SPSS Analysis

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STATE OF CALIFORNIA
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT
DOCUMENTATION FOR
HOSPITAL QUARTERLY FINANCIAL
AND UTILIZATION DATA FILES
ON OSHPD WEB-SITE
For Calendar Quarters Ended In
2015 and After
January 2016
Office of Statewide Health Planning and Development
Quarterly Data File Labels
Quarters Ended 2015 and After
Data Item
Item
No.
Col.
Ref.
1
2
3
4
5
6
A
B
C
D
E
F
7
8
9
10
11
12
13
14
15
16
17
G
H
I
J
K
L
M
N
O
P
Q
18
19
20
R
S
T
21
22
23
24
25
26
27
28
29
30
31
32
U
V
W
X
Y
Z
AA
AB
AC
AD
AE
AF
January 2016
2015 and After
Column Label
Quarterly Report Information
OSHPD Facility No.
Facility DBA Name
Report Period Year_Quarter
Report Period Begin Date
Report Period End Date
Current Operating Status
General Hospital Information
County Number
Health Service Area
Health Facility Planning Area
Type of Control
Type of Hospital
Teaching or Small/Rural Hospital
Phone Number
Street Address
City
Zip Code
Chief Executive Officer
Utilization Data
Licensed Beds
Available Beds
Staffed Beds
Hospital Discharges
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers (new)
Total Hospital Discharges
Long-term Care (LTC) Discharges
Line
Number
Source
FAC_NO
FAC_NAME
YEAR_QTR
BEG_DATE
END_DATE
OP_STATUS
COUNTY
HSA
HFPA
TYPE_CNTRL
TYPE_HOSP
TEACH_RURL
PHONE
ADDRESS
CITY
ZIP_CODE
CEO
LIC_BEDS
AVL_BEDS
STF_BEDS
25
30
35
DIS_MCAR
DIS_MCAR_MC
DIS_MCAL
DIS_MCAL_MC
DIS_CNTY
DIS_CNTY_MC
DIS_THRD
DIS_THRD_MC
DIS_INDGNT
DIS_OTH
DIS_TOT
DIS_LTC
50
55
60
65
70
75
80
85
90
95
100
105
Quarterly_Labels_2015 After.xls
Office of Statewide Health Planning and Development
Quarterly Data File Labels
Quarters Ended 2015 and After
Data Item
Item
No.
Col.
Ref.
33
34
35
36
37
38
39
40
41
42
43
44
AG
AH
AI
AJ
AK
AL
AM
AN
AO
AP
AQ
AR
45
46
47
48
49
50
51
52
53
54
55
AS
AT
AU
AV
AW
AX
AY
AZ
BA
BB
BC
56
57
58
59
60
61
62
63
64
65
66
BD
BE
BF
BG
BH
BI
BJ
BK
BL
BM
BN
January 2016
2015 and After
Column Label
Patient (Census) Days
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers (new)
Total Patient (Census) Days
Long-term Care (LTC) Patient (Census) Days
Outpatient Visits
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers (new)
Total Outpatient Visits
Gross Inpatient Revenue
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers (new)
Total Gross Inpatient Revenue
Line
Number
Source
DAY_MCAR
DAY_MCAR_MC
DAY_MCAL
DAY_MCAL_MC
DAY_CNTY
DAY_CNTY_MC
DAY_THRD
DAY_THRD_MC
DAY_INDGNT
DAY_OTH
DAY_TOT
DAY_LTC
150
155
160
165
170
175
180
185
190
195
200
205
VIS_MCAR
VIS_MCAR_MC
VIS_MCAL
VIS_MCAL_MC
VIS_CNTY
VIS_CNTY_MC
VIS_THRD
VIS_THRD_MC
VIS_INDGNT
VIS_OTH
VIS_TOT
250
255
260
265
270
275
280
285
290
295
300
GRIP_MCAR
GRIP_MCAR_MC
GRIP_MCAL
GRIP_MCAL_MC
GRIP_CNTY
GRIP_CNTY_MC
GRIP_THRD
GRIP_THRD_MC
GRIP_INDGNT
GRIP_OTH
GRIP_TOT
350
355
360
365
370
375
380
385
390
395
400
Quarterly_Labels_2015 After.xls
Office of Statewide Health Planning and Development
Quarterly Data File Labels
Quarters Ended 2015 and After
Data Item
Item
No.
