4 6 492..................................... 2672 15.6662 3 5 8 25 34 493..................................... 54859 5.7621 1 3 5 7 11 494..................................... 29900 2.4482 1 1 2 3 5 495..................................... 153 15.0261 7 9 12 18 26 496..................................... 1444 9.5824 4 5 7 12 18 497..................................... 23721 6.1748 3 4 7 12 18 498..................................... 22152 3.3273 3 4 6 12 18 499..................................... 30284 4.6986 1 2 3 6 9 500..................................... 43962 2.6146 1 1 2 3 5 501..................................... 2180 10.9670 4 6 8 13 21 502..................................... 586 6.5648 3 4 5 8 11 503..................................... 5551 3.9996 1 2 3 5 7 504..................................... 114 29.5877 9 14 24 41 54 505..................................... 145 3.3517 1 1 1 3 7 506..................................... 915 17.4000 4 8 14 22 35 507..................................... 290 8.2621 2 4 7 11 18 508..................................... 657 7.4718 2 3 5 9 15 509..................................... 176 4.5455 1 2 4 6 9 510..................................... 1619 7.1779 2 3 5 9 15 511..................................... 602 4.7591 1 2 3 6 10 512..................................... .............. .............. 1 2 3 6 10 513..................................... .............. .............. 1 2 3 6 10 514..................................... .............. .............. 1 2 3 6 10 515..................................... .............. .............. 1 2 3 6 10 516..................................... .............. .............. 1 2 3 6 10 517..................................... .............. .............. 1 2 3 6 10 518..................................... .............. .............. 1 2 3 6 10 519..................................... .............. .............. 1 2 3 6 10 520..................................... .............. .............. 1 2 3 6 10 521..................................... .............. .............. 1 2 3 6 10 522..................................... .............. .............. 1 2 3 6 10 523..................................... .............. .............. 1 2 3 6 10 ---------------- 10811358 -------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 22859]] Table 7B.--Medicare Prospective Payment System, Selected Percentile Lengths of Stay [FY2000 MEDPAR update 12/00 Grouper V19.0] -------------------------------------------------------------------------------------------------------------------------------------------------------- Number Arithmetic 10th 25th 50th 75th 90th DRG discharges mean LOS percentile percentile percentile percentile percentile -------------------------------------------------------------------------------------------------------------------------------------------------------- 1....................................... 33822 8.9935 2 3 6 12 19 2....................................... 6772 9.9778 3 5 8 13 20 3....................................... 2 43.5000 35 35 52 52 52 4....................................... 6035 7.1639 1 2 5 9 15 5....................................... 93311 3.1649 1 1 2 3 7 6....................................... 366 2.9672 1 1 2 4 6 7....................................... 12470 9.9739 2 4 7 12 20 8....................................... 4164 3.2759 1 1 2 4 7 9....................................... 1610 6.3491 1 3 5 8 13 10...................................... 17577 6.5503 2 3 5 8 13 11...................................... 3128 4.0767 1 2 3 5 8 12...................................... 46758 5.8962 2 3 4 7 11 13...................................... 6415 5.2011 2 3 4 6 9 14...................................... 319523 5.8762 2 3 5 7 11 15...................................... 145366 3.5498 1 2 3 4 7 16...................................... 11155 6.0293 2 3 5 7 12 17...................................... 3519 3.3231 1 2 3 4 6 18...................................... 25961 5.4162 2 3 4 7 10 19...................................... 8638 3.6972 1 2 3 5 7 20...................................... 5629 10.1482 3 5 8 13 20 21...................................... 1309 6.5516 2 3 5 8 13 22...................................... 2535 4.8174 1 2 4 6 9 23...................................... 9464 4.1855 1 2 3 5 8 24...................................... 52753 4.9830 1 2 4 6 10 25...................................... 25370 3.2236 1 2 3 4 6 26...................................... 31 2.7097 1 1 2 3 6 27...................................... 3441 5.0584 1 1 3 6 11 28...................................... 11316 6.2100 1 3 5 8 13 29...................................... 4486 3.6097 1 2 3 5 7 30...................................... 1 1.0000 1 1 1 1 1 31...................................... 3488 4.4903 1 2 3 5 8 32...................................... 1738 2.5621 1 1 2 3 5 33...................................... 1 1.0000 1 1 1 1 1 34...................................... 20249 5.0786 1 2 4 6 10 35...................................... 5728 3.3959 1 2 3 4 6 36...................................... 3190 1.4649 1 1 1 1 2 37...................................... 1452 4.0296 1 1 2 5 9 38...................................... 102 2.6569 1 1 2 3 5 39...................................... 912 1.9079 1 1 1 2 4 40...................................... 1545 3.4252 1 1 2 4 7 42...................................... 2223 2.2852 1 1 1 3 5 43...................................... 85 3.1882 1 2 3 4 6 44...................................... 1238 4.9548 2 3 4 6 9 45...................................... 2444 3.1678 1 2 3 4 6 46...................................... 3051 4.6834 1 2 4 6 9 47...................................... 1281 3.2560 1 1 3 4 6 49...................................... 2241 4.8104 1 2 3 6 9 50...................................... 2488 1.9425 1 1 1 2 3 51...................................... 203 2.6995 1 1 1 2 6 52...................................... 220 1.9318 1 1 1 2 3 53...................................... 2478 3.5557 1 1 2 4 8 54...................................... 2 1.5000 1 1 2 2 2 55...................................... 1505 2.7442 1 1 1 3 6 56...................................... 503 2.7256 1 1 2 3 5 57...................................... 708 3.9492 1 1 2 5 9 59...................................... 107 2.7850 1 1 2 3 5 60...................................... 2 3.5000 2 2 5 5 5 61...................................... 231 5.0996 1 1 2 6 12 62...................................... 3 1.3333 1 1 1 2 2 63...................................... 3003 4.4409 1 2 3 5 9 64...................................... 3033 6.1800 1 2 4 8 13 65...................................... 34466 2.8420 1 1 2 4 5 66...................................... 6978 3.1635 1 1 2 4 6 67...................................... 495 3.5960 1 2 3 4 7 68...................................... 16724 4.1158 1 2 3 5 7 69...................................... 5435 3.2736 1 2 3 4 6 70...................................... 24 2.9167 1 2 2 4 5 71...................................... 82 3.8049 1 2 3 4 7 72...................................... 883 3.5663 1 2 3 4 6 73...................................... 6630 4.4065 1 2 3 6 9 [[Page 22860]] 75...................................... 39010 9.9124 3 5 7 12 19 76...................................... 38998 11.2677 3 5 9 14 21 77...................................... 2352 4.9184 1 2 4 7 10 78...................................... 32087 6.7848 3 4 6 8 11 79...................................... 169783 8.4892 3 4 7 11 16 80...................................... 9018 5.6618 2 3 5 7 10 81...................................... 4 18.2500 3 3 4 8 58 82...................................... 61883 6.9447 2 3 5 9 14 83...................................... 6446 5.5496 2 3 4 7 10 84...................................... 1508 3.3455 1 2 3 4 6 85...................................... 20572 6.3122 2 3 5 8 12 86...................................... 2118 3.6643 1 2 3 5 7 87...................................... 60110 6.2840 1 3 5 8 12 88...................................... 389694 5.1207 2 3 4 6 9 89...................................... 525838 5.9470 2 3 5 7 11 90...................................... 53895 4.1549 2 3 4 5 7 91...................................... 54 4.5185 2 2 3 5 10 92...................................... 13774 6.3499 2 3 5 8 12 93...................................... 1672 4.0353 1 2 3 5 7 94...................................... 12030 6.2988 2 3 5 8 12 95...................................... 1595 3.7179 1 2 3 5 7 96...................................... 61986 4.6292 2 3 4 6 8 97...................................... 31444 3.6560 1 2 3 5 7 98...................................... 18 4.2222 1 2 2 4 6 99...................................... 18996 3.1991 1 1 2 4 6 100..................................... 7619 2.1869 1 1 2 3 4 101..................................... 19997 4.3938 1 2 3 5 9 102..................................... 5146 2.6570 1 1 2 3 5 103..................................... 475 46.6021 9 13 25 60 98 104..................................... 19650 14.1922 6 8 12 17 25 105..................................... 25952 9.7562 4 6 8 11 17 106..................................... 3401 11.4963 5 7 10 14 20 107..................................... 87868 10.3783 5 7 9 12 17 108..................................... 6047 10.2128 3 5 8 13 19 109..................................... 60265 7.6926 4 5 6 9 12 110..................................... 52587 9.2019 2 5 7 11 18 111..................................... 8545 4.7604 1 2 5 6 8 113..................................... 42250 12.1885 3 6 9 15 24 114..................................... 8712 8.3768 2 4 7 10 16 115..................................... 14329 8.1687 1 4 7 11 16 116..................................... 91838 4.4683 1 2 3 6 9 117..................................... 3717 4.1512 1 1 2 5 9 118..................................... 7667 2.6849 1 1 1 3 6 119..................................... 1307 4.8829 1 1 3 6 12 120..................................... 37500 8.5321 1 2 6 11 19 121..................................... 162112 6.3821 2 3 5 8 12 122..................................... 78969 3.7027 1 2 3 5 7 123..................................... 40659 4.5833 1 1 3 6 11 124..................................... 132801 4.3427 1 2 3 5 8 125..................................... 80169 2.7657 1 1 2 4 5 126..................................... 5150 11.6882 3 6 9 14 22 127..................................... 678903 5.2745 2 3 4 7 10 128..................................... 9424 5.6175 2 4 5 7 9 129..................................... 4140 2.7621 1 1 1 3 6 130..................................... 86009 5.6760 2 3 5 7 10 131..................................... 28236 4.2426 1 2 4 6 7 132..................................... 147648 3.0002 1 1 2 4 6 133..................................... 8321 2.3367 1 1 2 3 4 134..................................... 36118 3.2406 1 2 3 4 6 135..................................... 7266 4.5531 1 2 3 6 9 136..................................... 1221 2.7158 1 1 2 3 5 138..................................... 194087 3.9932 1 2 3 5 8 139..................................... 82604 2.5072 1 1 2 3 5 140..................................... 69724 2.6533 1 1 2 3 5 141..................................... 90403 3.6691 1 2 3 5 7 142..................................... 45776 2.6508 1 1 2 3 5 143..................................... 203918 2.1253 1 1 2 3 4 144..................................... 81577 5.3196 1 2 4 7 11 145..................................... 7224 2.7460 1 1 2 3 5 146..................................... 10683 10.2826 5 7 9 12 17 [[Page 22861]] 147..................................... 2629 6.4196 3 5 6 8 9 148..................................... 129247 12.1904 5 7 10 15 22 149..................................... 18462 6.5184 4 5 6 8 9 150..................................... 19795 11.2770 4 7 10 14 20 151..................................... 4814 5.8286 2 3 5 8 10 152..................................... 4381 8.1438 3 5 7 9 14 153..................................... 2083 5.3711 3 4 5 7 8 154..................................... 28660 13.1491 4 7 10 16 25 155..................................... 6596 4.2179 1 2 3 6 8 156..................................... 4 7.5000 1 1 5 6 18 157..................................... 7903 5.3790 1 2 4 7 11 158..................................... 4630 2.5395 1 1 2 3 5 159..................................... 16309 4.9926 1 2 4 6 10 160..................................... 11655 2.6619 1 1 2 3 5 161..................................... 11119 4.2027 1 1 3 5 9 162..................................... 7199 1.9267 1 1 1 2 4 163..................................... 5 4.4000 1 1 3 4 13 164..................................... 4824 8.4279 4 5 7 10 15 165..................................... 2066 4.8049 2 3 5 6 8 166..................................... 3532 5.0337 2 2 4 6 10 167..................................... 3269 2.5990 1 2 2 3 5 168..................................... 1327 4.7641 1 2 3 6 10 169..................................... 834 2.3405 1 1 2 3 5 170..................................... 10975 11.1690 2 5 8 14 22 171..................................... 1284 4.6597 1 2 4 6 9 172..................................... 30412 6.9363 2 3 5 9 14 173..................................... 2685 3.6648 1 1 3 5 7 174..................................... 240400 4.7974 2 3 4 6 9 175..................................... 32375 2.9414 1 2 3 4 5 176..................................... 15101 5.2286 2 3 4 6 10 177..................................... 9190 4.5348 2 2 4 6 8 178..................................... 3597 3.0703 1 2 3 4 6 179..................................... 12291 5.9729 2 3 5 7 11 180..................................... 85599 5.3567 2 3 4 7 10 181..................................... 26315 3.4185 1 2 3 4 6 182..................................... 243506 4.3356 1 2 3 5 8 183..................................... 83969 2.9155 1 1 2 4 5 184..................................... 79 2.9620 1 2 2 4 6 185..................................... 4760 4.5210 1 2 3 6 9 186..................................... 3 9.3333 1 1 9 18 18 187..................................... 646 3.9164 1 1 3 5 8 188..................................... 75558 5.5580 1 2 4 7 11 189..................................... 11984 3.1542 1 1 2 4 6 190..................................... 49 7.0204 2 3 4 5 8 191..................................... 8867 13.7982 4 6 10 17 27 192..................................... 1105 6.5122 2 4 6 8 11 193..................................... 5258 12.5369 5 7 10 16 22 194..................................... 718 6.7869 2 4 6 8 12 195..................................... 4327 10.1470 4 6 9 12 17 196..................................... 1162 5.7212 2 4 5 7 10 197..................................... 18754 8.9335 3 5 7 11 16 198..................................... 5751 4.5416 2 3 4 6 8 199..................................... 1704 9.5827 2 4 7 13 20 200..................................... 1063 10.3518 1 3 7 13 22 201..................................... 1430 13.8098 3 6 11 18 27 202..................................... 25975 6.4045 2 3 5 8 13 203..................................... 29017 6.6364 2 3 5 9 13 204..................................... 57319 5.7964 2 3 4 7 11 205..................................... 22900 6.1735 2 3 5 8 12 206..................................... 1948 3.9168 1 2 3 5 7 207..................................... 30817 5.0832 1 2 4 6 10 208..................................... 10061 2.8946 1 1 2 4 6 209..................................... 343375 5.0786 3 3 4 6 8 210..................................... 120891 6.8189 3 4 6 8 11 211..................................... 31665 4.9325 3 4 4 6 7 212..................................... 6 13.5000 1 4 4 29 29 213..................................... 9144 8.9604 2 4 7 11 18 216..................................... 5956 9.6949 2 4 8 12 20 217..................................... 16333 13.1971 3 5 9 16 28 218..................................... 21296 5.4123 2 3 4 7 10 [[Page 22862]] 219..................................... 19530 3.2240 1 2 3 4 6 220..................................... 6 4.0000 1 1 3 7 7 223..................................... 13251 2.8497 1 1 2 3 6 224..................................... 11112 1.9343 1 1 2 2 3 225..................................... 5734 4.8575 1 2 3 6 11 226..................................... 5148 6.5874 1 2 4 8 14 227..................................... 4695 2.7242 1 1 2 3 5 228..................................... 2340 3.7970 1 1 2 5 8 229..................................... 1108 2.4838 1 1 2 3 5 230..................................... 2365 5.2592 1 2 3 6 11 231..................................... 11343 4.9395 1 2 3 6 11 232..................................... 807 2.8872 1 1 1 3 7 233..................................... 5059 7.5181 2 3 6 10 15 234..................................... 3168 3.4419 1 1 3 4 7 235..................................... 5036 5.0473 1 2 4 6 9 236..................................... 38265 4.8164 1 3 4 6 9 237..................................... 1687 3.5033 1 2 3 4 6 238..................................... 7930 8.5212 3 4 6 10 16 239..................................... 49088 6.2151 2 3 5 8 12 240..................................... 11318 6.6744 2 3 5 8 13 241..................................... 3168 3.8570 1 2 3 5 7 242..................................... 2434 6.6348 2 3 5 8 13 243..................................... 87407 4.6676 1 2 4 6 9 244..................................... 12162 4.8047 1 2 4 6 9 245..................................... 5130 3.4458 1 2 3 4 6 246..................................... 1386 3.8117 1 2 3 5 7 247..................................... 16832 3.3990 1 1 3 4 7 248..................................... 10529 4.8161 1 2 4 6 9 249..................................... 11336 3.6591 1 1 2 4 8 250..................................... 3456 4.1062 1 2 3 5 7 251..................................... 2406 2.8579 1 1 2 4 5 253..................................... 19677 4.7732 1 3 4 6 9 254..................................... 10449 3.1906 1 2 3 4 6 255..................................... 1 3.0000 3 3 3 3 3 256..................................... 6054 5.0766 1 2 4 6 10 257..................................... 16333 2.7359 1 1 2 3 5 258..................................... 15978 1.9342 1 1 2 2 3 259..................................... 3773 2.6801 1 1 1 2 6 260..................................... 4896 1.4167 1 1 1 2 2 261..................................... 1844 2.2749 1 1 1 3 5 262..................................... 612 3.9477 1 1 3 5 8 263..................................... 18146 12.0208 3 5 8 14 24 264..................................... 3608 7.4088 2 4 6 9 14 265..................................... 3681 6.8036 1 2 4 8 14 266..................................... 2698 3.3039 1 1 2 4 7 267..................................... 233 4.2060 1 1 3 6 9 268..................................... 878 3.4989 1 1 2 4 7 269..................................... 7390 8.2441 1 3 6 10 17 270..................................... 2623 3.5783 1 1 2 5 8 271..................................... 9621 7.6144 2 4 6 9 14 272..................................... 5459 6.1597 2 3 5 8 12 273..................................... 1286 4.0420 1 2 3 5 8 274..................................... 2334 6.5900 1 3 5 8 13 275..................................... 246 4.3130 1 1 3 5 9 276..................................... 1177 4.6669 1 2 4 6 8 277..................................... 85183 5.7309 2 3 5 7 10 278..................................... 33396 4.4205 2 3 4 6 8 279..................................... 3 2.3333 1 1 2 4 4 280..................................... 15577 4.1954 1 2 3 5 8 281..................................... 7128 3.0464 1 1 3 4 6 282..................................... 3 1.6667 1 1 2 2 2 283..................................... 5629 4.5756 1 2 4 6 9 284..................................... 1868 3.1124 1 1 2 4 6 285..................................... 6195 10.3080 3 5 8 13 20 286..................................... 2070 6.4396 2 3 5 7 13 287..................................... 5676 10.5374 3 5 7 12 21 288..................................... 2639 5.7704 2 3 4 6 9 289..................................... 4765 3.0002 1 1 2 3 7 290..................................... 8753 2.3103 1 1 2 2 4 291..................................... 65 1.8462 1 1 1 2 3 [[Page 22863]] 292..................................... 4654 10.4850 2 4 8 13 21 293..................................... 624 5.5096 1 2 4 7 12 294..................................... 87857 4.6066 1 2 4 6 9 295..................................... 3277 3.7376 1 2 3 5 7 296..................................... 235003 5.1556 2 2 4 6 10 297..................................... 43573 3.4124 1 2 3 4 6 298..................................... 86 2.8256 1 1 2 3 5 299..................................... 1178 5.2199 1 2 4 7 10 300..................................... 15999 6.1363 2 3 5 8 12 301..................................... 3208 3.6234 1 2 3 4 7 302..................................... 7703 8.8384 4 5 7 10 15 303..................................... 19452 8.4231 4 5 7 10 15 304..................................... 11765 8.7340 2 4 6 11 18 305..................................... 2984 3.6384 1 2 3 5 7 306..................................... 7320 5.6291 1 2 3 8 13 307..................................... 2082 2.2517 1 1 2 3 4 308..................................... 7463 6.1733 1 2 4 8 14 309..................................... 4096 2.2954 1 1 2 3 4 310..................................... 23873 4.4002 1 1 3 6 10 311..................................... 7963 1.8339 1 1 1 2 3 312..................................... 1487 4.4654 1 1 3 6 10 313..................................... 591 2.3316 1 1 1 3 5 315..................................... 30147 7.0663 1 1 4 9 16 316..................................... 104601 6.6228 2 3 5 8 13 317..................................... 1507 2.8779 1 1 2 3 6 318..................................... 5584 5.9979 1 3 5 8 12 319..................................... 422 2.7725 1 1 2 3 6 320..................................... 186678 5.3171 2 3 4 6 10 321..................................... 30428 3.7951 1 2 3 5 7 322..................................... 61 4.1475 2 2 3 5 8 323..................................... 17241 3.2172 1 1 2 4 7 324..................................... 7479 1.8826 1 1 1 2 3 325..................................... 8160 3.8241 1 2 3 5 7 326..................................... 2676 2.6648 1 1 2 3 5 327..................................... 11 3.0909 1 1 3 4 5 328..................................... 663 3.6305 1 1 3 5 8 329..................................... 77 2.0130 1 1 1 2 4 331..................................... 46045 5.5426 1 3 4 7 11 332..................................... 4930 3.2917 1 1 2 4 7 333..................................... 281 5.0569 1 2 4 6 10 334..................................... 8654 4.4386 2 3 4 5 7 335..................................... 10721 3.1791 2 2 3 4 5 336..................................... 9563 3.7848 1 2 3 4 8 337..................................... 3041 2.1500 1 1 2 3 3 338..................................... 1226 5.1117 1 2 3 7 11 339..................................... 1344 4.9821 1 1 3 7 12 340..................................... 1 1.0000 1 1 1 1 1 341..................................... 