PUBLIC USE FILE: 
DATA USED IN CALCULATION OF REBASED MEDICARE HOME HEALTH PAYMENT RATES
June 21, 2013

BACKGROUND:
Calculating the average costs per visit for rebasing home health payments used data from multiple sources: the FY2011 hospital and freestanding home health agency cost reports, the CY2011 Medicare claims, and the 2012 Provider of Services File (POS).  Specifically, a trimmed subset of the FY2011 cost reports provided costs and visit information to calculate providers average costs per visit in six labor disciplines and the providers number of PPS episodes, used to determine the size of providers for weighting purposes. Claims data on visit and episode counts along with the POS data on provider type and urban/rural location were used to determine the national allocation of visits and episode by provider type, size, and urban/rural location.  Providers in the subset of cost reports were then weighted such that the costs per visit averages were nationally representative along the three dimensions provider type, size, and urban/rural locationrather than solely representing the subset of providers in the trimmed set of cost reports.  

Detailed descriptions of the trimming methodology and development of the weighting procedure are available in the Analyses in Support of Rebasing & Updating Medicare Home Health Payment Rates" Technical Report, available at: http://www.cms.gov/Center/Provider-Type/Home-Health-Agency-HHA-Center.html.

As described in the Technical Report, a step in the trimming process cross-references sequential reports from the same provider over time.  However, because some providers have multiple reports in the same FY, sorting by provider and FY does not lead to a unique ordering of cost reports for these restrictions.  As such, it may be difficult to replicate this portion of the trimming methodology.  Additionally, Medicare claims data and the POS file are not publicly available to create the appropriate weights to replicate the weighted average costs per visit.  For these reasons, the public use file includes information for calculating the weighted costs per visit averages used in rebasing.
  
The provided public use file includes data on the trimmed subset of providers, including the Centers for Medicare & Medicaid Services (CMS) certification number (CCN), episode count grouping, and costs per visit for each discipline from the cost reports; the provider type and urban/rural location of providers as determined from the POS; and the provider-specific weight used in calculating the weighted average cost per visit for each discipline.  The weighted average costs per visit can be replicated using the providers costs per visit by the discipline weights listed in the file.  In order to calculate the weighted average for each discipline: (1) multiplying each providers average costs per visit by the providers weight; (2) sum the products from step one over all providers; (3) sum the weights for the discipline over all providers; (4) divide step 2 by step 3 to calculate the weighted average costs per visit.  Alternatively, standard statistical packages commonly allow for weights to be used when calculating means.

APPENDIX A: 
PUBLIC USE FILE VARIABLE NAMES AND SOURCE DESCRIPTIONS FOR THE 2011 DATA

1) provider: 
The CCN listed on the cost report.

2) provider_type: 
A character variable describing whether the provider is a freestanding non-profit, freestanding for-profit, freestanding government, or facility-based provider as denoted using the control type and facility type variables on the POS.

3) episode_count: 
A character variable denoting the number of PPS episodes recorded on the cost report; values listed are Less than 95, 95 to 249, 250 to 499, 500 to 999, or 1,000 or more.  Calculated on the hospital cost report as the sum of values on sheet S4, column 5, rows 36 and 37; and on the freestanding HHA cost report sum of values on sheet S3 part IV, column 7, rows 45 and 46.

4) urban_rural: 
A character variable indicating whether the provider is located in a CBSA (Urban) or not (Rural) as recorded on the POS.

5) fy_start_dt and fy_end_dt: 
The starting and ending dates of the cost report period.

6) SN_cost_per_visit, PT_cost_per_visit, OT_cost_per_visit, SLP_cost_per_visit, MSS_cost_per_visit, HHA_cost_per_visit:  
The providers average costs for one visit for skilled nursing, physical therapy, occupational therapy, speech language pathology, medical social service, and home health aide, respectively, as calculated on the cost report. Sources: On the hospital cost report, costs are from  sheet H2, column 28, rows 2-7 and visits are from sheet H3, column 4, rows 1-6; on the freestanding HHA cost report, costs are from sheet B, column 6, rows 6-11 and visits are from S3, column 5, rows 1-6.

7) provider_weight_SN, provider_weight_PT, provider_weight_OT, provider_weight_SLP, provider_weight_MSS, provider_weight_HHA: 
The providers discipline-specific weights used in calculating the weighted average costs per visit; equal to the providers number of visits time the claims-to-ratio value in each discipline.
 