Col.
Ref.
67
68
69
70
71
72
73
74
75
76
77
BO
BP
BQ
BR
BS
BT
BU
BV
BW
BX
BY
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
Gross Outpatient Revenue
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers (new)
Total Gross Outpatient Revenue
Deductions from Revenue
BZ Provision for Bad Debts
CA Medicare – Traditional Contractual Adjustments
CB Medicare – Managed Care Contractual Adjustments
CC Medi-Cal – Traditional Contractual Adjustments
CD Medi-Cal – Managed Care Contractual Adjustments
CE Dispro Share Payments for Medi-Cal Patient Days (SB 855)
CF County Indigent Programs – Traditional Contractual Adj
CG County Indigent Programs – Managed Care Contractual Adj
CH Other Third Parties – Traditional Contractual Adjustments
CI Other Third Parties – Managed Care Contractual Adj
CJ Charity – Hill-Burton
CK Charity – Other
CL Restricted Donations and Subsidies for Indigent Care
CM Teaching Allowance
CN Clinical Teaching Support
CO Other Adjustments and Allowances
CP Total Deductions from Revenue (new)
Capitation Premium Revenue
CQ Capitation Premium Revenue – Medicare
CR Capitation Premium Revenue – Medi-Cal
CS Capitation Premium Revenue – County Indigent Programs
CT Capitation Premium Revenue – Other Third Parties
CU Total Capitation Premium Revenue
January 2016
2015 and After
Column Label
Line
Number
Source
GROP_MCAR
GROP_MCAR_MC
GROP_MCAL
GROP_MCAL_MC
GROP_CNTY
GROP_CNTY_MC
GROP_THRD
GROP_THRD_MC
GROP_INDGNT
GROP_OTH
GROP_TOT
450
455
460
465
470
475
480
485
490
495
500
BAD_DEBT
CADJ_MCAR
CADJ_MCAR_MC
CADJ_MCAL
CADJ_MCAL_MC
DISP_855
CADJ_CNTY
CADJ_CNTY_MC
CADJ_THRD
CADJ_THRD_MC
CHAR_HB
CHAR_OTH
SUB_INDGNT
TCH_ALLOW
TCH_SUPP
DED_OTH
DED_TOT
545
550
555
560
565
566
570
575
580
585
590
595
600
605
610
615
620
CAP_MCAR
CAP_MCAL
CAP_CNTY
CAP_THRD
CAP_TOT
650
660
670
680
700
Quarterly_Labels_2015 After.xls
Office of Statewide Health Planning and Development
Quarterly Data File Labels
Quarters Ended 2015 and After
Data Item
Item
No.
Col.
Ref.
100
101
102
103
104
105
106
107
108
109
110
CV
CW
CX
CY
CZ
DA
DB
DC
DD
DE
DF
2015 and After
Column Label
122
123
124
Net Patient Revenue
Medicare – Traditional
NET_MCAR
Medicare – Managed Care
NET_MCAR_MC
Medi-Cal – Traditional
NET_MCAL
Medi-Cal – Managed Care
NET_MCAL_MC
County Indigent Programs – Traditional
NET_CNTY
County Indigent Programs – Managed Care
NET_CNTY_MC
Other Third Parties – Traditional
NET_THRD
Other Third Parties – Managed Care
NET_THRD_MC
Other Indigent
NET_INDGNT
Other Payers (new)
NET_OTH
Total Net Patient Revenue
NET_TOT
Other Revenue and Expense Data
DG Other Operating Revenue
OTH_OP_REV
DH Total Operating Expenses
TOT_OP_EXP
DI Physician Professional Component Expenses (PPC)
PHY_COMP
DJ Nonoperating Revenue Net of Nonoperating Expenses
NONOP_REV
Purchased Inpatient Services
DK Discharges
DIS_PIPS
DL Patient Days
DAY_PIPS
DM Expenses
EXP_PIPS
Purchased Outpatient Services
DN Expenses
EXP_POPS
Other Financial Data Items
DO Total Capital Expenditures
CAP_EXP
DP Fixed Assets Net of Accumulated Depreciation
FIX_ASSETS
DQ Dispro. Share Funds Transferred to Related Public Entity DISP_TRNFR
Covered California (optional)
DIS_TOT_CC
DR Total Discharges
PAT_DAY_TOT_CC
DS Total Patient Days
TOT_OUT_VIS_CC
DT Total Outpatient Visits
125
126
127
DU Total Gross Inpatient Revenue