2738 3.1088 1 1 1 3 6 342..................................... 298 3.4094 1 1 2 4 7 344..................................... 3502 2.3829 1 1 1 2 5 345..................................... 410 5.1244 1 2 3 6 10 346..................................... 4441 5.8726 1 3 4 7 12 347..................................... 365 2.9479 1 1 2 4 6 350..................................... 6270 4.3933 1 2 4 5 8 352..................................... 756 3.9577 1 2 3 5 8 353..................................... 2533 6.4212 2 3 5 7 12 354..................................... 7562 5.8375 3 3 4 7 11 355..................................... 5504 3.2862 2 3 3 4 5 356..................................... 25128 2.2924 1 1 2 3 4 357..................................... 5548 8.4874 3 4 7 10 16 358..................................... 20294 4.3121 2 3 3 5 7 359..................................... 29890 2.7295 2 2 3 3 4 360..................................... 15941 2.8557 1 2 2 3 5 361..................................... 378 2.9233 1 1 2 3 5 363..................................... 2862 3.4693 1 2 2 3 7 364..................................... 1644 3.8534 1 1 3 5 8 365..................................... 1722 7.2410 1 3 5 9 16 366..................................... 4410 6.7329 1 3 5 8 14 367..................................... 583 3.0617 1 1 2 4 6 368..................................... 3110 6.4810 2 3 5 8 12 [[Page 22864]] 369..................................... 3133 3.2515 1 1 2 4 7 370..................................... 1095 5.8429 3 3 4 5 10 371..................................... 1307 3.6526 2 3 3 4 5 372..................................... 927 3.2891 1 2 2 3 5 373..................................... 3734 2.2499 1 2 2 3 3 374..................................... 120 3.1583 1 2 2 3 4 375..................................... 10 2.3000 1 2 2 3 4 376..................................... 247 3.0931 1 2 2 4 6 377..................................... 48 5.0000 1 1 3 6 12 378..................................... 157 2.4140 1 1 2 3 4 379..................................... 337 3.4303 1 1 2 4 6 380..................................... 58 2.1207 1 1 1 2 5 381..................................... 152 2.5132 1 1 1 3 5 382..................................... 45 1.2889 1 1 1 1 2 383..................................... 1707 3.5817 1 1 2 4 7 384..................................... 114 2.1842 1 1 1 3 5 385..................................... 1 1.0000 1 1 1 1 1 389..................................... 15 11.7333 1 3 6 10 24 390..................................... 14 4.0000 1 2 3 6 7 391..................................... 1 4.0000 4 4 4 4 4 392..................................... 2323 9.6750 3 4 7 12 20 394..................................... 1870 7.1428 1 2 4 8 16 395..................................... 86911 4.4001 1 2 3 6 9 396..................................... 15 4.6667 1 2 4 6 7 397..................................... 17554 5.1878 1 2 4 7 10 398..................................... 17526 5.9417 2 3 5 7 11 399..................................... 1721 3.5758 1 2 3 5 7 400..................................... 6444 9.1189 1 3 6 12 20 401..................................... 5581 11.2575 2 5 9 15 23 402..................................... 1498 4.1128 1 1 3 6 9 403..................................... 31732 8.0627 2 3 6 10 17 404..................................... 4639 4.2720 1 2 3 6 9 406..................................... 2513 9.8607 3 4 7 12 20 407..................................... 720 4.4417 1 2 4 5 8 408..................................... 2178 8.0317 1 2 5 10 18 409..................................... 2822 5.9072 2 3 4 6 12 410..................................... 33412 3.9069 1 2 4 5 6 411..................................... 13 2.3077 1 1 2 2 5 412..................................... 29 2.4483 1 1 2 3 4 413..................................... 6419 7.0662 2 3 5 9 14 414..................................... 767 4.2529 1 2 3 5 9 415..................................... 38683 14.2779 4 6 11 18 28 416..................................... 183557 7.3848 2 4 6 9 14 417..................................... 16 5.0000 2 2 4 6 9 418..................................... 22822 6.1160 2 3 5 7 11 419..................................... 15294 4.7204 2 2 4 6 9 420..................................... 3109 3.5002 1 2 3 4 6 421..................................... 11464 3.7872 1 2 3 5 7 422..................................... 80 3.0625 1 2 3 4 6 423..................................... 7452 8.1162 2 3 6 10 16 424..................................... 1275 13.4204 2 5 9 16 26 425..................................... 15710 3.9945 1 2 3 5 8 426..................................... 4443 4.4510 1 2 3 5 9 427..................................... 1633 4.6418 1 2 3 6 9 428..................................... 835 6.8192 1 2 4 8 14 429..................................... 25967 6.3055 2 3 5 7 12 430..................................... 58669 8.0151 2 3 6 10 16 431..................................... 313 6.2045 1 3 5 7 11 432..................................... 469 4.7271 1 2 3 5 9 433..................................... 5418 3.0945 1 1 2 4 6 439..................................... 1343 8.4080 1 3 5 10 19 440..................................... 5131 9.0209 2 3 6 11 20 441..................................... 601 3.2313 1 1 2 4 7 442..................................... 15366 8.4839 1 3 6 10 18 443..................................... 3730 3.4399 1 1 3 4 7 444..................................... 5185 4.1338 1 2 3 5 8 445..................................... 2427 2.9250 1 1 2 4 5 447..................................... 5451 2.4748 1 1 2 3 5 449..................................... 28048 3.7457 1 1 3 5 8 450..................................... 6867 2.0051 1 1 1 2 4 [[Page 22865]] 451..................................... 3 1.3333 1 1 1 2 2 452..................................... 22666 4.8553 1 2 3 6 10 453..................................... 5068 2.8035 1 1 2 3 6 454..................................... 3940 4.5652 1 2 3 5 9 455..................................... 931 2.5994 1 1 2 3 5 461..................................... 3490 4.3739 1 1 2 5 11 462..................................... 12994 11.2271 4 6 9 14 21 463..................................... 21790 4.1239 1 2 3 5 8 464..................................... 6533 2.9963 1 1 2 4 6 465..................................... 154 3.4481 1 1 2 4 7 466..................................... 1470 3.9925 1 1 2 5 9 467..................................... 534 3.8390 1 1 2 4 8 468..................................... 56874 12.7662 3 6 10 16 25 471..................................... 11639 5.5322 3 4 4 6 9 473..................................... 7599 12.5038 1 3 7 18 32 475..................................... 107089 11.1800 2 5 9 15 22 476..................................... 4126 10.8924 2 5 9 14 21 477..................................... 24823 8.1004 1 3 6 11 17 478..................................... 106997 7.3166 1 3 5 9 15 479..................................... 24939 3.5376 1 1 3 5 7 480..................................... 540 20.1370 7 9 13 25 43 481..................................... 377 23.9310 10 18 22 27 38 482..................................... 5686 12.9474 4 7 10 15 25 483..................................... 42087 39.0295 14 22 33 49 70 484..................................... 313 12.6773 2 6 10 17 26 485..................................... 2880 9.5955 4 5 7 11 18 486..................................... 1856 12.4402 1 5 10 16 25 487..................................... 3339 7.3612 1 3 6 10 15 488..................................... 770 17.0078 3 7 13 22 36 489..................................... 14005 8.4383 2 3 6 10 17 490..................................... 5378 5.3405 1 2 4 6 10 491..................................... 12205 3.4483 2 2 3 4 6 492..................................... 2672 15.6662 3 5 8 25 34 493..................................... 54859 5.7621 1 3 5 7 11 494..................................... 29900 2.4482 1 1 2 3 5 495..................................... 153 15.0261 7 9 12 18 26 496..................................... 1468 9.5320 4 5 7 12 19 497..................................... 17184 6.5116 3 4 5 7 11 498..................................... 12708 4.1701 2 3 4 5 6 499..................................... 30284 4.6986 1 2 3 6 9 500..................................... 43962 2.6146 1 1 2 3 5 501..................................... 2180 10.9670 4 6 8 13 21 502..................................... 586 6.5648 3 4 5 8 11 503..................................... 5551 3.9996 1 2 3 5 7 504..................................... 114 29.5877 9 14 24 41 54 505..................................... 145 3.3517 1 1 1 3 7 506..................................... 915 17.4000 4 8 14 22 35 507..................................... 290 8.2621 2 4 7 11 18 508..................................... 657 7.4718 2 3 5 9 15 509..................................... 176 4.5455 1 2 4 6 9 510..................................... 1619 7.1779 2 3 5 9 15 511..................................... 602 4.7591 1 2 3 6 10 512..................................... 328 15.2439 7 8 11 17 28 513..................................... 112 12.6161 6 7 8 12 20 514..................................... 16927 7.9786 2 3 6 10 16 515..................................... 3774 6.0297 1 1 4 8 14 516..................................... 75742 4.7497 2 2 4 6 9 517..................................... 171198 2.7066 1 1 2 3 6 518..................................... 47731 3.4397 1 1 2 4 8 519..................................... 5448 4.7412 1 2 3 6 11 520..................................... 10509 2.7887 1 1 2 3 6 521..................................... 22732 5.0204 1 2 4 6 9 522..................................... 11649 9.7928 3 5 8 12 20 523..................................... 14818 4.1079 1 2 3 5 7 ---------------- 10916166 -------------------------------------------------------------------------------------------------------------------------------------------------------- [[Page 22866]] Table 8A.--Statewide Average Operating Cost-to-Charge Ratios for Urban and Rural Hospitals (Case Weighted) March 2001 ------------------------------------------------------------------------ State Urban Rural ------------------------------------------------------------------------ ALABAMA............................................. 0.344 0.410 ALASKA.............................................. 0.417 0.696 ARIZONA............................................. 0.356 0.491 ARKANSAS............................................ 0.466 0.446 CALIFORNIA.......................................... 0.339 0.436 COLORADO............................................ 0.422 0.577 CONNECTICUT......................................... 0.497 0.506 DELAWARE............................................ 0.511 0.450 DISTRICT OF COLUMBIA................................ 0.508 ........ FLORIDA............................................. 0.352 0.369 GEORGIA............................................. 0.459 0.470 HAWAII.............................................. 0.413 0.554 IDAHO............................................... 0.545 0.561 ILLINOIS............................................ 0.406 0.502 INDIANA............................................. 0.524 0.533 IOWA................................................ 0.486 0.612 KANSAS.............................................. 0.421 0.635 KENTUCKY............................................ 0.479 0.492 LOUISIANA........................................... 0.410 0.488 MAINE............................................... 0.615 0.543 MARYLAND............................................ 0.759 0.819 MASSACHUSETTS....................................... 0.512 0.571 MICHIGAN............................................ 0.460 0.563 MINNESOTA........................................... 0.494 0.589 MISSISSIPPI......................................... 0.452 0.447 MISSOURI............................................ 0.405 0.479 MONTANA............................................. 0.537 0.594 NEBRASKA............................................ 0.449 0.610 NEVADA.............................................. 0.306 0.498 NEW HAMPSHIRE....................................... 0.549 0.581 NEW JERSEY.......................................... 0.394 ........ NEW MEXICO.......................................... 0.466 0.491 NEW YORK............................................ 0.528 0.609 NORTH CAROLINA...................................... 0.516 0.464 NORTH DAKOTA........................................ 0.620 0.654 OHIO................................................ 0.501 0.570 OKLAHOMA............................................ 0.409 0.494 OREGON.............................................. 0.613 0.595 PENNSYLVANIA........................................ 0.398 0.525 PUERTO RICO......................................... 0.486 0.583 RHODE ISLAND........................................ 0.520 ........ SOUTH CAROLINA...................................... 0.440 0.463 SOUTH DAKOTA........................................ 0.529 0.638 TENNESSEE........................................... 0.438 0.453 TEXAS............................................... 0.402 0.494 UTAH................................................ 0.497 0.586 VERMONT............................................. 0.572 0.599 VIRGINIA............................................ 0.454 0.494 WASHINGTON.......................................... 0.583 0.638 WEST VIRGINIA....................................... 0.568 0.527 WISCONSIN........................................... 0.525 0.611 WYOMING............................................. 0.522 0.717 ------------------------------------------------------------------------ Table 8B.--Statewide Average Capital Cost-to-Charge Ratios (Case Weighted) March 2001 ------------------------------------------------------------------------ State Ratio ------------------------------------------------------------------------ ALABAMA....................................................... 0.044 ALASKA........................................................ 0.058 ARIZONA....................................................... 0.037 ARKANSAS...................................................... 0.049 CALIFORNIA.................................................... 0.034 COLORADO...................................................... 0.045 CONNECTICUT................................................... 0.036 DELAWARE...................................................... 0.051 DISTRICT OF COLUMBIA.......................................... 0.040 FLORIDA....................................................... 0.043 GEORGIA....................................................... 0.051 HAWAII........................................................ 0.038 IDAHO......................................................... 0.046 ILLINOIS...................................................... 0.040 INDIANA....................................................... 0.056 IOWA.......................................................... 0.050 KANSAS........................................................ 0.050 KENTUCKY...................................................... 0.046 LOUISIANA..................................................... 0.048 MAINE......................................................... 0.040 MARYLAND...................................................... 0.013 MASSACHUSETTS................................................. 0.053 MICHIGAN...................................................... 0.044 MINNESOTA..................................................... 0.047 MISSISSIPPI................................................... 0.044 MISSOURI...................................................... 0.044 MONTANA....................................................... 0.058 NEBRASKA...................................................... 0.054 NEVADA........................................................ 0.030 NEW HAMPSHIRE................................................. 0.061 NEW JERSEY.................................................... 0.036 NEW MEXICO.................................................... 0.045 NEW YORK...................................................... 0.051 NORTH CAROLINA................................................ 0.046 NORTH DAKOTA.................................................. 0.072 OHIO.......................................................... 0.048 OKLAHOMA...................................................... 0.046 OREGON........................................................ 0.046 PENNSYLVANIA.................................................. 0.039 PUERTO RICO................................................... 0.045 RHODE ISLAND.................................................. 0.029 SOUTH CAROLINA................................................ 0.046 SOUTH DAKOTA.................................................. 0.059 TENNESSEE..................................................... 0.049 TEXAS......................................................... 0.046 UTAH.......................................................... 0.047 VERMONT....................................................... 0.052 VIRGINIA...................................................... 0.055 WASHINGTON.................................................... 0.063 WEST VIRGINIA................................................. 0.045 WISCONSIN..................................................... 0.051 WYOMING....................................................... 0.065 ------------------------------------------------------------------------ Appendix A--Regulatory Impact Analysis I. Introduction We generally prepare a regulatory flexibility analysis that is consistent with the Regulatory Flexibility Act (RFA) (5 U.S.C. 601 through 612), unless we certify that a proposed rule would not have a significant economic impact on a substantial number of small entities. For purposes of the RFA, we consider all hospitals to be small entities. We estimate the total impact of these changes for FY 2002 payments compared to FY 2001 payments to be approximately a $1.7 billion increase. Therefore, we have prepared an impact analysis for this proposed rule. Also, section 1102(b) of the Act requires us to prepare a regulatory impact analysis for any proposed rule that may have a significant impact on the operations of a substantial number of small rural hospitals. Such an analysis must conform to the provisions of section 603 of the RFA. With the exception of hospitals located in certain New England counties, for purposes of section 1102(b) of the Act, we define a small rural hospital as a hospital with fewer than 100 beds that is located outside of a Metropolitan Statistical Area (MSA) or New England County Metropolitan Area (NECMA). Section 601(g) of the Social Security Amendments of 1983 (Public Law 98-21) designated hospitals in certain New England counties as belonging to the adjacent NECMA. Thus, for purposes of the hospital inpatient prospective payment systems, we classify these hospitals as urban hospitals. It is clear that the changes being proposed in this document would affect both a substantial number of small rural hospitals as well as other classes of hospitals, and the effects on some may be significant. Therefore, the discussion below, in combination with the rest of this proposed rule, constitutes a combined regulatory impact analysis and regulatory flexibility analysis. We have reviewed this proposed rule under the threshold criteria of Executive Order 13132, Federalism, and have determined that the proposed rule will not have any negative impact on the rights, roles, and responsibilities of State, local, or tribal governments. Section 202 of the Unfunded Mandate Reform Act of 1995 (Public Law 104-4) also requires that agencies assess anticipated costs and benefits before issuing any proposed rule (or a final rule that has been preceded by a proposed rule) that may result in an expenditure in any one year by State, local, or tribal governments, in the aggregate, or by the private sector, of $110 million. This proposed rule would not mandate any requirements for State, local, or tribal governments. In accordance with the provisions of Executive Order 12866, this proposed rule was reviewed by the Office of Management and Budget. II. Objectives The primary objective of the hospital inpatient prospective payment system is to create incentives for hospitals to operate efficiently and minimize unnecessary costs while at the same time ensuring that payments are sufficient to adequately compensate hospitals for their legitimate costs. In addition, we share national goals of preserving the Medicare Trust Fund. We believe the proposed changes would further each of these goals while maintaining the financial viability of the hospital industry and ensuring access to high quality health care for Medicare beneficiaries. We expect that these proposed changes would ensure that the outcomes of this payment system are reasonable and equitable while avoiding or minimizing unintended adverse consequences. III. Limitations of Our Analysis As has been the case in our previously published regulatory impact analyses, the following quantitative analysis presents the projected effects of our proposed policy changes, as well as statutory changes [[Page 22867]] effective for FY 2002, on various hospital groups. We estimate the effects of individual policy changes by estimating payments per case while holding all other payment policies constant. We use the best data available, but we do not attempt to predict behavioral responses to our policy changes, and we do not make adjustments for future changes in such variables as admissions, lengths of stay, or case-mix. As we have done in previous proposed rules, we are soliciting comments and information about the anticipated effects of these changes on hospitals and our methodology for estimating them. IV. Hospitals Included In and Excluded From the Prospective Payment System The prospective payment systems for hospital inpatient operating and capital-related costs encompass nearly all general, short-term, acute care hospitals that participate in the Medicare program. There were 44 Indian Health Service hospitals in our database, which we excluded from the analysis due to the special characteristics of the prospective payment method for these hospitals. Among other short- term, acute care hospitals, only the 67 such hospitals in Maryland remain excluded from the prospective payment system under the waiver at section 1814(b)(3) of the Act. Thus, as of February 2001, we have included 4,583 hospitals in our analysis. This represents about 80 percent of all Medicare-participating hospitals. The majority of this impact analysis focuses on this set of hospitals. The remaining 20 percent are specialty hospitals that are excluded from the prospective payment system and continue to be paid on the basis of their reasonable costs (subject to a rate-of- increase ceiling on their inpatient operating costs per discharge). These hospitals include psychiatric, rehabilitation, long-term care, children's, and cancer hospitals. The impacts of our final policy changes on these hospitals are discussed below. V. Impact on Excluded Hospitals and Units As of February 2001, there were 1,058 specialty hospitals excluded from the prospective payment system and instead paid on a reasonable cost basis subject to the rate-of-increase ceiling under Sec. 413.40. Broken down by specialty, there were 517 psychiatric, 203 