Financial and Quality Reports (DataGen Reports)

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

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

Updated June 11, 2020

Critical Access Hospital and Small Rural PPS Utilization

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

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

Updated June 2024.

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

Medicare VBP Estimates for Critical Access Hospitals

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

Updated September 2024.

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

Updated September 2024.

Enacted Medicare Cuts Analysis

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

Updated February 2024.

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

Updated June 2024.

The calendar year (CY) 2025 Medicare Home Health (HH) Prospective Payment System (PPS) Final Rule Analysis is intended to show HH providers how Medicare fee-for-service (FFS) payments will change from CY 2024 to CY 2025 based on the policies set forth in the CY 2025 HH PPS final rule.

Updated December 2024.

The calendar year (CY) 2025 Medicare Home Health (HH) Prospective Payment System (PPS) Proposed Rule Analysis is intended to show Home Health Agencies (HHA) how Medicare fee-for-service (FFS) payments will change from CY 2024 to CY 2025, based on the policies set forth in the CY 2025 HH PPS proposed rule.

Updated August 2024.

The Hospital-Acquired Condition (HAC) Reduction Program Analysis is intended to provide hospitals with a preview of the potential impact of the FFY 2025 Medicare Inpatient HAC Reduction Program, based on publicly available data and the program rules established by the Centers for Medicare and Medicaid Services (CMS).

Hospital performance is evaluated under the FFY 2025 program in this analysis. This analysis uses the 2Q2023 and 2Q2024 updates of Care Compare for Healthcare-Associated Infection (HAI) measures and the 4Q2023 update of Care Compare for the Patient Safety Indicators (PSI)-90 measure. The analysis includes estimates and details on how HAC measures and domain scores are calculated as well as how payment penalties are determined and applied under the program.

Updated September 2024.

Final Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 IPF PPS final rule.

Updated August 2024.

Proposed Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Proposed Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 IPF PPS proposed rule.

Updated July 2024.

Final Rule Analysis

The Medicare IRF PPS Final Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments may change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 IRF PPS final rule.

Updated August 2024.

Proposed Rule Analysis

The FFY 2025 Medicare IRF PPS Proposed Rule Analysis is intended to show providers how Medicare fee-for-service (FFS) payments may change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 IRF PPS proposed rule.

Updated April 2024.

LTCH Final Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Final Rule Impact Analysis is intended to show providers how Medicare LTCH fee-for-service (FFS) payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 LTCH PPS final rule.

Updated September 2024.

LTCH Proposed Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) Proposed Rule Impact Analysis is intended to show providers how Medicare LTCH fee-for-service (FFS) payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2025 LTCH PPS proposed rule.

Updated May 2024.

Medicare Inpatient Prospective Payment System Final Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Inpatient Prospective Payment System (IPPS) Final Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments may change from FFY 2024 to FFY 2025, based on the policies set forth in the FFY 2025 IPPS final rule. The analysis compares the year-over-year change in operating, capital, and uncompensated care IPPS payments and includes breakout sections that provide detailed insight into specific policies that influence IPPS payment changes, including:

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

Updated August 2024.

Medicare Inpatient Prospective Payment System Proposed Rule Analysis

The federal fiscal year (FFY) 2025 Medicare Inpatient Prospective Payment System (IPPS) Proposed Rule Analysis is intended to show providers how Medicare inpatient fee-for-service (FFS) payments would change from FFY 2024 to FFY 2025 based on the policies set forth in the FFY 2024 IPPS proposed rule. The analysis compares the year-over-year change in operating, capital, and uncompensated care IPPS payments.

Updated May 2024.

The Medicare Fee-For-Service Margins Analysis shows the trends in Medicare margins over the most recent ten-year period (FFY 2013 through FFY 2022). The margins are shown graphically for hospitals and various comparison groups.

Updated March 2024.

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

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

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

Updated February 2024.

The calendar year (CY) 2025 Medicare Outpatient Prospective Payment System (OPPS) Final Rule Analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments will change from CY 2024 to CY 2025 based on the policies set forth in the CY 2025 OPPS final rule.

Updated November 2024.

The calendar year (CY) 2025 Medicare Outpatient Prospective Payment System (OPPS) Proposed Rule Analysis is intended to show providers how Medicare outpatient fee-for-service (FFS) payments will change from CY 2024 to CY 2025 based on the policies set forth in the CY 2025 OPPS proposed rule.

Updated August 2024.

The Quality Program Measure Trends Analysis (3^rd quarter 2024 update) is designed to provide hospitals with a comparative review over time of the quality data collected by the Centers for Medicare and Medicaid Services (CMS) and published on the Hospital Compare website at http://www.medicare.gov/hospitalcompare.

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

Updated December 2024.

This report is a one page summary of actual hospital quality performance and estimated impacts for each of the Centers for Medicare and Medicaid Services’ (CMS’) three Medicare fee-for-service (FFS) inpatient quality programs: Value-Based Purchasing; Readmissions Reduction Program; and the Hospital Acquired Condition Reduction program, from FFYs 2020 – FFY 2022.

Updated March 2022.

The Outpatient Quality Measure Trends Analysis (2^nd quarter 2024 update) is designed to provide hospitals with a comparative review of the quality data collected over time by the Centers for Medicare and Medicaid Services (CMS) which is published on the Care Compare website at https://www.medicare.gov/care-compare/.

The measures analyzed represent several commonly used outpatient quality measures divided into categories:

• Process;
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) Outpatient Survey;
• Imaging and Efficiency; and
• Readmissions.

Updated September 2024.

The Readmissions Reduction Program (RRP) Analysis is intended to provide detailed performance information on the readmissions measures that are currently evaluated under the Medicare Hospital Readmissions Reduction Program and to provide hospitals with an in-depth review of actual performance under the Federal Fiscal Years (FFYs) 2024 and 2025 programs.

Updated October 2024.

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

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

Estimated Change in Medicare Payments to Free Standing SNFs

Updated August 2022.

The Value-Based Purchasing (VBP) Impact Analysis is intended to provide hospitals with a preview of the potential impact of the federal fiscal year (FFY) 2026 Medicare inpatient hospital VBP program based on publicly available data and program rules established by the Centers for Medicare and Medicaid Services (CMS).

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

For FFYs 2024 and 2025 VBP, performance periods are impacted by the extraordinary circumstances exception granted by CMS in response to the COVID-19 public health emergency, so no claims data or chart-abstracted data reflecting services provided January 1, 2020- June 30, 2020 will be used in calculations for the VBP Program.

Updated December 2024.

Medicare Hospital Wage Index and Occupational Mix Analysis
The Medicare Hospital Wage Index  and Occupational Mix Data Analysis – Preliminary Data (May 23, 2024 update) is intended to provide hospitals with a comparative review of the wage and occupational mix data that will be used to develop the federal fiscal year (FFY) 2026 Medicare hospital wage index.

Updated June 2024

Medicare Hospital Wage Index Reclassification
This analysis is intended to allow hospitals to test their potential ability to obtain a federal fiscal year (FFY) 2026 Medicare hospital wage index reclassification.

Updated August 2024