DV Total Gross Outpatient Revenue
DW Total Contractual Adjustments
128
129
130
DX
DY
DZ
119
120
121
DO
DP
DQ
111
112
113
114
115
116
117
118
119
120
121
January 2016
Total Other Deductions
Total Capitation Premium Revenue
Total Net Patient Revenue
Quality Assurance Fee Program (QAF)
Total Capital Expenditures
Fixed Assets Net of Accumulated Depreciation
Dispro. Share Funds Transferred to Related Public Entity
Line
Number
Source
750
755
760
765
770
775
780
785
790
795
800
810
830
835
840
850
855
860
870
880
885
900
1000
1005
1010
GROS_INPAT_REV_CC
GROS_OUTPAT_REV_CC
CONTR_ADJ_CC
OTHR_DEDUCT_CC
CAP_PREM_REV_CC
NET_PAT_REV_CC
1015
1020
1025
CAP_EXP
FIX_ASSETS
DISP_TRNFR
880
885
900
1030
1035
1040
Quarterly_Labels_2015 After.xls
CALCULATIONS AND FORMULAS FOR OSHPD QUARTERLY REPORTS
QUARTERS ENDED 2015 AND AFTER
Utilization Calculations
Formulas
Average Length of Stay (ALOS)
Patient Days Total (Line No. 200) ÷ Discharges
Total (Line No. 100)
Note: To calculate ALOS by payer category, see
table below.
Average Length of Stay (excluding LTC)
[Patient Days Total (Line No. 200) – Patient Days
Long-term Care (Line No. 205)] ÷ [Discharges Total
(Line No. 100) – Discharges Long-term Care (Line
No. 105)]
Licensed Bed Occupancy Rate
Patient Days Total (Line No. 200) ÷ (Licensed Beds
(Line No. 25) x Days in Report Period)
Days in Report Period is Report Period End Date
(END_DATE) minus Report Period Begin Date
(BEG_DATE) plus one.
Available Bed Occupancy Rate
Patient Days Total (Line No. 200) ÷ (Available Beds
(Line No. 30) x Days in Report Period)
Staffed Bed Occupancy Rate
Patient Days Total (Line No. 200) ÷ (Staffed Beds
(Line No. 35) x Days in Report Period)
Occupied Beds (Average Daily Census)
Licensed Beds (Line No. 25) x “Licensed Bed
Occupancy Rate”
Adjusted Patient Days
[(Gross Inpatient Revenue Total (Line No.
400) + Gross Outpatient Revenue Total (Line No.
500)) ÷ Gross Inpatient Revenue Total (Line No.
400)] x Patient Days Total (Line No. 200)
Calculations by Payer Category
ALOS
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
Co. Indigent Prog. – Traditional
Co. Indigent Prog. – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payers
L150 ÷ L50
L155 ÷ L55
L160 ÷ L60
L165 ÷ L65
L170 ÷ L70
L175 ÷ L75
L180 ÷ L80
L185 ÷ L85
L190 ÷ L90
L195 ÷ L95
Gross I/P Rev
Per Day
L350 ÷ L150
L355 ÷ L155
L360 ÷ L160
L365 ÷ L165
L370 ÷ L170
L375 ÷ L175
L380 ÷ L180
L385 ÷ L185
L390 ÷ L190
L395 ÷ L195
Gross I/P Rev
per Discharge
L350 ÷ L50
L355 ÷ L55
L360 ÷ L60
L365 ÷ L65
L370 ÷ L70
L375 ÷ L75
L380 ÷ L80
L385 ÷ L85
L390 ÷ L90
L395 ÷ L95
Gross O/P
Rev Per Visit
L450 ÷ L250
L455 ÷ L255
L460 ÷ L260
L465 ÷ L265
L470 ÷ L270
L475 ÷ L275
L480 ÷ L280
L485 ÷ L285
L490 ÷ L290
L495 ÷ L295
January 2016
CALCULATIONS AND FORMULAS FOR OSHPD QUARTERLY REPORTS
QUARTERS ENDED 2015 AND AFTER
Financial Calculations
Formulas
Gross Inpatient Revenue Per Discharge
Gross Inpatient Revenue Total (Line No. 400) ÷
Discharges Total (Line No. 100)
Gross Inpatient Revenue Per Day
Gross Inpatient Revenue Total (Line No. 400) ÷
Patient Days Total (Line No. 200)
Gross Outpatient Revenue Per Visit
Gross Outpatient Revenue Total (Line No. 500) ÷
Outpatient Visits Total (Line No. 300)
Note: To compute these amounts by payer
category, use the formulas on the previous page.