rehabilitation, 253 long-term care, 75 children's, and 10 cancer hospitals. In addition, there were 1,457 psychiatric units and 925 rehabilitation units in hospitals otherwise subject to the prospective payment system. These excluded units are also paid in accordance with Sec. 413.40. Under Sec. 413.40(a)(2)(i)(A), the rate-of-increase ceiling is not applicable to the 67 specialty hospitals and units in Maryland that are paid in accordance with the waiver at section 1814(b)(3) of the Act. As required by section 1886(b)(3)(B) of the Act, the update factor applicable to the rate-of-increase limit for excluded hospitals and units for FY 2002 would be between 0.5 and 3.0 percent, or 0 percent, depending on the hospital's or unit's costs in relation to its limit for the most recent cost reporting period for which information is available. The impact on excluded hospitals and units of the update in the rate-of-increase limit depends on the cumulative cost increases experienced by each excluded hospital or unit since its applicable base period. For excluded hospitals and units that have maintained their cost increases at a level below the percentage increases in the rate-of-increase limits since their base period, the major effect will be on the level of incentive payments these hospitals and units receive. Conversely, for excluded hospitals and units with per-case cost increases above the cumulative update in their rate- of-increase limits, the major effect will be the amount of excess costs that would not be reimbursed. We note that, under Sec. 413.40(d)(3), an excluded hospital or unit whose costs exceed 110 percent of its rate-of-increase limit receives its rate-of-increase limit plus 50 percent of the difference between its reasonable costs and 110 percent of the limit, not to exceed 110 percent of its limit. In addition, under the various provisions set forth in Sec. 413.40, certain excluded hospitals and units can obtain payment adjustments for justifiable increases in operating costs that exceed the limit. At the same time, however, by generally limiting payment increases, we continue to provide an incentive for excluded hospitals and units to restrain the growth in their spending for patient services. VI. Graduate Medical Education Impact A. National Average Per Resident Amount (PRA) As discussed in detail in section IV.G.2. of this proposed rule, we are proposing to implement section 511 of Public Law 106-554, which increases the floor of the locality-adjusted national average (PRA for the purposes of computing direct GME payments for cost reporting periods beginning during FY 2002. The national average PRA payment methodology, as provided in section 311 of Public Law 106- 113, establishes a "floor" and "ceiling" based on a locality- adjusted, updated national average PRA for cost reporting periods beginning on or after October 1, 2000 and before October 1, 2005. Section 511 of Public Law 106-554 increased the floor from 70 percent to equal 85 percent of a locality-adjusted national average PRA for FY 2002. For this purpose rule, we have calculated an estimated impact of this proposed policy on teaching hospital's PRAs for FY 2002, making assumptions about update factors and geographic adjustment factors (GAF) for each hospital. Generally, using FY 1997 data, we calculated a floor based on 70 percent of the national average PRA and a floor based on 85 percent of the national average PRA. We then determined the amount of direct GME payments that would have been paid had the floor remained at 70 percent of the national average PRA. Next, we determined the amount of direct GME payments that would be paid with the floor increased to equal 85 percent of the national average PRA. We subtracted the difference between the two and inflated the difference to FY 2002 to determine the impact of this provision. The figures we use in this impact, except for the FY 1997 weighted PRA of $68,464, are estimations and are for demonstrative purposes only. Hospitals must use the methodology stated in section IV.G. of this proposed rule to revise (if appropriate) their individual PRAs. In calculating this impact, we used Medicare cost report data for all cost reports ending in FY 1997. We excluded hospitals that file manual cost reports because we did not have access to their Medicare utilization data. We also excluded all teaching hospitals in Maryland, because these hospitals are paid on a Medicare waiver outside of the prospective payment system, and those hospitals' PRAs do not determine their level of direct GME payments. For hospitals that had two cost reporting periods ending in FY 1997, we used the later of the two periods. A total of 1,231 teaching hospitals were included in the analysis. Using the FY 1997 weighted average PRA of $68,464, we determined an 85 percent floor of $58,194 for FY 1997. We then determined that, for cost reporting periods ending in FY 1997, approximately 562 hospitals had PRAs that were below $58,194 (336 hospitals of these hospitals had PRAs that were below the 70-percent floor, and 226 hospitals had PRAs that were above the 70-percent floor but below the 85-percent floor). The estimated total cost to the Medicare program in FY 2002 of replacing the PRAs of the 562 hospitals with the 85-percent floor is $104.4 million. B. Closed Training Programs or Hospitals That Close Their Training Programs As discussed in IV.G.5, of this proposed rule, we are proposing to allow a hospital to receive a temporary adjustment to its FTE cap to reflect residents added because of the closure of another hospital's GME program if the hospital that closed its program agrees to temporarily reduce its FTE cap. We have calculated an estimated impact on the Medicare program for FY 2002 as a result of this proposal. We used the best available cost report data from the FY 1997 HCRIS in our analysis. We estimate that approximately 5 to 10 programs, each with an average of 25 residents, close each year without advance warning, displacing the residents before they complete their training. Therefore, the number of residents displaced each year could be between 125 and 250. We estimated the impact of this proposed change based on direct GME and IME payment amounts in FY 1997 to determine a total GME amount and updated the total with the CPI-U for FY 2002. At most, the estimated impact for this proposed provision for FY 2002 is moving payments of between $10 and $20 million among different hospitals. This would result from redirecting these payments from the hospital that closed its program to the hospital(s) that takes on the residents. VII. Quantitative Impact Analysis of the Proposed Policy Changes Under the Prospective Payment System for Operating Costs A. Basis and Methodology of Estimates In this proposed rule, we are announcing policy changes and payment rate updates for [[Page 22868]] the prospective payment systems for operating and capital-related costs. We have prepared separate impact analyses of the proposed changes to each system. This section deals with changes to the operating prospective payment system. The data used in developing the quantitative analyses presented below are taken from the FY 2000 MedPAR file and the most current provider-specific file that is used for payment purposes. Although the analyses of the changes to the operating prospective payment system do not incorporate cost data, the most recently available hospital cost report data were used to categorize hospitals. Our analysis has several qualifications. First, we do not make adjustments for behavioral changes that hospitals may adopt in response to these proposed policy changes. Second, due to the interdependent nature of the prospective payment system, it is very difficult to precisely quantify the impact associated with each proposed change. Third, we draw upon various sources for the data used to categorize hospitals in the tables. In some cases, particularly the number of beds, there is a fair degree of variation in the data from different sources. We have attempted to construct these variables with the best available source overall. For individual hospitals, however, some miscategorizations are possible. Using cases in the FY 2000 MedPAR file, we simulated payments under the operating prospective payment system given various combinations of payment parameters. Any short-term, acute care hospitals not paid under the general prospective payment systems (Indian Health Service hospitals and hospitals in Maryland) are excluded from the simulations. Payments under the capital prospective payment system, or payments for costs other than inpatient operating costs, are not analyzed here. Estimated payment impacts of proposed FY 2001 changes to the capital prospective payment system are discussed in section IX. of this Appendix. The proposed changes discussed separately below are the following: The effects of the annual reclassification of diagnoses and procedures and the recalibration of the diagnosis-related group (DRG) relative weights required by section 1886(d)(4)(C) of the Act. The effects of changes in hospitals' wage index values reflecting wage data from hospitals' cost reporting periods beginning during FY 1998, compared to the FY 1997 wage data. The effects of our proposal to increase the accuracy of the wage index calculation by changing the overhead allocation method used so that the salaries and hours of lower-range, overhead employees and the overhead wage-related costs associated with the excluded areas of the hospital are more accurately removed when calculating the overhead costs attributable to wages. The effects of our proposal to include the contract labor costs of laboratories and pharmacies from Worksheet S-3 Part II Lines 9.01 and 9.02 in the wage index calculation. The combined effects of our proposed changes to the wage index data and calculations and the changes in the DRG recalibration. The effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB) that will be effective in FY 2002 not including the effects of our proposed policy to hold-harmless other hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic area as well as the area to which they are reclassified. The effects of geographic reclassifications by the MGCRB that will be effective in FY 2002 including the effects of our proposed policy to hold-harmless other hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic area as well as the area to which they are reclassified. The total change in payments based on FY 2002 policies relative to payments based on FY 2001 policies. To illustrate the impacts of the FY 2002 proposed changes, our analysis begins with a FY 2002 baseline simulation model using: the FY 2001 DRG GROUPER (version 18.0); the FY 2001 wage index; and no MGCRB reclassifications. Outlier payments are set at 5.1 percent of total DRG plus outlier payments. Each proposed and statutory policy change is then added incrementally to this baseline model, finally arriving at an FY 2002 model incorporating all of the changes. This allows us to isolate the effects of each change. Our final comparison illustrates the percent change in payments per case from FY 2001 to FY 2002. Five factors have significant impacts here. The first is the update to the standardized amounts. In accordance with section 1886(d)(3)(A)(iv) of the Act, as amended by section 301 of Public Law 106-554, we are proposing to update the large urban and the other areas average standardized amounts for FY 2002 using the most recently forecasted hospital market basket increase for FY 2002 of 3.1 percent minus 0.55 percentage points (for an update of 2.55 percent). Under section 1886(b)(3) of the Act, the updates to the hospital-specific amounts for sole community hospitals (SCHs) and for Medicare-dependent small rural hospitals (MDHs) is equal to the market basket increase of 3.1 percent minus 0.55 percentage points (for an update of 2.55 percent). A second significant factor that impacts changes in hospitals' payments per case from FY 2001 to FY 2002 is the change in MGCRB status from one year to the next. That is, hospitals reclassified in FY 2001 that are no longer reclassified in FY 2002 may have a negative payment impact going from FY 2001 to FY 2002; conversely, hospitals not reclassified in FY 2001 that are reclassified in FY 2002 may have a positive impact. In some cases, these impacts can be quite substantial, so if a relatively small number of hospitals in a particular category lose their reclassification status, the percentage change in payments for the category may be below the national mean. This effect may be alleviated somewhat by section 304(a) of Public Law 106-554, which provided that reclassifications for purposes of the wage index are for a 3 year period. A third significant factor is that we currently estimate that actual outlier payments during FY 2001 will be 5.9 percent of actual total DRG payments. When the FY 2001 final rule was published, we projected FY 2001 outlier payments would be 5.1 percent of total DRG plus outlier payments; the standardized amounts were offset correspondingly. The effects of the higher than expected outlier payments during FY 2001 (as discussed in the Addendum to this proposed rule) are reflected in the analyses below comparing our current estimates of FY 2001 payments per case to estimated FY 2002 payments per case. Fourth, section 213 of Public Law 106-554 provided that all SCHs may receive payment on the basis of their costs per case during their cost reporting period that began during 1996. For FY 2001, eligible SCHs that are rebased receive a hospital-specific rate comprised of the greater of 50-percent of the higher of their FY 1982 or FY 1987 hospital-specific rate or 50-percent of the federal rate, and 50-percent of their FY 1996 hospital-specific rate. Fifth, sections 302 and 303 of Public Law 106-554 affect payments for indirect medical education (IME) and disproportionate share hospitals (DSH), respectively. These sections increased IME and DSH payments during FY 2001 (effective with discharges on or after April 1, 2001). For FY 2002, section 302 established IME payments at the same level as FY 2001 (6.5 percent), and section 303 established DSH payments at the adjustment the hospital would otherwise receive minus 3 percent. Table I demonstrates the results of our analysis. The table categorizes hospitals by various geographic and special payment consideration groups to illustrate the varying impacts on different types of hospitals. The top row of the table shows the overall impact on the 4,795 hospitals included in the analysis. This number is 93 fewer hospitals than were included in the impact analysis in the FY 2001 final rule (65 FR 47191). The next four rows of Table I contain hospitals categorized according to their geographic location (all urban (which is further divided into large urban and other urban) and rural). There are 2,721 hospitals located in urban areas (MSAs or NECMAs) included in our analysis. Among these, there are 1,563 hospitals located in large urban areas (populations over 1 million), and 1,158 hospitals in other urban areas (populations of 1 million or fewer). In addition, there are 2,074 hospitals in rural areas. The next two groupings are by bed-size categories, shown separately for urban and rural hospitals. The final groupings by geographic location are by census divisions, also shown separately for urban and rural hospitals. The second part of Table I shows hospital groups based on hospitals' FY 2002 payment classifications, including any reclassifications under section 1886(d)(10) of the Act. For example, the rows labeled urban, large urban, other urban, and rural show that the number of hospitals paid based on these categorizations (after consideration of geographic reclassifications) are 2,766, 1,643, 1,123, and 2,029, respectively. The next three groupings examine the impacts of the proposed changes on hospitals [[Page 22869]] grouped by whether or not they have residency programs (teaching hospitals that receive an IME adjustment) or receive DSH payments, or some combination of these two adjustments. There are 3,674 non- teaching hospitals in our analysis, 881 teaching hospitals with fewer than 100 residents, and 240 teaching hospitals with 100 or more residents. In the DSH categories, hospitals are grouped according to their DSH payment status, and whether they are considered urban or rural after MGCRB reclassifications. Hospitals in the rural DSH categories, therefore, represent hospitals that were not reclassified for purposes of the standardized amount or for purposes of the DSH adjustment. (They may, however, have been reclassified for purposes of the wage index.) We note that section 211 of Public Law 106-554 reduced the qualifying DSH threshold to 15 percent for all hospitals (this threshold previously applied to urban hospitals with 100 or more beds and rural hospitals with 500 or more beds). Consequently, many more hospitals qualify for DSH. In the FY 2001 final rule, there were 3,070 hospitals that did not receive a DSH adjustment (65 FR 47192). In Table I, that number declines to 1,879. The number of urban hospitals with fewer than 100 beds receiving DSH increases from 72 prior to section 211 to 325 after its implementation. Among rural hospitals with fewer than 100 beds, 103 received DSH prior to section 211; for FY 2002 that number increases to 443. The next category groups hospitals considered urban after geographic reclassification, in terms of whether they receive the IME adjustment, the DSH adjustment, both, or neither. The next five rows examine the impacts of the proposed changes on rural hospitals by special payment groups (SCHs, rural referral centers (RRCs), and MDHs), as well as rural hospitals not receiving a special payment designation. The RRCs (165), SCHs (667), MDHs (328), and SCH and RRCs that are not included in the SCH or the RRC categories (69) shown here were not reclassified for purposes of the standardized amount. There are 20 RRCs, 1 MDH, 5 SCHs and 2 SCH and RRCs that will be reclassified as urban for the standardized amount in FY 2002 and, therefore, are not included in these rows. The next two groupings are based on type of ownership and the hospital's Medicare utilization expressed as a percent of total patient days. These data are taken primarily from the FY 1999 Medicare cost report files, if available (otherwise FY 1998 data are used). Data needed to determine ownership status or Medicare utilization percentages were unavailable for 46 and 78 hospitals, respectively. For the most part, these are new hospitals. The next series of groupings concern the geographic reclassification status of hospitals. The first grouping displays all hospitals that were reclassified by the MGCRB for FY 2002. The next two groupings separate the hospitals in the first group by urban and rural status. The final row in Table I contains hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act. Table I.--Impact Analysis of Changes for FY 2002 Operating Prospective Payment System [Percent changes in payments per case] -------------------------------------------------------------------------------------------------------------------------------------------------------- New Include All FY Number of DRG re- New wage overhead contract DRG & WI MCGRB Reclassification 2001 hosps.\1\ calib.\2\ data \3\ alloc.\4\ labor \5\ changes reclassification hold-harmless changes (0) (1) (2) (3) (4) \6\ (5) \7\ (6) policy \8\ (7) \9\ (8) -------------------------------------------------------------------------------------------------------------------------------------------------------- By Geographic Location: All hospitals............ 4,795 0.5 0.2 0.0 0.0 0.0 -0.2 0.2 1.9 Urban hospitals.......... 2,721 0.6 0.2 0.0 0.0 0.0 -0.7 0.2 1.7 Large urban areas 1,563 0.7 -0.1 0.0 0.0 -0.1 -0.8 0.3 1.5 (populations over 1 million)................ Other urban areas 1,158 0.5 0.6 0.0 0.0 0.2 -0.5 0.1 2.0 (populations of 1 million of fewer)....... Rural hospitals.......... 2,074 -0.1 0.5 0.1 0.1 -0.2 2.7 0.1 3.2 Bed Size (Urban): 0-99 beds................ 712 -0.1 0.3 0.0 0.0 -0.4 -0.8 0.2 2.1 100-199 beds............. 943 0.4 0.2 0.0 0.0 -0.2 -0.7 0.3 1.6 200-299 beds............. 530 0.6 0.3 0.0 0.1 0.1 -0.7 0.3 1.8 300-499 beds............. 391 0.7 0.1 0.0 0.0 0.0 -0.7 0.2 1.6 500 or more beds......... 145 1.0 0.0 0.0 0.0 0.2 -0.6 0.1 1.5 Bed Size (Rural): 0-49 beds................ 1,209 -0.4 0.5 0.1 0.1 -0.5 0.4 0.0 3.0 50-99 beds............... 520 -0.2 0.5 0.1 0.1 -0.4 1.1 0.0 3.3 100-149 beds............. 204 -0.1 0.6 0.1 0.1 -0.1 3.2 0.2 3.0 150-199 beds............. 75 0.1 0.4 0.1 0.1 -0.1 5.2 0.2 3.4 200 or more beds......... 66 0.3 0.4 0.1 0.1 0.0 5.2 0.1 3.6 Urban by Region: New England.............. 139 0.6 2.2 -0.1 0.0 1.3 -0.2 0.0 1.7 Middle Atlantic.......... 417 0.7 -1.2 -0.1 0.0 -1.4 -0.8 0.6 0.2 South Atlantic........... 395 0.7 0.9 0.0 0.0 0.9 -0.8 0.3 2.8 East North Central....... 462 0.5 0.1 0.0 0.1 -0.2 -0.6 0.1 1.6 East South Central....... 160 0.6 1.1 0.1 0.0 1.1 -0.7 0.0 3.0 West North Central....... 189 0.6 0.5 0.1 0.1 0.3 -0.7 0.0 2.0 West South Central....... 342 0.7 -0.8 0.0 0.0 -0.9 -0.7 0.0 0.7 Mountain................. 137 0.6 0.9 0.0 0.0 0.7 -0.7 0.0 2.4 Pacific.................. 434 0.7 0.4 0.1 0.0 0.4 -0.8 0.2 2.2 Puerto Rico.............. 46 0.4 1.3 0.1 0.0 1.0 -0.5 -0.3 2.6 Rural by Region: [[Page 22870]] New England.............. 49 0.0 0.6 0.1 0.0 -0.1 3.0 0.1 3.7 Middle Atlantic.......... 74 0.0 -0.2 0.0 0.0 -1.0 2.5 0.0 2.2 South Atlantic........... 267 0.1 0.6 0.1 0.1 0.0 2.9 0.1 3.6 East North Central....... 273 -0.2 0.6 0.0 0.1 -0.3 2.2 0.2 2.8 East South Central....... 263 0.0 0.5 0.1 0.1 -0.2 3.3 0.0 3.6 West North Central....... 479 -0.3 0.8 0.2 0.1 -0.1 2.1 0.1 2.5 West South Central....... 331 -0.1 0.7 0.1 0.1 0.0 3.5 0.1 4.2 Mountain................. 194 -0.1 0.4 0.2 0.0 -0.4 1.9 0.0 2.9 Pacific.................. 139 0.0 -0.2 0.1 0.1 -0.9 2.3 0.1 2.7 Puerto Rico.............. 5 -0.3 3.9 0.1 0.0 2.9 1.9 -0.8 8.4 By Payment Classification: Urban hospitals.......... 2,766 0.6 0.2 0.0 0.0 0.0 -0.7 0.2 1.7 Large urban areas 1,643 0.7 -0.1 0.0 0.0 -0.1 -0.7 0.3 1.5 (populations over 1 million)................ Other urban areas 1,123 0.5 0.6 0.0 0.0 0.2 -0.6 0.1 2.0 (populations of 1 million of fewer)....... Rural areas.............. 2,029 -0.1 0.5 0.1 0.1 -0.2 2.5 0.0 3.2 Teaching Status: Non-teaching............. 3,674 0.3 0.4 0.0 0.0 -0.1 0.2 0.2 2.2 Fewer than 100 Residents. 881 0.6 0.3 0.0 0.0 0.1 -0.6 0.2 1.9 100 or more Residents.... 240 1.0 -0.2 0.0 0.0 0.0 -0.5 0.1 1.3 Urban DSH: Non-DSH.................. 1,879 0.4 0.2 0.0 0.0 -0.1 -0.2 0.3 1.7 100 or more beds......... 1,378 0.7 0.2 0.0 0.0 0.1 -0.7 0.2 1.7 Less than 100 beds....... 325 0.0 0.4 0.1 0.0 -0.3 -0.8 0.3 3.3 Rural DSH: Sole Community (SCH)..... 540 -0.2 0.4 0.1 0.0 -0.5 0.4 0.0 3.1 Referral Center (RRC).... 157 0.2 0.5 0.1 0.1 0.0 5.3 0.1 3.7 Other Rural: 100 or more beds..... 73 -0.1 0.7 0.1 0.1 -0.1 1.3 0.1 3.2 Less than 100 beds... 443 -0.2 0.5 0.1 0.1 -0.4 0.6 0.0 4.3 Urban teaching and DSH: Both teaching and DSH.... 754 0.8 0.1 0.0 0.0 0.0 -0.7 0.2 1.6 Teaching and no DSH...... 295 0.7 0.2 0.0 0.1 0.0 -0.6 0.3 1.6 No teaching and DSH...... 949 0.4 0.4 0.0 0.0 0.1 -0.6 0.3 2.0 No teaching and no DSH... 768 0.3 0.2 0.0 0.0 -0.2 -0.6 0.3 1.5 Rural Hospital Types: Non special status 800 -0.3 0.7 0.1 0.1 -0.2 0.9 0.0 3.6 hospitals........... RRC.................. 165 0.2 0.5 0.1 0.1 0.0 6.3 0.1 3.6 SCH.................. 667 -0.2 0.4 0.1 0.0 -0.5 0.4 0.0 2.5 [[Page 22871]] Medicare-dependent 328 -0.3 0.5 0.1 0.1 -0.5 0.5 0.0 3.2 hospitals (MDH)..... SCH and RRC.......... 69 0.1 0.4 0.0 0.0 -0.3 2.5 0.0 2.7 Type of Ownership: Voluntary................ 2,785 0.6 0.2 0.0 0.0 -0.1 -0.3 0.2 1.8 Proprietary.............. 777 0.6 0.2 0.1 0.0 0.1 -0.3 0.2 2.0 Government............... 1,187 0.5 0.6 0.1 0.0 0.3 0.1 0.1 2.5 Unknown.................. 46 0.3 1.3 0.0 0.0 0.7 -1.7 1.0 2.6 Medicare Utilization as a Percent of Inpatient Days: 0-25................. 396 0.9 0.2 0.0 0.0 0.4 -0.5 0.1 2.2 25-50................ 1,886 0.7 0.1 0.0 0.0 0.0 -0.6 0.2 1.7 50-65................ 1,843 0.4 0.4 0.0 0.0 0.0 0.1 0.2 2.2 Over 65.............. 592 0.2 0.2 0.0 0.1 -0.2 0.2 0.3 1.9 Unknown.............. 78 0.5 -2.1 -0.1 0.0 -2.4 -0.7 0.1 -1.1 Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2002 Reclassifications: All Reclassified 636 0.3 0.6 0.0 0.1 0.2 4.5 0.3 2.9 Hospitals............... Standardized Amount 74 0.1 0.7 0.0 0.0 0.0 1.9 1.0 4.0 Only................ Wage Index Only...... 391 0.3 0.5 0.1 0.1 0.1 5.3 0.1 2.5 Both................. 58 0.4 0.7 0.0 0.1 0.4 4.1 0.6 0.0 Nonreclassified Hospitals.... 4,246 0.6 0.2 0.0 0.0 0.0 -0.8 0.2 1.9 All Reclassified Urban 119 0.7 0.8 0.0 0.1 0.6 2.8 0.4 2.0 Hospitals................... Urban Nonreclassified 18 0.2 0.5 0.0 0.0 -0.2 -1.2 1.9 -0.6 Hospitals............... Standardized Amount Only 81 0.8 0.7 0.0 0.1 0.6 3.3 0.1 2.2 Wage Index Only.......... 20 0.5 1.4 0.0 0.1 1.1 1.9 2.1 2.5 Both..................... 2,564 0.6 0.2 0.0 0.0 0.0 -0.9 0.2 1.6 All Reclassified Rural 517 0.1 0.5 0.1 0.1 -0.1 5.6 0.2 3.6 Hospitals................... Standardized Amount Only. 19 -0.2 0.5 0.1 0.0 -0.5 3.9 1.5 2.0 Wage Index Only.......... 475 0.1 0.5 0.1 0.1 -0.1 5.5 0.1 3.6 Both..................... 23 0.1 0.8 0.1 0.1 0.2 7.7 1.5 4.2 Rural Nonreclassified 1,554 -0.3 0.5 0.1 0.1 -0.4 -0.6 0.0 2.8 Hospitals................... Other Reclassified Hospitals 41 -0.1 -6.1 0.1 0.1 0.4 0.3 0.1 3.9 (Section 1886(D)(8)(B))..... -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ Because data necessary to classify some hospitals by category were missing, the total number of hospitals in each category may not equal the national total. Discharge data are from FY 2000, and hospital cost report data are from reporting periods beginning in FY 1999 and FY 1998. \2\ This column displays the payment impact of the recalibration of the DRG weights based on FY 2000 MedPAR data and the DRG reclassification changes, in accordance with section 1886(d)(4)(C) of the Act. \3\ This column shows the payment effects of updating the data used to calculate the wage index with data from the FY 1998 cost reports. \4\ This column displays the impact of removing the salaries and hours of lower-range, overhead employees and the overhead wage-related costs associated with the excluded areas of the hospital from the wage index calculation. \5\ This column displays the impact of including contract pharmacy and contract laboratory costs and hours in the wage index calculation. [[Page 22872]] \6\ This column displays the combined impact of the reclassification and recalibration of the DRGs, the updated and revised wage data used to calculate the wage index, the revised overhead allocation, the laboratory and pharmacy contract labor costs, and the budget neutrality adjustment factor for these two changes, in accordance with sections 1886(d)(4)(C)(iii) and 1886(d)(3)(E) of the Act. Thus, it represents the combined impacts shown in columns 1, 2 3, and 4, and the FY 2002 budget neutrality factor of .992394. \7\ Shown here are the effects of geographic reclassifications by the Medicare Geographic Classification Review Board (MGCRB). The effects demonstrate the FY 2002 payment impact of going from no reclassifications to the reclassifications scheduled to be in effect for FY 2002. Reclassification for prior years has no bearing on the payment impacts shown here. \8\ Shown here are the effects of geographic reclassifications by the MGCRB including the effects of our proposed policy to hold-harmless other hospitals in an urban area where certain hospitals are reclassified elsewhere by including the wage data of reclassified hospitals in their geographic area as well as the area to which they are reclassified. \9\ This column shows changes in payments from FY 2001 to FY 2002. It incorporates all of the changes displayed in columns 5, 6, and 7 (the changes displayed in columns 1, 2, 3, and 4 are included in column 5). It also displays the impact of the FY 2002 update, changes in hospitals' reclassification status in FY 2002 compared to FY 2001, and the difference in outlier payments from FY 2001 to FY 2002. It also reflects section 213 of Public Law 106-554, which permitted all SCHs to rebase for a 1996 hospital-specific rate. The sum of these columns may be different from the percentage changes shown here due to rounding and interactive effects. B. Impact of the Proposed Changes to the DRG Reclassifications and Recalibration of Relative Weights (Column 1) In column 1 of Table I, we present the combined effects of the DRG reclassifications and recalibration, as discussed in section II. of the preamble to this proposed rule. Section 1886(d)(4)(C)(i) of the Act requires us to annually make appropriate classification changes and to recalibrate the DRG weights in order to reflect changes in treatment patterns, technology, and any other factors that may change the relative use of hospital resources. We compared aggregate payments using the FY 2001 DRG relative weights (GROUPER version 18) to aggregate payments using the proposed FY 2002 DRG relative weights (GROUPER version 19). Overall payments increase 0.5 percent due to the DRG reclassification and recalibration. We note that, consistent with section 1886(d)(4)(C)(iii) of the Act, we have applied a budget neutrality factor to ensure that the overall payment impact of the DRG changes is budget neutral. This budget neutrality factor of 0.992493 is applied to payments in Column 5. The DRG changes we are proposing in this proposed rule would result in higher payments to urban hospitals (0.6 percent) and somewhat lower payments to rural hospitals (-0.1). The changes also would result in higher payments to larger hospitals than to smaller hospitals. This impact is consistent for both urban and rural bed size groups. This distributional impact likely results from the changes we are proposing to major diagnostic category (MDC) 5 "Diseases and Disorders of the Circulatory System." As described in section II., we are proposing to remove cardiac defribrillator cases from DRGs 104 and 105, and create two new DRGs for these cases. In addition, we are proposing to revise the basis of the DRG assignment for cases involving percutaneous transluminal coronary angioplasty based on whether the patient experienced an acute myocardial infarction. Because MDC 5 is a high volume category, refining the categorizations of these cases has a noticeable impact. C. Impact of Updating the Wage Data and the Proposed Changes to the Wage Index Calculation (Columns 2, 3 & 4) Section 1886(d)(3)(E) of the Act requires that, beginning October 1, 1993, we annually update the wage data used to calculate the wage index. In accordance with this requirement, the proposed wage index for FY 2002 is based on data submitted for hospital cost reporting periods beginning on or after October 1, 1997 and before October 1, 1998. As with column 1, the impact of the new data on hospital payments is isolated in column 2 by holding the other payment parameters constant in the two simulations. That is, column 2 shows the percentage changes in payments when going from a model using the FY 2001 wage index (based on FY 1997 wage data before geographic reclassifications to a model using the FY 2002 pre- reclassification wage index based on FY 1998 wage data). The wage data collected on the FY 1998 cost reports are similar to the data used in the calculation of the FY 2001 wage index. For a thorough discussion of the data used to calculate the wage index, see section III.B of this proposed rule. The results indicate that the new wage data are estimated to provide a 0.2 percent increase for hospital payments overall (prior to applying the budget neutrality factor, see column 5). Rural hospitals appear to experience the greatest benefit from the update to the 1998 wage data, with an increase of 0.5 percent. Rural hospitals in Nevada, Connecticut and Arizona experience wage index increases of more than 5 percent. Rural hospitals in Puerto Rico experience a 3.9 percent increase. Urban hospitals as a group are not significantly affected by the updated wage data. While large urban hospitals appear to experience a 0.1 percent decline, estimated payments to urban hospitals overall showed an increase of 0.2 percent. Payments in other urban areas increase by 0.6 percent. Among urban census divisions, the New England division experiences a 2.2 percent increase, Middle Atlantic a 1.2 percent decrease, East South Central a 1.1 percent increase, and Puerto Rico a 1.3 percent increase. Columns 3 and 4, respectively, show that the proposed change to the overhead calculation and the proposal to include contract labor costs in the wage index discussed in detail in Section III.C. of this proposed rule both appear to have negligible impacts on hospital payments overall. Urban hospitals as a group are not effected by these proposals as there is a 0.0 percent impact to their payments from each proposed change. Rural hospitals, however, do appear to benefit slightly from these changes, as evidenced by the estimated 0.1 percent increase in payments to this group. We note that the wage data used for the proposed wage index are based upon the data available as of February 22, 2001 and, therefore, do not reflect revision requests received and processed by the fiscal intermediaries after that date. To the extent these requests are granted by hospitals' fiscal intermediaries, these revisions will be reflected in the final rule. In addition, we continue to verify the accuracy of the data for hospitals with extraordinary changes in their data from the prior year. The following chart compares the shifts in wage index values for labor market areas for FY 2001 relative to FY 2002. This chart demonstrates the impact of the proposed changes for the FY 2002 wage index relative to the FY 2001 wage index. The majority of labor market areas (318) experience less than a 5-percent change. A total of 36 labor market areas experience an increase of more than 5 percent with 4 having an increase greater than 10 percent. A total of 13 areas experience decreases of more than 5-percent. Of those, 4 decline by 10 percent or more. ------------------------------------------------------------------------ Number of labor market areas Percentage change in area wage index values --------------------- FY 2001 FY 2002 ------------------------------------------------------------------------ Increase more than 10 percent..................... 1 4 Increase more than 5 percent and less than 10 20 36 percent.......................................... Increase or decrease less than 5 percent.......... 339 318 Decrease more than 5 percent and less than 10 14 13 percent.......................................... Decrease more than 10 percent..................... 1 4 ------------------------------------------------------------------------ Among urban hospitals, 163 would experience an increase of between 5 and 10 percent and 16 more than 10 percent. A total of 33 rural hospitals have increases greater than 5 percent, but none greater than 10 percent. On the negative side, 121 urban hospitals have decreases in their wage index values of at least 5 percent but less than 10 percent. Five urban hospitals have decreases in their wage index values greater than 10 percent. There are no rural hospitals with decreases in their wage index values greater than 5 percent or with increases of more than 10 percent. The following chart shows the projected impact for urban and rural hospitals. [[Page 22873]] ------------------------------------------------------------------------ Number of hospitals Percentage change in area wage index values --------------------- Urban Rural ------------------------------------------------------------------------ Increase more than 10 percent..................... 16 0 Increase more than 5 percent and less than 10 101 15 percent.......................................... Increase or decrease less than 5 percent.......... 2,395 2,135 Decrease more than 5 percent and less than 10 121 0 percent.......................................... Decrease more than 10 percent..................... 5 0 ------------------------------------------------------------------------ D. Combined Impact of DRG and Wage Index Changes--Including Budget Neutrality Adjustment (Column 5) The impact of DRG reclassifications and recalibration on aggregate payments is required by section 1886(d)(4)(C)(iii) of the Act to be budget neutral. In addition, section 1886(d)(3)(E) of the Act specifies that any updates or adjustments to the wage index are to be budget neutral. As noted in the Addendum to this proposed rule, we compared simulated aggregate payments using the FY 2001 DRG relative weights and wage index to simulated aggregate payments using the proposed FY 2002 DRG relative weights and blended wage index. Based on this comparison, we computed a wage and recalibration budget neutrality factor of 0.992493. In Table I, the combined overall impacts of the effects of both the DRG reclassifications and recalibration and the updated wage index are shown in column 5. The 0.0 percent impact for all hospitals demonstrates that these changes, in combination with the budget neutrality factor, are budget neutral. For the most part, the changes in this column are the sum of the changes in columns 1, 2, 3 and 4, minus approximately 0.7 percent attributable to the budget neutrality factor. There may be some variation of plus or minus 0.1 percent due to rounding. E. Impact of MGCRB Reclassifications (Columns 6 & 7) Our impact analysis to this point has assumed hospitals are paid on the basis of their actual geographic location (with the exception of ongoing policies that provide that certain hospitals receive payments on bases other than where they are geographically located, such as hospitals in rural counties that are deemed urban under section 1886(d)(8)(B) of the Act). The changes in column 5 reflect the per case payment impact of moving from this baseline to a simulation incorporating the MGCRB decisions for FY 2002. The changes in column 6 add in the post-reclassified wage index values resulting from the proposed change to include the wage data for a reclassified hospital in both the area to which it is reclassified and the area where the hospital is physically located. As noted below, these decisions affect hospitals' standardized amount and wage index area assignments. By February 28 of each year, the MGCRB makes reclassification determinations that will be effective for the next fiscal year, which begins on October 1. The MGCRB may approve a hospital's reclassification request for the purpose of using the other area's standardized amount, wage index value, or both. The proposed FY 2002 wage index values incorporate all of the MGCRB's reclassification decisions for FY 2002. The wage index values also reflect any decisions made by the HCFA Administrator through the appeals and review process for MGCRB decisions as of February 28, 2001. Additional changes that result from the Administrator's review of MGCRB decisions or a request by a hospital to withdraw its application will be reflected in the final rule for FY 2002. The overall effect of geographic reclassification is required by section 1886(d)(8)(D) of the Act to be budget neutral. Therefore, we applied an adjustment of 0.991054 to ensure that the effects of reclassification are budget neutral. (See section II.A.4.b. of the Addendum to this proposed rule.) This results in a larger budget neutrality offset than the FY 2001 factor of 0.993187. This larger offset is accounted for by the extension of wage index reclassifications for 3 years as a result of section 304 of Public Law 106-554, and our proposed policy to hold-harmless the calculation of urban areas' wage indexes for reclassifications out of the area (see Column 7). We have identified 162 hospitals that were reclassified for FY 2001 but not FY 2002, that will nonetheless continue to be reclassified due to section 304 of Public Law 106- 554. As a group, rural hospitals benefit from geographic reclassification. Their payments rise 2.7 percent in Column 6. Payments to urban hospitals decline 0.7 percent. Hospitals in other urban areas see a decrease in payments of 0.5 percent, while large urban hospitals lose 0.8 percent. Among urban hospital groups (that is, bed size, census division, and special payment status), payments generally decline. A positive impact is evident among most of the rural hospital groups. The smallest increase among the rural census divisions is 1.9 percent for Mountain and Puerto Rico regions. The largest increases are in rural West South Central and New England. These regions receive increases of 3.5 and 3.0 percent respectively. Among all the hospitals that were reclassified for FY 2002, the MGCRB changes are estimated to provide a 4.5 percent increase in payments. Urban hospitals reclassified for FY 2002 are anticipated to receive an increase of 2.8 percent, while rural reclassified hospitals are expected to benefit from the MGCRB changes with a 5.6 percent increase in payments. Overall, among hospitals that were reclassified for purposes of the standardized amount only, a payment increase of 3.3 percent is expected, while those reclassified for purposes of the wage index only show a 1.9 percent increase in payments. Payments to urban and rural hospitals that did not reclassify are expected to decrease slightly due to the MGCRB changes, decreasing by 1.2 for urban hospitals and 0.6 for rural hospitals. Those hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act are expected to receive an increase in payments of 0.3 percent. Column 7 shows the impacts of our proposed policy to include the wage data for a reclassified hospital in both the area to which it is reclassified and the area where the hospital is physically located. This change affects overall payments by 0.2 percent, partially accounting for the larger budget neutrality factor compared to FY 2001. The payment impacts are generally largest in urban hospital groups, with the largest impact, 0.6 percent, experienced by urban hospitals in the Middle Atlantic census division. The foregoing analysis was based on MGCRB and HCFA Administrator decisions made by February 28, 2001. As previously noted, there may be changes to some MGCRB decisions through the appeals, review, and applicant withdrawal process. The outcome of these cases will be reflected in the analysis presented in the final rule. F. All Changes (Column 8) Column 8 compares our estimate of payments per case, incorporating all changes reflected in this proposed rule for FY 2002 (including statutory changes), to our estimate of payments per case in FY 2001. It includes the effects of the 2.55 percent update to the standardized amounts and the hospital-specific rates for MDHs and SCHs. It also reflects the 0.8 percentage point difference between the projected outlier payments in FY 2001 (5.1 percent of total DRG payments) and the current estimate of the percentage of actual outlier payments in FY 2001 (5.9 percent), as described in the introduction to this Appendix and the Addendum to this proposed rule. We also note that section 211 of Public Law 106-554 changed the criteria for hospitals to qualify for DSH payment status. Since more hospitals are now eligible to receive DSH payments for the full FY 2002, as opposed to for just the second 6 months of FY 2001, DSH payments to providers in FY 2002 would increase and this change is also captured in column 8. Section 213 of Public Law 106-554 provided that all SCHs may elect to receive payment on the basis of their costs per case during their cost reporting period that began during 1996. For FY 2002, eligible SCHs that rebase receive a hospital-specific rate comprised of 50 percent of the higher of their FY 1982 or FY 1987 hospital- specific rate or their Federal rate, and 50 percent of their 1996 hospital-specific rate. The impact of this provision is modeled in column 8 as well. There might also be interactive effects among the various factors comprising the payment system that we are not able to isolate. For these reasons, the values in column 7 may not equal the sum of the changes in columns 5 and 6, plus the other impacts that we are able to identify. Hospitals in urban areas experience a 1.7 percent increase in payments per case compared to FY 2001. The 0.7 percent [[Page 22874]] negative impact due to reclassification is offset by a similar negative impact for FY 2001 of 0.4 percent (65 FR 47196). Hospitals in rural areas, meanwhile, experience a 3.2 percent payment increase. This is primarily due to the change in the DSH threshold to 15 percent for all hospitals enacted by section 211 of Public Law 106-554 and effective for discharges on or after April 1, 2001, and the positive effect of the reclassification changes (2.7 percent increase, plus an additional 0.1 percent increase from the proposal to include the wage data for a reclassified hospital in both the area to which it is reclassified and the area where the hospital is physically located). The impact of lowering the DSH threshold is demonstrated in Column 8, although we would note that the estimated FY 2001 payments do reflect 6 months of payments to hospitals affected by this change. The impacts are seen in the rows displaying urban hospitals with fewer than 100 beds receiving DSH (3.3 percent increase), and all rural DSH categories. Among urban census divisions, payments increased between 0.2 and 3.0 percent between FY 2001 and FY 2002. The rural census division experiencing the smallest increase in payments was the Mid-Atlantic region (2.2 percent). The largest increases by rural hospitals is in Puerto Rico, where payments appear to increase by 8.4 percent and West South Central, where payments appear to increase by 4.2 percent. Rural New England and South Atlantic regions also benefited with 3.7 and 3.6 percent respectively. Among special categories of rural hospitals, those hospitals receiving payment under the hospital-specific methodology (SCHs, MDHs, and SCH/RRCs) experience payment increases of 3.1 percent, 3.7 percent, and 3.2 percent, respectively. This outcome is primarily related to the fact that, for hospitals receiving payments under the hospital-specific methodology, there are no outlier payments. Therefore, these hospitals do not experience negative payment impacts from the decline in outlier payments from FY 2001 to FY 2002 (from 5.9 percent of total DRG plus outlier payments to 5.1 percent) as do hospitals paid based on the national standardized amounts. Among hospitals that were reclassified for FY 2002, hospitals overall are estimated to receive a 2.9 percent increase in payments. Urban hospitals reclassified for FY 2002 are anticipated to receive an increase of 2.0 percent, while rural reclassified hospitals are expected to benefit from reclassification with a 3.6 percent increase in payments. Overall, among hospitals reclassified for purposes of the standardized amount, only a payment increase of 4.0 percent is expected, while those hospitals reclassified for purposes of the wage index only show an expected 2.5 percent increase in payments. Those hospitals located in rural counties but deemed to be urban under section 1886(d)(8)(B) of the Act are expected to receive an increase in payments of 3.9 percent. Table II.