Net Inpatient Revenue (est.)
[Gross Inpatient Revenue Total (Line No. 400) ÷
(Gross Inpatient Revenue Total (Line No. 400) +
Gross Outpatient Revenue Total (Line No. 500))] x
Net Patient Revenue Total (Line No. 800)
Net Inpatient Revenue by Payer (est.)
You can calculate Net Inpatient Revenue by payer
category by substituting payer detail (Line Nos.
350-395, 450-495, and 750-795) for “Total”.
Net Outpatient Revenue (est.)
[Gross Outpatient Revenue Total (Line No. 500) ÷
(Gross Inpatient Revenue Total (Line No. 400) +
Gross Outpatient Revenue Total (Line No. 500))] x
Net Patient Revenue Total (Line No. 800)
Net Outpatient Revenue by Payer (est.)
You can calculate Net Outpatient Revenue by
payer category by substituting payer detail (Line
Nos. 350-395, 450-495, and 750-795) for “Total”.
Note: You can divide “Net Inpatient Revenue” by
Patient Days and/or Discharges, and “Net
Outpatient Revenue” by Outpatient Visits to
calculate the average amount collected per
day/discharge/visit. You can perform this
calculation in “Total” or for each payer category.
Inpatient Operating Expenses (est.)
[Gross Inpatient Revenue Total (Line No. 400) ÷
(Gross Inpatient Revenue Total (Line No. 400) +
Gross Outpatient Revenue Total (Line No. 500))] x
Total Operating Expenses (Line No. 830)
Outpatient Operating Expenses (est.)
[Gross Outpatient Revenue Total (Line No. 500) ÷
(Gross Inpatient Revenue Total (Line No. 400) +
Gross Outpatient Revenue Total (Line No. 500))] x
Total Operating Expenses (Line No. 830)
Note: You can divide “Inpatient Operating
Expenses” by Patient Days and/or Discharges, and
“Outpatient Operating Expenses” by Outpatient
Visits to estimate the average cost per
day/discharge/visit.
January 2016
CALCULATIONS AND FORMULAS FOR OSHPD QUARTERLY REPORTS
QUARTERS ENDED 2015 AND AFTER
Financial Calculations
Formulas
Pre-tax Net Income (Loss)
Net Patient Revenue Total (Line No. 800) + Other
Operating Revenue (Line No. 810) – Total
Operating Expenses (Line No. 830) + Net
Nonoperating Revenue and Expenses (Line No.
840)
Operating Margin
(“Net from Operations” ÷ “Total Operating
Revenue”) x 100
“Net from Operations” equals Net Patient Revenue
Total (Line No. 800) + Other Operating Revenue
(Line No. 810) – Total Operating Expenses (Line
No. 830)
“Total Operating Revenue” equals Net Patient
Revenue Total (Line No. 800) + Other Operating
Revenue (Line No. 810)
Total Margin
(“Pre-tax Net Income” ÷ “Total Operating Revenue”)
x 100
“Pre-tax Net Income” and “Total Operating
Revenue” are defined above.