--Impact Analysis of Changes for FY 2001 Operating Prospective Payment System [Payments per case] ---------------------------------------------------------------------------------------------------------------- Average FY Average FY 2001 2001 All FY 2001 Number of payment per payment per changes hosps. (1) case \1\ case \1\ (4) (2) (3) ---------------------------------------------------------------------------------------------------------------- By Geographic Location: All hospitals........................................... 4,795 6,969 7,100 1.9 Urban hospitals......................................... 2,721 7,548 7,674 1.7 Large urban areas (populations over 1 million).......... 1,563 8,087 8,207 1.5 Other urban areas (populations of 1 million of fewer)... 1,158 6,854 6,989 2.0 Rural hospitals......................................... 2,074 4,705 4,856 3.2 Bed Size (Urban): 0-99 beds............................................... 712 5,114 5,220 2.1 100-199 beds............................................ 943 6,294 6,397 1.6 200-299 beds............................................ 530 7,192 7,320 1.8 300-499 beds............................................ 391 8,127 8,261 1.6 500 or more beds........................................ 145 9,946 10,099 1.5 Bed Size (Rural): 0-49 beds............................................... 1,209 3,922 4,041 3.0 50-99 beds.............................................. 520 4,410 4,554 3.3 100-149 beds............................................ 204 4,780 4,922 3.0 150-199 beds............................................ 75 5,291 5,470 3.4 200 or more beds........................................ 66 5,961 6,173 3.6 Urban by Region: New England............................................. 139 8,077 8,214 1.7 Middle Atlantic......................................... 417 8,561 8,579 0.2 South Atlantic.......................................... 395 7,183 7,386 2.8 East North Central...................................... 462 7,210 7,323 1.6 East South Central...................................... 160 6,771 6,973 3.0 West North Central...................................... 189 7,287 7,430 2.0 West South Central...................................... 342 7,039 7,087 0.7 Mountain................................................ 137 7,282 7,454 2.4 Pacific................................................. 434 8,840 9,037 2.2 Puerto Rico............................................. 46 3,235 3,319 2.6 Rural by Region: New England............................................. 49 5,615 5,821 3.7 Middle Atlantic......................................... 74 5,052 5,165 2.2 South Atlantic.......................................... 267 4,871 5,046 3.6 East North Central...................................... 273 4,743 4,875 2.8 East South Central...................................... 263 4,398 4,556 3.6 West North Central...................................... 479 4,506 4,620 2.5 West South Central...................................... 331 4,177 4,351 4.2 Mountain................................................ 194 5,020 5,166 2.9 Pacific................................................. 139 5,762 5,920 2.7 Puerto Rico............................................. 5 2,529 2,742 8.4 By Payment Classification: Urban hospitals......................................... 2,766 7,526 7,652 1.7 [[Page 22875]] Large urban areas (populations over 1 million).......... 1,643 8,002 8,121 1.5 Other urban areas (populations of 1 million of fewer)... 1,123 6,870 7,008 2.0 Rural areas............................................. 2,029 4,687 4,838 3.2 Teaching Status: Non-teaching............................................ 3,674 5,605 5,728 2.2 Fewer than 100 Residents................................ 881 7,309 7,445 1.9 100 or more Residents................................... 240 11,258 11,410 1.3 Urban DSH: Non-DSH................................................. 1,879 6,354 6,461 1.7 100 or more beds........................................ 1,378 8,129 8,267 1.7 Less than 100 beds...................................... 325 4,925 5,089 3.3 Rural DSH: Sole Community (SCH).................................... 540 4,295 4,427 3.1 Referral Center (RRC)................................... 157 5,521 5,723 3.7 Other Rural: 100 or more beds.................................... 73 4,304 4,441 3.2 Less than 100 beds.................................. 443 3,928 4,095 4.3 Urban teaching and DSH: Both teaching and DSH................................... 754 9,091 9,238 1.6 Teaching and no DSH..................................... 295 7,562 7,683 1.6 No teaching and DSH..................................... 949 6,298 6,424 2.0 No teaching and no DSH.................................. 768 5,932 6,022 1.5 Rural Hospital Types: Non special status hospitals........................ 800 4,042 4,186 3.6 RRC................................................. 165 5,434 5,630 3.6 SCH................................................. 667 4,562 4,676 2.5 Medicare-dependent hospitals (MDH).................. 328 3,844 3,966 3.2 SCH and RRC......................................... 69 5,649 5,803 2.7 Type of Ownership: Voluntary........................................... 2,785 7,136 7,261 1.8 Proprietary......................................... 777 6,580 6,712 2.0 Government.......................................... 1,187 6,486 6,651 2.5 Unknown......................................... 46 6,283 6,449 2.6 Medicare Utilization as a Percent of Inpatient Days: 0-25................................................ 396 9,504 9,713 2.2 25-50............................................... 1,886 8,030 8,164 1.7 50-65............................................... 1,843 6,012 6,142 2.2 Over 65............................................. 592 5,393 5,497 1.9 Unknown................................................. 78 10,244 10,132 -1.1 Hospitals Reclassified by the Medicare Geographic Classification Review Board: FY 2002 Reclassifications: All Reclassified Hospitals.............................. 636 6,153 6,334 2.9 Standardized Amount Only................................ 74 5,200 5,407 4.0 Wage Index Only......................................... 391 6,004 6,152 2.5 Both.................................................... 58 6,818 6,816 0.0 All Nonreclassified Hospitals............................... 4,246 7,105 7,236 1.9 All Urban Reclassified Hospitals............................ 119 8,253 8,415 2.0 Urban Nonreclassified Hospitals............................. 18 6,176 6,136 -0.6 Standardized Amount Only................................ 81 8,946 9,141 2.2 Wage Index Only......................................... 20 6,193 6,346 2.5 Both.................................................... 2,564 7,531 7,654 1.6 All Reclassified Rural Hospitals............................ 517 5,277 5,466 3.6 Standardized Amount Only................................ 19 4,658 4,750 2.0 Wage Index Only......................................... 475 5,283 5,472 3.6 Both.................................................... 23 5,396 5,622 4.2 Rural Nonreclassified Hospitals............................. 1,554 4,153 4,268 2.8 Other Reclassified Hospitals (Section 1886(D)(8)(B))........ 41 4,841 5,032 3.9 ---------------------------------------------------------------------------------------------------------------- \1\ These payment amounts per case do not reflect any estimates of annual case-mix increase. Table II presents the projected impact of the proposed changes for FY 2002 for urban and rural hospitals and for the different categories of hospitals shown in Table I. It compares the estimated payments per case for FY 2001 with the average estimated per case payments for FY 2002, as calculated under our models. Thus, this table presents, in terms of the average dollar amounts paid per discharge, the combined effects of the changes presented in Table I. The percentage changes shown in the last column of Table II equal the percentage changes in average payments from column 8 of Table I. [[Page 22876]] VIII. Impact for Critical Access Hospitals (CAHs) There are approximately 365 facilities that qualify as CAHs. These CAHs are paid based on reasonable costs for their services to inpatients and outpatients. We examined several parts of the proposed rule, as discussed in detail in section VI.B. of the preamble, for their potential impact on CAHs. A. Exclusion of CAHs From Payment Window Requirements In this proposed rule, we are proposing to clarify the policy that CAHs are not subject to the payment window provisions of section 1886(a)(3) of the Act. Existing regulations do not require that these provisions be applied to CAHs, and we are not aware of specific situations in which they are now being applied. Consequently, we do not expect any increase or decrease in Medicare spending based on this clarification. B. Availability of CRNA Pass-Through for CAHs Under existing Sec. 412.113(c), CRNA pass-through payment is available only to hospitals that either qualified for the pass- through of costs of anesthesia services furnished in calendar year 1989, or employed or contracted with a qualified nonphysician anesthetist as of January 1, 1988, to perform anesthesia services. We are proposing that certain CAHs that meet the pass-through criteria would qualify for pass-through payments. Under the existing criterion, the only facilities that could qualify for the pass- through as CAHs are those that would have qualified for the pass- through if they had elected to continue participating in Medicare as hospitals rather than converting to CAH status. We do not expect any increase or decrease in Medicare spending based on the proposed change in the regulations. C. Payment for Emergency Room On-Call Physicians In accordance with the amendments made by section 204 of Public Law 106-544, we are proposing to recognize as allowable costs, amounts for reasonable compensation and related costs for emergency room physicians who are on call but who are not present on the premises of a CAH. We expect that at least some CAHs will elect to compensate emergency room physicians for being on call, and that as a result, Medicare spending for CAH services will increase. However, we do not have information to develop a reliable estimate of how many CAHs will make this election, or how much physician compensation costs they will incur for on call time. D. Treatment of Ambulance Services Furnished by Certain CAHs In accordance with the provisions of section 205 of Public Law 106-554, we are proposing to amend the existing CAH regulations to provide for payment to CAHs for the reasonable costs of ambulance services furnished by a CAH or an entity owned or operated by the CAH if certain statutory requirements are met. We expect that at least some CAHs or entities owned or operated by CAHs will be able to qualify for payment for their ambulance services. To the extent that CAHs or CAH owned or operated entities furnish these services under the conditions specified in the law, ambulance services will be paid for at higher rates than would otherwise apply. As a result, Medicare spending for ambulance services will increase. However, we do not have sufficient information or data to develop a reliable estimate of how many CAHs or entities will qualify or the dollar amount of ambulance service costs they will incur. E. Qualified Practitioners for Preanesthesia and Postanesthesia Evaluations in CAHs As discussed in section VI.B. of this proposed rule, in an effort to eliminate or minimize potential issues relating to beneficiary access to medical services in rural areas, we are proposing to allow CRNAs who administer the anesthesia to conduct the preanesthesia and postanesthesia evaluations in a CAH. As with any licensed independent health care provider, the proposed change would not permit CRNAs to practice beyond his or her licensed scope of practice. We believe that this proposal would increase flexibility of providers in furnishing medical services in rural areas. However, we do not have information or data to develop a reliable estimate of how many CRNAs would be used to conduct preanesthesia and postanesthesia evaluations in CAHs or what the associated costs would be. IX. Impact of Proposed Changes in the Capital Prospective Payment System A. General Considerations We now have cost report data for the 8th year of the capital prospective payment system (cost reports beginning in FY 1999) available through the December 2000 update of the HCRIS. We also have updated information on the projected aggregate amount of obligated capital approved by the fiscal intermediaries. However, our impact analysis of payment changes for capital-related costs is still limited by the lack of hospital-specific data on several items. These are the hospital's projected new capital costs for each year, its projected old capital costs for each year, and the actual amounts of obligated capital that will be put in use for patient care and recognized as Medicare old capital costs in each year. The lack of this information affects our impact analysis in the following ways: Major investment in hospital capital assets (for example, in building and major fixed equipment) occurs at irregular intervals. As a result, there can be significant variation in the growth rates of Medicare capital-related costs per case among hospitals. We do not have the necessary hospital-specific budget data to project the hospital capital growth rate for individual hospitals. Our policy of recognizing certain obligated capital as old capital makes it difficult to project future capital-related costs for individual hospitals. Under Sec. 412.302(c), a hospital is required to notify its intermediary that it has obligated capital by the later of October 1, 1992, or 90 days after the beginning of the hospital's first cost reporting period under the capital prospective payment system. The intermediary must then notify the hospital of its determination whether the criteria for recognition of obligated capital have been met by the later of the end of the hospital's first cost reporting period subject to the capital prospective payment system or 9 months after the receipt of the hospital's notification. The amount that is recognized as old capital is limited to the lesser of the actual allowable costs when the asset is put in use for patient care or the estimated costs of the capital expenditure at the time it was obligated. We have substantial information regarding fiscal intermediary determinations of projected aggregate obligated capital amounts. However, we still do not know when these projects will actually be put into use for patient care, the actual amount that will be recognized as obligated capital when the project is put into use, or the Medicare share of the recognized costs. Therefore, we do not know actual obligated capital commitments for purposes of the FY 2002 capital cost projections. In Appendix B of this proposed rule, we discuss the assumptions and computations that we employ to generate the amount of obligated capital commitments for use in the FY 2002 capital cost projections. In Table III of this section, we present the redistributive effects that are expected to occur between "hold-harmless" hospitals and "fully prospective" hospitals in FY 2002. In addition, we have integrated sufficient hospital-specific information into our actuarial model to project the impact of the proposed FY 2002 capital payment policies by the standard prospective payment system hospital groupings. While we now have actual information on the effects of the transition payment methodology and interim payments under the capital prospective payment system and cost report data for most hospitals, we still need to randomly generate numbers for the change in old capital costs, new capital costs for each year, and obligated amounts that will be put in use for patient care services and recognized as old capital each year. We continue to be unable to predict accurately FY 2002 capital costs for individual hospitals, but with the most recent data on hospitals' experience under the capital prospective payment system, there is adequate information to estimate the aggregate impact on most hospital groupings. B. Projected Impact Based on the Proposed FY 2002 Actuarial Model 1. Assumptions In this impact analysis, we model dynamically the impact of the capital prospective payment system from FY 2001 to FY 2002 using a capital cost model. The FY 2002 model, as described in Appendix B of this proposed rule, integrates actual data from individual hospitals with randomly generated capital cost amounts. We have capital cost data from cost reports beginning in FY 1989 through FY 1999 as reported on the December 2000 update of HCRIS, interim payment data for hospitals already receiving capital prospective payments through PRICER, and data reported by the intermediaries that include the hospital- [[Page 22877]] specific rate determinations that have been made through January 1, 2001 in the provider-specific file. We used these data to determine the proposed FY 2002 capital rates. However, we do not have individual hospital data on old capital changes, new capital formation, and actual obligated capital costs. We have data on costs for capital in use in FY 1999, and we age that capital by a formula described in Appendix B. Therefore, we need to randomly generate only new capital acquisitions for any year after FY 1999. All Federal rate payment parameters are assigned to the applicable hospital. We will continue to pay regular exceptions during cost reporting periods beginning before October 1, 2001 but ending in FY 2002. However, in FY 2003 and later, payments will no longer be made under the regular exceptions provision, hence, we will no longer require the actuarial model described in Appendix B of this proposed rule. For purposes of this impact analysis, the proposed FY 2002 actuarial model includes the following assumptions: Medicare inpatient capital costs per discharge will change at the following rates during these periods: Average Percentage Change in Capital Costs Per Discharge ------------------------------------------------------------------------ Percentage Fiscal year change ------------------------------------------------------------------------ 2000....................................................... 1.39 2001....................................................... 1.37 2002....................................................... 2.58 ------------------------------------------------------------------------ We estimate that the Medicare case-mix index will increase by 0.0 percent in FY 2001 and will increase by 1.0 percent in FY 2002. The Federal capital rate and the hospital-specific rate were updated beginning in FY 1996 by an analytical framework that considers changes in the prices associated with capital-related costs and adjustments to account for forecast error, changes in the case-mix index, allowable changes in intensity, and other factors. The proposed FY 2002 update is 1.1 percent (see section IV. of the Addendum to this proposed rule). 2. Results We have used the actuarial model to estimate the change in payment for capital-related costs from FY 2001 to FY 2002. Table III shows the effect of the capital prospective payment system on low capital cost hospitals and high capital cost hospitals. We consider a hospital to be a low capital cost hospital if, based on a comparison of its initial hospital-specific rate and the applicable Federal rate, it will be paid under the fully prospective payment methodology. A high capital cost hospital is a hospital that, based on its initial hospital-specific rate and the applicable Federal rate, will be paid under the hold-harmless payment methodology. We are no longer displaying a column for the hospital-specific payments in Table III since the FY 2001 transition blend percentage for fully prospective hospitals is 100 percent of the Federal rate and zero percent of the hospital-specific rate, and all hospitals (except those defined as "new" under Sec. 412.300) are paid based on 100 percent of the Federal rate for FY 2002. Based on our actuarial model, the breakdown of hospitals is as follows: Capital Transition Payment Methodology for FY 2002 ---------------------------------------------------------------------------------------------------------------- Percent of Percent of Type of hospital Percent of Percent of capital capital hospitals discharges costs payments ---------------------------------------------------------------------------------------------------------------- Low Cost Hospital........................................... 66 62 57 61 High Cost Hospital.......................................... 34 38 43 39 ---------------------------------------------------------------------------------------------------------------- A low capital cost hospital may request to have its hospital- specific rate redetermined based on old capital costs in the current year, through the later of the hospital's cost reporting period beginning in FY 1994 or the first cost reporting period beginning after obligated capital comes into use (within the limits established in Sec. 412.302(c) for putting obligated capital into use for patient care). If the redetermined hospital-specific rate is greater than the adjusted Federal rate, these hospitals will be paid under the hold-harmless payment methodology. Regardless of whether the hospital became a hold-harmless payment hospital as a result of a redetermination, we continue to show these hospitals as low capital cost hospitals in Table III. Assuming no behavioral changes in capital expenditures, Table III displays the percentage change in payments from FY 2001 to FY 2002 using the above described actuarial model. With the proposed Federal rate, we estimate aggregate Medicare capital payments will increase by 3.80 percent in FY 2002. This increase is somewhat lower than last year's (5.48 percent) due in part to the fact that because the transition period ends after FY 2001, there is no longer an increase in the Federal blend percentage, which increased from 90 to 100 percent from FY 2000 to FY 2001, for fully prospective hospitals. Table III.--Impact of Proposed Changes for FY 2002 on Payments per Discharge -------------------------------------------------------------------------------------------------------------------------------------------------------- Adjusted Average Hold Percent Number of Discharges Federal Federal harmless Exceptions Total change over hospitals payment percent payment payment payment FY 2001 -------------------------------------------------------------------------------------------------------------------------------------------------------- FY 2001 Payments per Discharge Low Cost Hospitals....................... 3,128 6,718,804 $626.20 99.70 $2.38 $5.69 $634.27 ........... Fully Prospective.................... 2,945 6,231,764 627.54 100.00 ........... 5.09 632.63 ........... 100% Federal Rate.................... 163 451,843 627.89 100.00 ........... 7.75 635.64 ........... Hold Harmless........................ 20 35,197 367.32 50.30 454.71 85.44 907.47 ........... High Cost Hospitals...................... 1,577 4,110,246 636.96 97.69 19.34 10.64 666.93 ........... 100% Federal Rate.................... 1,386 3,744,619 648.86 100.00 ........... 8.82 657.68 ........... Hold Harmless........................ 191 365,627 515.12 75.29 217.38 29.23 761.73 ........... Total Hospitals.................. 4,705 10,829,050 630.28 98.92 8.82 7.57 646.67 ........... FY 2002 Payments per Discharge Low Cost Hospitals....................... 3,128 6,826,288 647.17 100.00 ........... 3.19 650.36 2.54 [[Page 22878]] Fully Prospective.................... 2,945 6,331,437 646.59 100.00 ........... 2.96 649.55 2.68 100% Federal Rate.................... 183 494,852 654.56 100.00 ........... 6.11 660.67 3.94 High Cost Hospitals...................... 1,577 4,176,324 671.77 100.00 ........... 5.72 677.49 1.58 100% Federal Rate.................... 1,577 4,176,324 671.77 100.00 ........... 5.72 677.49 3.01 Total Hospitals.................. 4,705 11,002,612 656.51 100.00 ........... 4.15 660.66 2.16 -------------------------------------------------------------------------------------------------------------------------------------------------------- We project that low capital cost hospitals paid under the fully prospective payment methodology will experience an average increase in payments per case of 2.54 percent, and high capital cost hospitals will experience an average increase of 1.58 percent. These results are due to the fact that there is no longer an increase in the Federal blend percentage with the conclusion of the capital transition period in FY 2001 for fully prospective hospitals. Beginning FY 2002, all hospitals (except those defined as "new" under Sec. 412.300) are paid based on 100 percent of the Federal rate for FY 2002. For hospitals paid under the fully prospective payment methodology, the Federal rate payment percentage remains at 100 percent from FY 2001 (last year of the transition period) since they no longer receive payments based on the hospital-specific rate. The Federal rate payment percentage in FY 2001 for hospitals paid under the hold-harmless payment methodology is based on the hospital's ratio of new capital costs to total capital costs. The average Federal rate payment percentage for high cost hospitals receiving a hold-harmless payment for old capital in FY 2001 will increase from 75.29 percent to 100 percent since the transition period will have ended. All hold-harmless hospitals will be paid based on 100 percent of the Federal rate in FY 2002. We estimate that high cost hospitals (paid based on 100 percent of the Federal rate) will receive a decrease in exceptions payments from $8.82 per discharge in FY 2001 to $5.72 per discharge in FY 2002. This is primarily due to the expiration of the regular exceptions provision in FY 2002. We are no longer presenting the average hospital-specific rate payment per discharge in Table III because the FY 2001 transition blend percentage for fully prospective hospitals is 100 percent of the Federal rate and zero percent of the hospital-specific rate, and all hospitals (except those defined as "new" under Sec. 412.300) will be paid based on 100 percent of the Federal rate for FY 2002. As stated previously, we will continue to pay regular exceptions for cost reporting periods beginning before October 1, 2001, but ending in FY 2002. However, in FY 2003 and later, regular exception payments will no longer be made under the regular exceptions provision, however, eligible hospitals could receive special exception payments under Sec. 412.348(g). We estimate that regular exceptions payments will decrease from 1.17 percent of total capital payments in FY 2001 to 0.63 percent of payments in FY 2002. These results are primarily due to the expiration of the regular exceptions after FY 2001 and the limited nature of the special exceptions policy in FY 2002. The projected distribution of the exception payments is shown in the chart below: Estimated FY 2002 Exceptions Payments ------------------------------------------------------------------------ Percent of Type of hospital Number of exceptions hospitals payments ------------------------------------------------------------------------ Low Capital Cost.............................. 122 48 High Capital Cost............................. 116 52 ------------------------- Total................................... 238 100 ------------------------------------------------------------------------ In the past we presented a cross-sectional summary of hospital groupings by the capital prospective payment transition period methodology generated by our actuarial model (Appendix B). We are no longer including such a comparison since all hospitals (except those defined as "new" under Sec. 412.300) will be paid based on 100 percent of the Federal rate in FY 2002 with the conclusion of the 10-year capital transition period. C. Cross-Sectional Analysis of Changes in Aggregate Payments We used our FY 2002 actuarial model to estimate the potential impact of our proposed changes for FY 2002 on total capital payments per case, using a universe of 4,705 hospitals. The individual hospital payment parameters are taken from the best available data, including: The January 1, 2001 update to the provider-specific file, cost report data, and audit information supplied by intermediaries. In Table IV we present the results of the cross-sectional analysis using the results of our actuarial model and the aggregate impact of the proposed FY 2002 payment policies. As we explain in Appendix B of this proposed rule, we were not able to use 90 of the 4,795 hospitals in our database due to insufficient (missing or unusable) data. Consequently, the payment methodology distribution is based on 4,705 hospitals. These data should be fully representative of the payment methodologies that will be applicable to hospitals. Columns 3 and 4 show estimates of payments per case under our model for FY 2001 and FY 2002. Column 5 shows the total percentage change in payments from FY 2001 to FY 2002. Column 6 presents the percentage change in payments that can be attributed to Federal rate changes alone. Federal rate changes represented in Column 6 include the 1.85 percent increase in the Federal rate, a 1.0 percent increase in case mix, changes in the adjustments to the Federal rate (for example, the effect of the new hospital wage index on the geographic adjustment factor), and reclassifications by the MGCRB. Column 5 includes the effects of the Federal rate changes represented in Column 6. Column 5 also reflects the effects of all other changes, including the change for all hold-harmless hospitals being paid based on 100 percent of the Federal rate, and changes in exception payments. The comparisons are provided by: (1) Geographic location, (2) region, and (3) payment classification. The simulation results show that, on average, capital payments per case can be expected to increase 2.2 percent in FY 2002. The results show that the effect of the Federal rate change alone is to increase payments by 3.0 percent. In addition to the increase attributable to the Federal rate change, a 0.8 percent decrease is attributable to the effects of all other changes. Our comparison by geographic location shows an overall increase in payments to hospitals in all areas. This comparison also shows that urban and rural hospitals will experience slightly different rates of increase in capital payments per case (2.3 percent and 1.2 percent, respectively). This difference is due to the lower rate of decrease for urban hospitals relative to rural hospitals (0.7 percent and 1.7 percent, respectively) from the effect of all other changes. Urban hospitals will gain approximately the same as rural hospitals (3.0 percent versus 2.9 percent, respectively) from the effects of Federal rate changes alone. Most regions are estimated to receive increases in total capital payments per case, partly due to the fact that payments to all hospitals (except those defined as "new" under Sec. 412.300) will be based on 100 percent of the Federal rate in FY 2002. Changes by region vary from a minimum [[Page 22879]] maximum decrease of 0.6 percent (Mountain urban region) to a maximum increase of 3.0 percent (New England urban rural region). By type of ownership, voluntary hospitals are projected to have the largest rate of increase of total payment changes (2.5 percent, a 3.0 percent increase due to the Federal rate changes, and a 0.5 percent decrease from the effects of all other changes). Similarly, payments to government hospitals will increase 2.2 percent (a 3.0 percent increase due to Federal rate changes, and a 0.8 percent decrease from the effects of all other changes), while payments to proprietary hospitals will increase 0.5 percent (a 2.9 percent increase due to Federal rate changes, and a 2.4 percent decrease from the effects of all other changes). This 2.4 percent decrease from all other changes is primarily due to the estimated decrease in exceptions payments and the change for all hold-harmless hospitals being paid based on 100 percent of the Federal rate. Section 1886(d)(10) of the Act established the MGCRB. Hospitals may apply for reclassification for purposes of the standardized amount, wage index, or both and for purposes of DSH for FYs 1999 through 2001. Although the Federal capital rate is not affected, a hospital's geographic classification for purposes of the operating standardized amount does affect a hospital's capital payments as a result of the large urban adjustment factor and the disproportionate share adjustment for urban hospitals with 100 or more beds. Reclassification for wage index purposes also affects the geographic adjustment factor, since that factor is constructed from the hospital wage index. To present the effects of the hospitals being reclassified for FY 2001 compared to the effects of reclassification for FY 2000, we show the average payment percentage increase for hospitals reclassified in each fiscal year and in total. For FY 2001 reclassifications, we indicate those hospitals reclassified for standardized amount purposes only, for wage index purposes only, and for both purposes. The reclassified groups are compared to all other nonreclassified hospitals. These categories are further identified by urban and rural designation. Hospitals reclassified for FY 2001 as a whole are projected to experience a 2.0 percent increase in payments (a 3.0 percent increase attributable to Federal rate changes and a 1.0 percent decrease attributable to the effects of all other changes). Payments to nonreclassified hospitals will increase slightly more (2.2 percent) than reclassified hospitals (2.0 percent) overall. Payments to nonreclassified hospitals will increase the same as reclassified hospitals from the Federal rate changes (3.0 percent), and they will lose less from the effects of all other changes (0.8 percent compared to 1.0 percent, respectively). Table IV.--Comparison of Total Payments Per Case [FY 2001 Payments Compared to FY 2002 Payments] ---------------------------------------------------------------------------------------------------------------- Portion Number of Average FY Average FY attributable hospitals 2001 payments/ 2002 payments/ All changes to Federal case case rate change ---------------------------------------------------------------------------------------------------------------- By Geographic Location: All hospitals............... 4,705 647 661 2.2 3.0 Large urban areas 1,519 749 766 2.3 3.0 (populations over 1 million)................... Other urban areas 1,125 635 650 2.4 3.0 (populations of 1 million or fewer).................. Rural areas................. 2,061 439 444 1.2 2.9 Urban hospitals............. 2,644 699 716 2.3 3.0 0-99 beds............... 654 522 507 -2.8 2.8 100-199 beds............ 927 596 607 1.8 2.9 200-299 beds............ 528 667 684 2.6 3.0 300-499 beds............ 390 739 762 3.1 3.0 500 or more beds........ 145 902 925 2.6 2.9 Rural hospitals............. 2,061 439 444 1.2 2.9 0-49 beds............... 1,200 369 372 1.0 2.9 50-99 beds.............. 516 412 416 1.0 2.9 100-149 beds............ 204 452 457 1.1 2.9 150-199 beds............ 75 485 495 2.2 2.9 200 or more beds........ 66 548 553 1.0 3.0 By Region: Urban by Region............. 2,644 699 716 2.3 3.0 New England............. 138 745 768 3.0 3.0 Middle Atlantic......... 407 782 800 2.4 2.9 South Atlantic.......... 393 669 684 2.2 3.0 East North Central...... 448 672 690 2.7 3.0 East South Central...... 156 638 655 2.7 2.9 West North Central...... 181 688 708 2.9 3.0 West South Central...... 321 665 673 1.3 2.9 Mountain................ 127 702 698 -0.6 2.9 Pacific................. 427 787 808 2.7 3.0 Puerto Rico............. 46 295 304 3.1 3.1 Rural by Region............. 2,061 439 444 1.2 2.9 New England............. 49 522 534 2.3 3.0 Middle Atlantic......... 73 463 469 1.5 2.9 South Atlantic.......... 267 457 458 0.1 2.9 East North Central...... 273 449 455 1.4 2.9 East South Central...... 260 410 415 1.2 2.9 West North Central...... 477 422 428 1.4 2.9 West South Central...... 325 390 398 2.1 2.9 Mountain................ 193 466 467 0.1 2.8 Pacific................. 139 520 530 2.0 3.0 By Payment Classification: All hospitals............... 4,705 647 661 2.2 3.0 Large urban areas 1,599 742 759 2.3 3.0 (populations over 1 million)................... Other urban areas 1,090 636 651 2.4 3.0 (populations of 1 million or fewer).................. Rural areas................. 2,016 437 442 1.2 2.9 [[Page 22880]] Teaching Status: Non-teaching............ 3,586 533 540 1.3 2.9 Fewer than 100 Residents 879 675 695 2.9 3.0 100 or more Residents... 240 999 1,026 2.7 2.9 Urban DSH: 100 or more beds........ 1,374 734 752 2.4 3.0 Less than 100 beds...... 317 489 491 0.4 2.8 Rural DSH: Sole Community (SCH/ 540 395 390 -1.3 2.8 EACH).................. Referral Center (RRC/ 157 504 511 1.4 2.9 EACH).................. Other Rural: 100 or more beds.... 73 409 419 2.4 2.9 Less than 100 beds.. 439 369 380 2.8 3.0 Urban teaching and DSH: Both teaching and DSH... 753 814 836 2.7 3.0 Teaching and no DSH..... 294 717 740 3.3 3.0 No teaching and DSH..... 938 585 595 1.7 2.9 No teaching and no DSH.. 704 590 595 0.9 2.9 Rural Hospital Types: Non special status 788 384 394 2.8 3.0 hospitals.............. RRC/EACH................ 165 504 517 2.6 3.0 SCH/EACH................ 667 423 417 -1.5 2.8 Medicare-dependent 327 363 365 0.7 2.9 hospitals (MDH)........ SCH, RRC and EACH....... 69 510 508 -0.4 2.8 Hospitals Reclassified by the Medicare Geographic Classification Review Board: Reclassification Status 482 564 576 2.1 3.0 During FY01 and FY02: Reclassified During FY02 153 571 580 1.6 2.9 Only................... FY02 Reclassifications: All Reclassified 635 566 577 2.0 3.0 Hospitals.............. All Nonreclassified 4,157 659 674 2.2 3.0 Hospitals.............. All Urban Reclassified 119 741 763 2.9 3.0 Hospitals.............. Urban Nonreclassified 2,487 699 715 2.3 3.0 Hospitals.............. All Reclassified Rural 516 492 499 1.4 2.9 Hospitals.............. Rural Nonreclassified 1,542 388 392 0.9 2.9 Hospitals.............. Other Reclassified Hospitals 41 461 455 -1.3 2.9 (Section 1886(D)(8)(B)).... Type of Ownership: Voluntary............... 2,769 660 677 2.5 3.0 Proprietary............. 755 639 642 0.5 2.9 Government.............. 1,179 581 594 2.2 3.0 Medicare Utilization as a Percent of Inpatient Days: 0-25.................... 389 825 846 2.5 3.0 25-50................... 1,872 736 755 2.5 3.0 50-65................... 1,832 568 580 2.2 3.0 Over 65................. 585 522 519 -0.7 2.9 ---------------------------------------------------------------------------------------------------------------- Appendix B: Technical Appendix on the Capital Cost Model and Required Adjustments Under section 1886(g)(1)(A) of the Act, we set capital prospective payment rates for FY 1992 through FY 1995 so that aggregate prospective payments for capital costs were projected to be 10 percent lower than the amount that would have been payable on a reasonable cost basis for capital-related costs in that year. To implement this requirement, we developed the capital acquisition model to determine the budget neutrality adjustment factor. Even though the budget neutrality requirement expired effective with FY 1996, we must continue to determine the recalibration and geographic reclassification budget neutrality adjustment factor and the reduction in the Federal and hospital-specific rates for exceptions payments. To determine these factors, we must continue to project capital costs and payments. We will continue to pay regular exceptions for cost reporting periods beginning before October 1, 2001 but ending in FY 2002. In FY 2003 and later, no payments will be made under the regular exceptions policy, hence we will not compute a budget neutrality factor for regular exceptions in FY 2003 and later. As described in section V.D. of the preamble of this proposed rule, the budget neutrality adjustment for special exceptions will be based on historical costs. Consequently, there will be no need to estimate capital costs with the capital acquisition model. We will not publish this appendix after the final rule for the FY 2002 capital rates. We used the capital acquisition model from the start of prospective payments for capital costs through FY 1997. We now have 8 years of cost reports under the capital prospective payment system. For FY 1998, we developed a new capital cost model to replace the capital acquisition model. This revised model makes use of the data from these cost reports. The following cost reports are used in the capital cost model for this proposed rule: the December 31, 2000 update of the cost reports for PPS-IX (cost reporting periods beginning in FY 1992), PPS-X (cost reporting periods beginning in FY 1993), PPS-XI (cost reporting periods beginning in FY 1994), PPS-XII (cost reporting periods beginning in FY 1995), PPS-XIII (cost reporting periods beginning in FY 1996), PPS-XIV (cost reporting periods beginning in FY 1997), [[Page 22881]] PPS-XV (cost reporting periods beginning in FY 1998), and PPS-XVI (cost reporting periods beginning in FY 1999). In addition, to model payments, we use the January 1, 2001 update of the provider-specific file, and the March 1995 update of the intermediary audit file. Since hospitals under alternative payment system waivers (that is, hospitals in Maryland) are currently excluded from the capital prospective payment system, we excluded these hospitals from our model. We developed FY 1992 through FY 2001 hospital-specific rates using the provider-specific file and the intermediary audit file. (We used the cumulative provider-specific file, which includes all updates to each hospital's records, and chose the latest record for each fiscal year.) We checked the consistency between the provider- specific file and the intermediary audit file. We ensured that increases in the hospital-specific rates were at least as large as the published updates (increases) for the hospital-specific rates each year. We were able to match hospitals to the files as shown in the following table: ------------------------------------------------------------------------ Number of Source hospitals ------------------------------------------------------------------------ No match................................................... 4 Audit file only............................................ 90 Provider-specific file only................................ 185 Provider-specific and audit file........................... 4,516 ------------ Total................................................ 4,795 ------------------------------------------------------------------------ One hundred eighteen of the 4,795 hospitals had unusable or missing data, or had no cost reports available. For 52 of the 118 hospitals, we were unable to determine a hospital-specific rate from the available cost reports. However, there was adequate cost information to determine that these hospitals were paid under the hold-harmless methodology. Since the hospital-specific rate is not used to determine payments for hospitals paid under the hold- harmless methodology, there was sufficient cost report information available to include these 52 hospitals in the analysis. We were able to estimate hospital-specific amounts from the cost reports as shown in the following table. ------------------------------------------------------------------------ Number of Cost report hospitals ------------------------------------------------------------------------ PPS-9...................................................... 1 PPS-12..................................................... 1 PPS-13..................................................... 1 PPS-14..................................................... 1 PPS-15..................................................... 2 PPS-16..................................................... 8 ------------ Total................................................ 14 ------------------------------------------------------------------------ Hence we were able to use 66 (52 plus 14) of the 118 hospitals. The remaining 52 of the 118 hospitals could not be used in the analysis because we were not able to estimate their hospital- specific amount. An additional 38 hospitals could not be used in the analysis because we could not determine their capital costs, either because we had no cost reports for them or because there was insufficient cost report data. Accordingly, we used 4,705 hospitals for the analysis. Ninety (52 plus 38) hospitals could not be used in the analysis because of insufficient (missing or unusable) information. These hospitals account for about 0.3 percent of admissions. Therefore, any effects from the elimination of their cost report data should be minimal. We analyzed changes in capital-related costs (depreciation, interest, rent, leases, insurance, and taxes) reported in the cost reports. We found a wide variance among hospitals in the growth of these costs. For hospitals with more than 100 beds, the distribution and mean of these cost increases were different for large changes in bed-size (greater than 20 percent). We also analyzed changes in the growth in old capital and new capital for cost reports that provided this information. For old capital, we limited the analysis to decreases in old capital. We did this since the opportunity for most hospitals to treat "obligated" capital put into service as old capital has expired. Old capital costs should decrease as assets become fully depreciated and as interest costs decrease as the loan is amortized. The new capital cost model separates the hospitals into three mutually exclusive groups. Hold-harmless hospitals with data on old capital were placed in the first group. Of the remaining hospitals, those hospitals with fewer than 100 beds comprise the second group. The third group consists of all hospitals that did not fit into either of the first two groups. Each of these groups displayed unique patterns of growth in capital costs. We found that the gamma distribution is useful in explaining and describing the patterns of increase in capital costs. A gamma distribution is a statistical distribution that can be used to describe patterns of growth rates, with the greatest proportion of rates being at the low end. We use the gamma distribution to estimate individual hospital rates of increase as follows: (1) For hold-harmless hospitals, old capital cost changes were fitted to a truncated gamma distribution, that is, a gamma distribution covering only the distribution of cost decreases. New capital costs changes were fitted to the entire gamma distribution, allowing for both decreases and increases. (2) For hospitals with fewer than 100 beds (small), total capital cost changes were fitted to the gamma distribution, allowing for both decreases and increases. (3) Other (large) hospitals were further separated into three groups: Bed-size decreases over 20 percent (decrease). Bed-size increases over 20 percent (increase). Other (no change). Capital cost changes for large hospitals were fitted to gamma distributions for each bed-size change group, allowing for both decreases and increases in capital costs. We analyzed the probability distribution of increases and decreases in bed size for large hospitals. We found the probability somewhat dependent on the prior year change in bed size and factored this dependence into the analysis. Probabilities of bed-size change were determined. Separate sets of probability factors were calculated to reflect the dependence on prior year change in bed size (increase, decrease, and no change). The gamma distributions were fitted to changes in aggregate capital costs for the entire hospital. We checked the relationship between aggregate costs and Medicare per discharge costs. For large hospitals, there was a small variance, but the variance was larger for small hospitals. Since costs are used only for the hold-harmless methodology and to determine exceptions, we decided to use the gamma distributions fitted to aggregate cost increases for estimating distributions of cost per discharge increases. Capital costs per discharge calculated from the cost reports were increased by random numbers drawn from the gamma distribution to project costs in future years. Old and new capital were projected separately for hold-harmless hospitals. Aggregate capital per discharge costs were projected for all other hospitals. Because the distribution of increases in capital costs varies with changes in bed size for large hospitals, we first projected changes in bed size for large hospitals before drawing random numbers from the gamma distribution. Bed-size changes were drawn from the uniform distribution with the probabilities dependent on the previous year bed-size change. The gamma distribution has a shape parameter and a scaling parameter. (We used different parameters for each hospital group, and for old and new capital.) We used discharge counts from the cost reports to calculate capital cost per discharge. To estimate total capital costs for FY 2000 (the MedPAR data year) and later, we use the number of discharges from the MedPAR data. Some hospitals had considerably more discharges in FY 2000 than in the years for which we calculated cost per discharge from the cost report data. Consequently, a hospital with few cost report discharges would have a high capital cost per discharge, since fixed costs would be allocated over only a few discharges. If discharges increase substantially, the cost per discharge would decrease because fixed costs would be allocated over more discharges. If the projection of capital cost per discharge is not adjusted for increases in discharges, the projection of exceptions would be overstated. We address this situation by recalculating the cost per discharge with the MedPAR discharges if the MedPAR discharges exceed the cost report discharges by more than 20 percent. We do not adjust for increases of less than 20 percent because we have not received all of the FY 2000 discharges, and we have removed some discharges from the analysis because they are statistical outliers. This adjustment reduces our estimate of exceptions payments, and consequently, the reduction to the Federal rate for exceptions is smaller. We will continue to monitor our modeling of exceptions payments and make adjustments as needed. The average national capital cost per discharge generated by this model is the combined average of many randomly generated increases. This average must equal the projected average national capital cost per discharge, which we projected separately [[Page 22882]] (outside this model). We adjusted the shape parameter of the gamma distributions so that the modeled average capital cost per discharge matches our projected capital cost per discharge. The shape parameter for old capital was not adjusted since we are modeling the aging of "existing" assets. This model provides a distribution of capital costs among hospitals that is consistent with our aggregate capital projections. Once each hospital's capital-related costs are generated, the model projects capital payments. We use the actual payment parameters (for example, the case-mix index and the geographic adjustment factor) that are applicable to the specific hospital. To project capital payments, the model first assigns the applicable payment methodology (fully prospective or hold-harmless) to the hospital as determined from the provider-specific file and the cost reports. The model simulates Federal rate payments using the assigned payment parameters and hospital-specific estimated outlier payments. The case-mix index for a hospital is derived from the FY 2000 MedPAR file using the FY 2002 DRG relative weights included in section VI. of the Addendum to this proposed rule. The case-mix index is increased each year after FY 2000 based on analysis of past experiences in case-mix increases. Based on analysis of recent case-mix increases, we estimate that case-mix will increase 0.0 percent in FY 2001. We project that case-mix will increase 1.0 percent in FY 2002. (Since we are using FY 2000 cases for our analysis, the FY 2000 increase in case-mix has no effect on projected capital payments.) Changes in geographic classification and revisions to the hospital wage data used to establish the hospital wage index affect the geographic adjustment factor. Changes in the DRG classification system and the relative weights affect the case-mix index. Section 412.308(c)(4)(ii) requires that the estimated aggregate payments for the fiscal year, based on the Federal rate after any changes resulting from DRG reclassifications and recalibration and the geographic adjustment factor, equal the estimated aggregate payments based on the Federal rate that would have been made without such changes. For FY 2001, the budget neutrality adjustment factors were 0.99933 for the national rate and 1.00508 for the Puerto Rico rate. In determining these factors, we used the factors from the first half of FY 2001 (October 2000 through March 2001) published in the August 1, 2000 final rule since section 547 of Public Law 106- 554 specifies that the special increases and adjustments in effect between April and October 2001 do not apply for discharges occurring after FY 2001 and should not be included in determining the payment rates in subsequent years. Since we implemented a separate geographic adjustment factor for Puerto Rico, we applied separate budget neutrality adjustments for the national geographic adjustment factor and the Puerto Rico geographic adjustment factor. We applied the same budget neutrality factor for DRG reclassifications and recalibration nationally and for Puerto Rico. Separate adjustments were unnecessary for FY 1998 and earlier since the geographic adjustment factor for Puerto Rico was implemented in FY 1998. To determine the factors for FY 2002, we first determined the portions of the Federal national and Puerto Rico rates that would be paid for each hospital in FY 2002 based on its applicable payment methodology. Using our model, we then compared, separately for the national rate and the Puerto Rico rate, estimated aggregate Federal rate payments based on the FY 2001 DRG relative weights and the FY 2001 geographic adjustment factor to estimated aggregate Federal rate payments based on the FY 2001 relative weights and the FY 2002 geographic adjustment factor. In making the comparison, we held the FY 2002 Federal rate portion constant and set the other budget neutrality adjustment factor and the regular and special exceptions reduction factors to 1.00. To achieve budget neutrality for the changes in the national geographic adjustment factor, we applied an incremental budget neutrality adjustment of 0.99703 for FY 2002 to the previous cumulative FY 2001 adjustment of 0.99933, yielding a cumulative adjustment of 0.99637 through FY 2002. For the Puerto Rico geographic adjustment factor, we applied an incremental budget neutrality adjustment of 0.99943 for FY 2002 to the previous cumulative FY 2001 adjustment of 1.00508, yielding a cumulative adjustment of 1.00450 through FY 2002. We then compared estimated aggregate Federal rate payments based on the FY 2001 DRG relative weights and the FY 2002 geographic adjustment factors to estimated aggregate Federal rate payments based on the FY 2002 DRG relative weights and the FY 2002 geographic adjustment factors. The incremental adjustment for DRG classifications and changes in relative weights would be 0.99428 nationally and for Puerto Rico. The cumulative adjustments for DRG classifications and changes in relative weights and for changes in the geographic adjustment factors through FY 2002 would be 0.99067 nationally and 0.99876 for Puerto Rico. The following table summarizes the adjustment factors for each fiscal year: [[Page 22883]] Budget Neutrality Adjustment for DRG Reclassifications and Recalibration and the Geographic Adjustment Factors -------------------------------------------------------------------------------------------------------------------------------------------------------- National Puerto Rico ------------------------------------------------------------------------------------------------------------- Incremental adjustment Incremental adjustment Fiscal year ------------------------------------------------------------------------------------------------------------- Geographic DRG Geographic DRG adjustment reclassifications Combined Cumulative adjustment reclassifications Combined Cumulative factor and recalibration factor and recalibration -------------------------------------------------------------------------------------------------------------------------------------------------------- 1992...................................... .......... ................. .......... 1.00000 .......... ................. .......... .......... 1993...................................... .......... ................. 0.99800 0.99800 .......... ................. .......... .......... 1994...................................... .......... ................. 1.00531 1.00330 .......... ................. .......... .......... 1995...................................... .......... ................. 0.99980 1.00310 .......... ................. .......... .......... 1996...................................... .......... ................. 0.99940 1.00250 .......... ................. .......... .......... 1997...................................... .......... ................. 0.99873 1.00123 .......... ................. .......... .......... 1998...................................... .......... ................. 0.99892 1.00015 .......... ................. .......... 1.00000 1999...................................... 0.99944 1.00335 1.00279 1.00294 0.99898 1.00335 1.00233 1.00233 2000...................................... 0.99857 0.99991 0.99848 1.00142 0.99910 0.99991 0.99901 1.00134 2001 \1\.................................. 0.99846 1.00019 0.99865 0.99933 1.00365 1.00009 1.00374 1.00508 2001 \2\.................................. \3\ 0.9977 \3\ 1.00009 \3\ 0.9978 0.99922 \3\ 1.0036 \3\ 1.00009 \3\ 1.0037 1.00508 1 0 5 4 2002...................................... \4\ 0.9970 \4\ 0.99428 \4\ 0.9913 0.99067 \4\ 0.9994 \4\ 0.99428 \4\ 0.9937 0.99876 3 3 3 1 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ Factors effective for the first half of FY 2001 (October 2000 through March 2001). \2\ Factors effective for the second half of FY 2001 (April 2001 through September 2001). \3\ Incremental factors are applied to FY 2000 cumulative factors. \4\ Incremental factors are applied to the cumulative factors for the first half of FY 2001. [[Page 22884]] The methodology used to determine the recalibration and geographic (DRG/GAF) budget neutrality adjustment factor is similar to that used in establishing budget neutrality adjustments under the prospective payment system for operating costs. One difference is that, under the operating prospective payment system, the budget neutrality adjustments for the effect of geographic reclassifications are determined separately from the effects of other changes in the hospital wage index and the DRG relative weights. Under the capital prospective payment system, there is a single DRG/GAF budget neutrality adjustment factor (the national rate and the Puerto Rico rate are determined separately) for changes in the geographic adjustment factor (including geographic reclassification) and the DRG relative weights. In addition, there is no adjustment for the effects that geographic reclassification has on the other payment parameters, such as the payments for serving low-income patients or the large urban add-on payments. In addition to computing the DRG/GAF budget neutrality adjustment factor, we used the model to simulate total payments under the prospective payment system. Additional payments under the exceptions process are accounted for through a reduction in the Federal and hospital-specific rates. For FY 2002 additional payments for the "regular" exceptions are made only for cost reporting periods that begin before October 1, 2001. The adjustment for "special" exceptions payments (see Sec. 412.348(g)) is described in section V.D. of the preamble of this proposed rule. Therefore, we used the model to calculate the exceptions reduction factor. This exceptions reduction factor ensures that aggregate payments under the capital prospective payment system, including exceptions payments, are projected to equal the aggregate payments that would have been made under the capital prospective payment system without an exceptions process. In modeling exceptions for FY 2002, we calculated exceptions only for qualifying cost reporting periods. Since changes in the level of the payment rates change the level of payments under the exceptions process, the exceptions reduction factor must be determined through iteration. In the August 30, 1991 final rule (56 FR 43517), we indicated that we would publish each year the estimated payment factors generated by the model to determine payments for the next 5 years. Since we will no longer use the model after the final notice for the FY 2002 rates, we propose to discontinue publishing this table after the final notice for the FY 2002 rates. The table below provides the actual factors for FYs 1992 through 2001, the proposed factors for FY 2002, and the estimated factors that would be applicable through FY 2006. We caution that these are estimates for FYs 2002 and later, and are subject to revisions resulting from continued methodological refinements, receipt of additional data, and changes in payment policy. We note that in making these projections, we have assumed that the cumulative national DRG/GAF budget neutrality adjustment factor will remain at 0.99067 (0.99876 for Puerto Rico) for FY 2002 and later because we do not have sufficient information to estimate the change that will occur in the factor for years after FY 2002. The projections are as follows: -------------------------------------------------------------------------------------------------------------------------------------------------------- Exceptions Budget DRG/GAF Outlier Federal rate Fiscal year Update factor reduction neutrality adjustment adjustment Federal rate (after outlier factor factor factor \1\ factor adjustment reduction) -------------------------------------------------------------------------------------------------------------------------------------------------------- 1992.................................... N/A 0.9813 0.9602 .............. 0.9497 .............. 415.59 1993.................................... 6.07 .9756 .9162 .9980 .9496 .............. 417.29 1994.................................... 3.04 .9485 .8947 1.0053 .9454 \2\.9260 378.34 1995.................................... 3.44 .9734 .8432 .9998 .9414 .............. 376.83 1996.................................... 1.20 .9849 N/A .9994 .9536 \3\.9972 461.96 1997.................................... 0.70 .9358 N/A .9987 .9481 .............. 438.92 1998.................................... 0.90 9659 N/A .9989 .9382 \4\.8222 371.51 1999.................................... 0.10 .9783 N/A 1.0028 .9392 .............. 378.10 2000.................................... 0.30 .9730 N/A .9985 .9402 .............. 377.03 2001 \5\................................ 0.90 .9785 N/A .9979 .9409 .............. 382.03 2002.................................... 1.10 \6\.9925 N/A 0.9913 .9426 .............. 389.09 2003.................................... 0.60 .9975 N/A \7\ 1.0000 \7\.9426 \4\ 1.0255 403.44 2004.................................... 0.90 .9975 N/A 1.0000 .9426 .............. 407.07 2005.................................... 1.10 .9975 N/A 1.0000 .9426 .............. 411.55 2006.................................... 1.10 .9975 N/A 1.0000 .9426 .............. 416.07 -------------------------------------------------------------------------------------------------------------------------------------------------------- \1\ Note: The incremental change over the previous year. \2\ Note: OBRA 1993 adjustment. \3\ Note: Adjustment for change in the transfer policy. \4\ Note: Balanced Budget Act of 1997 adjustment. \5\ Note: Rates are for the first half of FY 2001 (October 1, 2000 through March 31, 2001). \6\ Note: Product of general exceptions factor (0.9937) and special exceptions factor (0.9988). \7\ Note: Future adjustments are, for purposes of this projection, assumed to remain at the same level. BILLING CODE 4120-01-P [[Page 22885]] Appendix C--Report to Congress [GRAPHIC] [TIFF OMITTED] TP04MY01.000 [[Page 22886]] [GRAPHIC] [TIFF OMITTED] TP04MY01.001 [[Page 22887]] [GRAPHIC] [TIFF OMITTED] TP04MY01.002 [[Page 22888]] [GRAPHIC] [TIFF OMITTED] TP04MY01.003 Appendix D: Recommendation of Update Factors for Operating Cost Rates of Payment for Inpatient Hospital Services I. Background Several provisions of the Act address the setting of update factors for inpatient services furnished in FY 2002 by hospitals subject to the prospective payment system and by hospitals or units excluded from the prospective payment system. Section 1886(b)(3)(B)(i)(XVII) of the Act, as amended by Section 301 of Public Law 106-554, sets the FY 2002 percentage increase in the operating cost standardized amounts equal to the rate of increase in the hospital market basket minus 0.55 percent for prospective payment hospitals in all areas. Section 1886(b)(3)(B)(iv) of the Act sets the FY 2002 percentage increase in the hospital-specific rates applicable to SCHs and MDHs equal to the rate set forth in section 1886(b)(3)(B)(i) of the Act, that is, the same update factor as all other hospitals subject to the prospective payment system, or the rate of increase in the market basket minus 0.55 percentage points. Under section 1886(b)(3)(B)(ii) of the Act, the FY 2002 percentage increase in the rate-of-increase limits for hospitals and units excluded from the prospective payment system ranges from the percentage increase in the excluded hospital market basket less a percentage between 0 and 2.5 percentage points, depending on the hospital's or unit's costs in relation to its limit for the most recent cost reporting period for which information is available, or 0 percentage point if costs do not exceed two-thirds of the limit. In accordance with section 1886(d)(3)(A) of the Act, we are proposing to update the standardized amounts, the hospital-specific rates, and the rate-of-increase limits for hospitals and units excluded from the prospective payment system as provided in section 1886(b)(3)(B) of the Act. Based on the first quarter 2001 forecast of the FY 2002 market basket increase of 3.1 percent for hospitals and units subject to the prospective payment system, the proposed update to the standardized amounts is 2.55 percent (that is, the market basket rate of increase minus 0.55 percent percentage points) for hospitals in both large urban and other areas. The proposed update to the hospital-specific rate applicable to SCHs and MDHs is also 2.55 percent. The proposed update for hospitals and units excluded from the prospective payment system would range from the percentage increase in the excluded hospital market basket (currently estimated at 3.0 percent) minus a percentage between 0 and 2.5 percentage points, or 0 percentage points, resulting in an increase in the rate-of-increase limit between 0.5 and 3.0 percent, or 0 percent. Section 1886(e)(4) of the Act requires that the Secretary, taking into consideration the recommendations of the Medicare Payment Advisory Commission (MedPAC), recommend update factors for each fiscal year that take into account the amounts necessary for the efficient and effective delivery of medically appropriate and necessary care of high quality. Under section 1886(e)(5) of the Act, we are required to publish the update factors recommended under section 1886(e)(4) of the Act. Accordingly, this Appendix provides the recommendations of appropriate update factors and the analysis underlying our recommendations and our response to MedPAC's recommendations concerning the update factors. In its March 1, 2001 report, MedPAC stated that the legislated update of market basket minus 0.55 percentage points would provide a reasonable level of payments to hospitals. MedPAC did not make a separate recommendation for the hospital-specific rate applicable to SCHs and MDHs. We discuss MedPAC's recommendations concerning the update factors and our responses to these recommendations in section III. below. II. Secretary's Recommendations Under section 1886(e)(4) of the Act, we are recommending that an appropriate update factor for the standardized amounts is 2.55 percentage points for hospitals located in large urban and other areas. We are also recommending an update of 2.55 percentage points to the hospital-specific rate for SCHs and MDHs. As MedPAC states in its March 2001 report, there are signs of substantial improvement in hospitals' financial performance in FY 2000 as a result of the enactment of Public Law 106-113 and Public Law 106-554. In conjunction with the various "give-back" provisions in Public Law 106-113 and Public Law 106-554 and the continuation of positive (MedPAC estimates 12 percent for FY 1999 (page 64)) Medicare [[Page 22889]] hospital inpatient margins, we believe these recommended update factors for FY 2002 would ensure that Medicare acts as a prudent purchaser and provide incentives to hospitals for increased efficiency, thereby contributing to the solvency of the Medicare Part A Trust Fund. We recommend that hospitals excluded from the prospective payment system receive an update of between 0.5 and 3.0 percentage points, or 0 percentage points. The update for excluded hospitals and units is equal to the increase in the excluded hospital operating market basket less a percentage between 0 and 2.5 percentage points, or 0 percentage points, depending on the hospital's or unit's costs in relation to its rate-of-increase limit for the most recent cost reporting period for which information is available. The market basket rate of increase for excluded hospitals and units is currently forecast at 3.0 percent. As required by section 1886(e)(4) of the Act, we have taken into consideration the recommendations of MedPAC in setting these recommended update factors. Our responses to the MedPAC recommendations concerning the update factors are discussed below. III. MedPAC Recommendations for Updating the Prospective Payment System Operating Standardized Amounts In its March 2001 Report to Congress, MedPAC recommended a combined operating and capital update for hospital inpatient prospective payment system payments for FY 2002. With the end of the transition to fully prospective capital payments ending with FY 2001, both operating and capital prospective system payments will be made using standard Federal rates adjusted by hospital specific payment variables. Currently, section 1886(b)(3)(B)(i)(XVII) of the Act sets forth the FY 2002 percentage increase in the prospective payment system operating cost standardized amounts. The prospective payment system capital update is set at the discretion of the Secretary under the framework outlined in Sec. 412.308(c)(1). MedPAC's FY 2001 combined operating and capital update framework uses a weighted average of HCFA's forecasts of the operating (prospective payment system input price index) and the capital input price index. This combined market basket was used to develop an estimate of the change in overall operating and capital prices. MedPAC calculated a combined market basket forecast by weighting the operating market basket forecast by 0.92 and the capital market basket forecast by 0.08, since operating costs are estimated to represent 92 percent of total hospital costs (capital costs are estimated to represent the remaining 8 percent of total hospital costs). MedPAC's combined market basket for FY 2002 is estimated to increase by 2.8 percent, based on HCFA's December 2000 forecasted operating market basket increase of 3.0 percent and HCFA's December 2000 forecasted capital market basket increase of 0.8 percent. For FY 2002, MedPAC's update framework would support a combined operating and capital update for hospital inpatient prospective payment system payments of 1.5 percent to 3.0 percent (or between the increase in the combined operating and capital market basket minus 1.3 percentage points and the increase in the combined operating and capital market basket plus 0.2 percentage points). In its update recommendation, MedPAC studied factors affecting the adequacy of payments in FY 2001 and factors expected to affect hospital costs in FY 2002. MedPAC concluded, "there is no compelling reason to change current law setting an operating update for fiscal year 2002 of 0.55 percent below the rate of increase in the operating market basket "(page 73). MedPAC also notes that while the number of hospitals with negative inpatient hospital margins have increased in FY 1999 (from 33.7 percent in 1998 to 36.7 percent in 1999) (page 71), overall high inpatient Medicare margins generally offset hospital losses on other lines of Medicare services (page 68). MedPAC continues to project substantially improved hospital total margins for FY 2000 based on performance in the first half of the fiscal year (page 72). Response: Our long-term goal is to develop a single update framework for operating and capital prospective payments. However, the operating system update has been determined by Congress through FY 2003 (as amended by section 301 of Public Law 106-554). In the meantime, we intend to maintain as much consistency as possible with the current operating framework in order to facilitate the eventual development of a unified framework. We agree with MedPAC's recommendation that the current law update for FY 2002 of the market basket minus 0.55 percentage points is appropriate for the operating system update. The following analyses measure changes in hospital productivity, scientific and technological advances, practice pattern changes, changes in case- mix, the effect of reclassification on recalibration, and forecast error correction. A. Productivity Service level labor productivity is defined as the ratio of total service output to full-time equivalent employees (FTEs). While we recognize that productivity is a function of many variables (for example, labor, nonlabor material, and capital inputs), we use the portion of productivity attributed to direct labor since this update framework applies to operating payment. To recognize that we are apportioning the short-run output changes to the labor input and not considering the nonlabor inputs, we weight our productivity measure by the share of direct labor services in the market basket to determine the expected effect on cost per case. Our recommendation for the service productivity component is based on historical trends in productivity and total output for both the hospital industry and the general economy, and projected levels of future hospital service output. MedPAC's predecessor, the Prospective Payment Assessment Commission (ProPAC), estimated cumulative service productivity growth to be 4.9 percent from 1985 through 1989, or 1.2 percent annually. At the same time, ProPAC estimated total output growth at 3.4 percent annually, implying a ratio of service productivity growth to output growth of 0.35. Since it is not possible at this time to develop a productivity measure specific to Medicare patients, we examined productivity (output per hour) and output (gross domestic product) for the economy. Depending on the exact time period, annual changes in productivity range from 0.3 to 0.35 percent of the change in output (that is, a 1.0 percent increase in output would be correlated with a 0.3 to 0.35 percent change in output per hour). Under our framework, the recommended update is based in part on expected productivity--that is, projected service output during the year, multiplied by the historical ratio of service productivity to total service output, multiplied by the share of direct labor in total operating inputs, as calculated in the hospital market basket. This method estimates an expected productivity improvement in the same proportion to expected total service growth that has occurred in the past and assumes that, at a minimum, growth in FTEs changes proportionally to the growth in total service output. Thus, the recommendation allows for unit productivity to be smaller than the historical averages in years that output growth is relatively low and larger in years that output growth is higher than the historical averages. Based on the above estimates from both the hospital industry and the economy, we have chosen to employ the range of ratios of productivity change to output change of 0.30 to 0.35. The expected change in total hospital service output is the product of projected growth in total admissions (adjusted for outpatient usage), projected real case-mix growth, expected quality- enhancing intensity growth, and net of expected decline in intensity due to reduction of cost-ineffective practice. Case-mix growth and intensity numbers for Medicare are used as proxies for those of the total hospital, since case-mix increases (used in the intensity measure as well) are unavailable for non-Medicare patients. Thus, expected FY 2002 hospital output growth is simply the sum of the expected change in intensity (0.3 percent), projected admissions change (1.6 percent for FY 2002), and projected real case-mix growth (1.0 percent), or 2.9 percent. The share of direct labor services in the market basket (consisting of wages, salaries, and employee benefits) is 61.4 percent. Multiplying the expected change in total hospital service output (2.9 percent) by the ratio of historical service productivity change to total service growth of 0.30 to 0.35 and by the direct labor share percentage 61.4, provides our productivity standard of -0.6 to -0.5 percent. In past years, MedPAC made an adjustment for productivity improvement to reflect the level of improvement in the production of health care services, without affecting the quality of those services. Typically, MedPAC made a downward adjustment in its framework to reflect expected improvements in hospital productivity. In its FY 2002 combined update framework, MedPAC did not make an adjustment for productivity. Instead, MedPAC believes that the costs associated with scientific and technological advances should be financed partially [[Page 22890]] through improvements in hospital productivity. As a result, MedPAC offset its adjustment for scientific and technological advances by a fixed standard of expected productivity growth of 0.5 percent for FY 2002. Our productivity adjustment of -0.6 to -0.5 percent is consistent with the range of MedPAC's fixed standard of expected productivity growth of 0.5 percent for FY 2002. B. Intensity We base our intensity standard on the combined effect of three separate factors: changes in the use of quality enhancing services, changes in the use of services due to shifts in within-DRG severity, and changes in the use of services due to reductions of cost- ineffective practices. For FY 2002, we recommend an adjustment of 0.2 to 0.3 percent. The basis of this recommendation is discussed below. We have no empirical evidence that accurately gauges the level of quality-enhancing technology changes. A study published in the Winter 1992 issue of the Health Care Financing Review, "Contributions of case mix and intensity change to hospital cost increases" (pages 151-163), suggests that one-third of the intensity change is attributable to high-cost technology. The balance was unexplained but the authors speculated that it is attributable to fixed costs in service delivery. Typically, a specific new technology increases cost in some uses and decreases cost in other uses. Concurrently, health status is improved in some situations while in other situations it may be unaffected or even worsened using the same technology. It is difficult to separate out the relative significance of each of the cost-increasing effects for individual technologies. Other things being equal, per-discharge fixed costs tend to fluctuate in inverse proportion to changes in volume. Fixed costs exist whether patients are treated or not. If volume is declining, per-discharge fixed costs will rise, but the reverse is true if volume is increasing. Following methods developed by HCFA's Office of the Actuary for deriving hospital output estimates from total hospital charges, we have developed Medicare-specific intensity measures based on a 5- year average using FYs 1996 through 2000 MedPAR billing data. Case- mix constant intensity is calculated as the change in total Medicare charges per discharge adjusted for changes in the average charge per unit of service as measured by the Consumer Price Index (CPI) for hospital and related services and changes in real case-mix. Thus, in order to measure changes in intensity, one must measure changes in real case-mix. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real case-mix. Without reliable estimates of the proportions of the overall annual intensity increases due, respectively, to ineffective practice patterns and to the combination of quality-enhancing new technologies and within-DRG complexity, we assume that one-half of the annual increase is due to each of these factors. For FY 2002, we have developed a Medicare-specific intensity measure based on a 5-year average using FY 1996 through 2000 data. In determining case-mix constant intensity, we estimate that real case-mix increase was 1.0 to 1.4 percent each year. The estimate for those years is supported by past studies of case-mix change by the RAND Corporation. The most recent study was "Has DRG Creep Crept Up? Decomposing the Case Mix Index Change Between 1987 and 1988" by G. M. Carter, J. P. Newhouse, and D. A. Relles, R-4098-HCFA/ProPAC (1991). The study suggested that real case-mix change was not dependent on total change, but was usually a fairly steady 1.0 to 1.4 percent per year. Following that study, we consider up to 1.4 percent of observed case-mix change as real for FY 1996 through FY 2000. We calculate case-mix constant intensity as the change in total charges per admission, adjusted for price level changes (the CPI for hospital and related services), and changes in real case-mix. The average percentage change in charge per discharge was 4.7 percent and the average annual change in the CPI for hospital and related services was 4.2 percent. Dividing the change in charge per discharge by the quantity of the real case-mix index change and the CPI for hospital and related services yields an average annual change in intensity of -0.9 percent. Assuming the technology/fixed cost ratio still holds (.33), technology would account for a -0.3 percent annual decline while fixed costs would account for a -0.6 percent annual decline. The decline in fixed costs per discharge makes intuitive sense as volume, measured by total discharges, has increased during the period. For FYs 1995 through 1999, observed case-mix index change ranged from a low of -0.7 percent to a high of 1.6 percent, with a 5-year average change of 0.2 percent. If we assume that the upper bound of real case-mix was 1.0 percent, we estimate that case-mix constant intensity increased by an average 0.3 percent during FYs 1996 through 2000, for a cumulative increase of 1.4 percent. If we assume that the upper bound of real case-mix increase was 1.4 percent, we estimate that case-mix constant intensity increased by an average 0.2 percent during FYs 1996 through 2000, for a cumulative increase of 1.2 percent. Thus, we are recommending an intensity adjustment for FY 2002 between 0.2 and 0.3 percent. MedPAC does not make an adjustment for intensity per se, but its combined update recommendation for FY 2002 includes two categories that we consider to be comparable with our intensity recommendation. MedPAC is recommending a 0.0 to 0.5 update for scientific and technological advances to account for anticipated uses of emerging technologies that enhance the quality of hospital services, but increase costs of hospital care. MedPAC recognized an allowance for science and technological advances of 0.5 percent to 1.0 percent. It believes that the costs associated with scientific and technological advances should be financed at least in part through improvements in hospital productivity. Hence, MedPAC offsets its allowance for science and technology by 0.5 percent for productivity. In addition, MedPAC includes, when appropriate, an adjustment for one-time factors expected to affect costs in FY 2002 and the removal of the adjustment for FY 2002 one-time factors in its science and technology adjustment. MedPAC concluded that a one-time adjustment of 0.5 percent for the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulatory requirements should be reflected in the FY 2002 payment update. Additionally, since MedPAC believes that the costs associated with one-time factors should not be built permanently into the rates, it recommended that the FY 2002 payment rates be reduced by 0.5 percent to offset the increase it recommended in the FY 2000 update for the costs associated with year 2000 (Y2K) computer improvements. Thus, MedPAC's combined FY 2002 adjustment for science and technological advances is 0.0 percent to 0.5 percent. MedPAC's recommendation also takes into account the trend of some acute care providers to shift care to a postacute care facility. While this can occur for many reasons and the shifting of costs may maintain or improve quality of care for Medicare beneficiaries, it leads to an inappropriate distribution of payments and reduces the resources available for acute care providers to pay for services to other Medicare beneficiaries. We agree with MedPAC that the site-of-care substitution effect is real and believe that it is factored into our intensity recommendation. C. Change in Case-Mix Our analysis takes into account projected changes in case-mix, adjusted for changes attributable to improved coding practices. For our FY 2002 update recommendation, we are projecting a 1.0 percent increase in the case-mix index. We define real case-mix change as actual changes in the mix (and resource requirements) of Medicare patients as opposed to changes in coding behavior that result in assignment of cases to higher-weighted DRGs, but do not reflect greater resource requirements. Unlike in past years, where we differentiated between "real" case-mix increase and increases attributable to changes in coding behavior, we do not believe changes in coding behavior will impact the overall case-mix in FY 2002. As such, for FY 2002, we estimate that real case-mix is equal to projected change in case-mix. Thus, we are recommending a 0.0 percent adjustment for case-mix. MedPAC's analysis indicates that coding change has reduced case- mix index growth. In the past, MedPAC has recommended a negative adjustment when DRG coding changes has led to case-mix index growth (upcoding) and has recommended a positive adjustment when DRG coding changes have led to a decline in case-mix (downcoding). In light of evidence that coding had no significant effect on case-mix change, MedPAC recommended an adjustment of 0.0 percent for FY 2002. MedPAC also makes an adjustment for within-DRG severity. In past years, MedPAC has included an adjustment for increased case complexity not captured by the DRG classification system. MedPAC recognizes [[Page 22891]] that as the DRG system matures, it should account for more of the variation in costs by DRG assignment, leaving less within-DRG variation in case complexity and costliness (page 76). Therefore, MedPAC recommended an adjustment of 0.0 percent for FY 2002. D. Effect of FY 2000 DRG Reclassification and Recalibration We estimate that DRG reclassification and recalibration for FY 2000 resulted in a 0.0 percent change in the case-mix index when compared with the case-mix index that would have resulted if we had not made the reclassification and recalibration changes to the GROUPER. E. Forecast Error Correction We make a forecast error correction if the actual market basket changes differ from the forecasted market basket by 0.25 percentage points or more. There is a 2-year lag between the forecast and the measurement of forecast error. The estimated market basket percentage increase used to update the FY 2000 payment rates was 2.9 percent. Our most recent data indicates the actual FY 2000 increase was 3.6 percent. The resulting forecast error in the FY 2000 market basket rate of increase is 0.7 percentage points. This forecast error is a result of prices for wages, benefits, and chemicals increasing more rapidly than expected. Market conditions enabled hospitals to be less restrictive with pay increases than initially projected. Prices for chemicals were underestimated due to the unanticipated surge in oil prices in FY 2000. MedPAC also made a recommendation in its FY 2002 combined update framework to adjust for any error in the market basket forecasts used to set FY 2000 payment rates. It recommended a combined adjustment for FY 2000 forecast error correction of 0.7 percent. MedPAC determined this forecast error adjustment by weighting the difference between the actual and forecasted operating (92 percent) and capital (8 percent) market basket increases for FY 2000. The forecasted FY 2000 operating market basket was 2.9 percent and the actual FY 2000 operating market basket increase was 3.6 percent. The FY 2000 capital market basket was forecasted to increase by 0.6 percent and the actual market basket increase was 0.9 percent. This implies that MedPAC's combined operating and capital market basket was forecasted at 2.7 percent and the combined actual operating and capital market basket was 3.4 percent. Accordingly, MedPAC recommended a 0.7 percent forecast error correction for its FY 2002 combined update recommendation. F. Medicare Policy Change In developing its update recommendation for FY 2002, MedPAC includes an adjustment for Medicare policy changes affecting financial status in its section of factors affecting current level of payments. While MedPAC's update framework has not considered such costs in the past, MedPAC believes that it is appropriate to account for significant costs incurred as a result of new Medicare policy. For FY 2002, MedPAC believes that legislated updates will match cost growth and that the overall the net affects of legislative changes (from Public Law 105-33, Public Law 106-113, and Public Law 106-554) will be small. Thus, it did not recommend any additional allowance for these costs for FY 2002. Accordingly, MedPAC recommended a 0.0 percent adjustment for Medicare policy changes in its update framework for FY 2002. Comparison of FY 2002 Update Recommendations ---------------------------------------------------------------------------------------------------------------- HHS MedPAC \1\ ---------------------------------------------------------------------------------------------------------------- Market basket MB MB \1\ ---------------------------------------------------------------------------------------------------------------- Policy Adjustment Factors: Productivity................. -0.6 to -0.5......................... (\2\) Site-of-Service Substitution. (\3\)................................. -2.0 to - 1.0. Intensity.................... 0.2 to 0.3............................ ..................................... Science & Technology......... ...................................... 0.0 to 0.5. Real Within DRG Change....... ...................................... (\4\) One-Time Factors............. ...................................... 0.0 Medicare Policy Changes...... ...................................... 0.0 ------------------------------------------------------------------------------ Subtotal................. -0.4 to -0.2.......................... -2.0 to -0.5 Case-Mix Adjustment Factors: Projected Case-Mix Change.... 1.0................................... ..................................... Real Across DRG Change....... 1.0................................... 0.0 Subtotal................. 0.0................................... 0.0 Effect of FY 2000 DRG Reclass/ 0.0................................... ..................................... Recalibration. Forecast Error Correction 0.7................................... 0.7 ------------------------------------------------------------------------------ Total Recommendation MB + 0.3 to MB + 0.5.................. MB \1\ -1.3 to MB \1\ + 0.2. Update. ---------------------------------------------------------------------------------------------------------------- \1\ Used HCFA's December 2000 operating and capital market basket forecast in its combined update recommendation. \2\ Included in MedPAC's Science and Technology Adjustment. \3\ Included in HHS' Intensity Factor. \4\ Included in MedPAC's Case-Mix Adjustment. While the above analysis would suggest an update between operating market basket plus 0.3 percentage points and the operating market basket plus 0.5 percentage points, consistent with current law, we are recommending an update of market basket increase minus 0.55 percentage points (or 2.55 percent). Just as MedPAC believes that market basket minus 0.55 percentage points will provide a reasonable level of payments for FY 2002, we believe that a 2.55 update factor for FY 2002 will appropriately reflect current trends in health care delivery, including the recent decreases in the use of hospital inpatient services and the corresponding increase in the use of hospital outpatient and postacute care services. Also consistent with current law, we are recommending that the hospital-specific rates applicable to SCHs and MDHs be increased by the same update, 2.55 percentage points. As MedPAC states in its March 2001 report, there are signs of substantial improvement in hospital financial performance in FY 2000. In conjunction with the various "give-back" provisions in Public Law 106-113 and Public Law 106-554 and the continuation of positive (12 percent for FY 1999) Medicare hospital inpatient margins, we believe these recommended update factors for FY 2002 would ensure that Medicare acts as a prudent purchaser and provide incentives to hospitals for increased efficiency, thereby contributing to the solvency of the Medicare Part A Trust Fund. [FR Doc. 01-11062 Filed 5-3-01; 8:45 am] BILLING CODE 4120-01-P