Cost-to-Charge Ratio
[Total Operating Expenses (Line No. 830) – Other
Operating Revenue (Line No. 810)] ÷ [Gross
Inpatient Revenue Total (Line No. 400) + Gross
Outpatient Revenue Total (Line No. 500)]
Percent of Gross Revenue Collected
[Net Patient Revenue Total (Line No. 800) ÷ (Gross
Inpatient Revenue Total (Line No. 400) + Gross
Outpatient Revenue Total (Line No. 500))] x 100
Note on Disproportionate Share Payments and Transfers
Disproportionate Share Payments for Medi-Cal Patient Days (SB 855) (Line No. 566) includes the gross
amount of SB 855 Disproportionate Share (DSH) payments received. Disproportionate Share Funds
Transferred to a Related Public Entity (Line No. 900) is an optional reporting item that is applicable
to county, district, and the University of California hospitals, and reflects DSH payments that a
hospital transfers back to a related entity. As a result, you may want to adjust certain financial data,
such as Total Deductions from Revenue (Line No. 620) and Net Patient Revenue (Line No. 800), to
account for such transfers. Because reporting a DSH Transfer (Line No. 900) is optional, a “zero” could
mean that no DSH transfers were made or that the hospital elected to leave the field blank.
January 2016
CALCULATIONS AND FORMULAS FOR OSHPD QUARTERLY REPORTS
QUARTERS ENDED 2015 AND AFTER
Uncompensated Care
When analyzing “Uncompensated Care”, you must first define it. The most common definition for
“Uncompensated Care” is the sum of Bad Debts (Line No. 545) and Charity – Other (Line No. 595).
However, this definition does not reflect OSHPD’s unique database and reporting requirements. Below
are some issues to consider:
•
You should use the data associated with the County Indigent Programs (CIP) payer category. This
payer category was established with the passage of California’s Tobacco Tax legislation, and
includes those indigent patients who are the responsibility of a county. Prior to this legislation,
these indigent patients were classified as Other payers and uncollectible amounts were reported as
Charity – Other. These write-offs now appear as CIP Contractual Adjustments.
Keep in mind that CIP Gross Patient Revenue (Line Nos. 370, 375, 470 and 475) measures the
volume of services provided, while CIP Contractual Adjustments (Line Nos. 570 and 575) reflects
the amount of uncollectible charges.
•
If you want to include non-county indigent patients in your analysis, you need to include the Other
Indigent payer category. This category relates to indigent patients who are NOT the responsibility
of a county. The data for Other Indigent was formerly reported in Other Payers.
•
Some data users may want to include Teaching Allowances (Line No. 605) in their analysis. This
amount is reported only by the University of California hospitals, and reflects write-offs for services
provided to indigent patients who benefit the hospital’s medical education programs.
•
Lastly, if you want to use Charity – Other net of any related compensation, you should subtract
Restricted Donations and Subsidies for Indigent Care (Line No. 600) from Charity – Other. As
defined, Provision for Bad Debts (Line No. 545) is reported net of Bad Debt Recoveries.
January 2016
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
AVAILABLE BEDS
CAPITAL EXPENDITURES
CAPITATION PREMIUM REVENUE
CAPITATION PREMIUM REVENUE COUNTY INDIGENT PROGRAMS
CAPITATION PREMIUM REVENUE – MEDICAL
CAPITATION PREMIUM REVENUE MEDICARE
CAPITATION PREMIUM REVENUE – OTHER
THIRD PARTIES
CHARITY – HILL-BURTON
CHARITY – OTHER
CHIEF EXECUTIVE OFFICER
CITY
CLINICAL TEACHING SUPPORT
CONTRACTUAL ADJUSTMENTS
COUNTY INDIGENT PROGRAMS MANAGED CARE
January 2016
Definition
The average daily complement of beds (excluding nursery bassinets) physically existing and actually available
for overnight use, regardless of staffing levels. Excludes beds placed in suspense or in nursing units converted
to non-patient care uses which cannot be placed into service within 24 hours.
The dollar value of all additions to property, plant and equipment, including amounts which have the effect of
increasing the capacity, efficiency, life-span, or economy of the operation of an existing capital asset. Includes
additions to construction-in-process.
The total amount of capitated revenue received (per member per month payments) for patients enrolled in
managed care health plans. For 2000, Capitation Premium Revenue is reported separately from Deductions
from Revenue, but still included in Net Patient Revenue.
See Capitation Premium Revenue.
See Capitation Premium Revenue.
See Capitation Premium Revenue.
See Capitation Premium Revenue.
Charity care provided by hospitals to satisfy obligations related to the federal Hill-Burton Program. On some
OSHPD products, Charity – Hill-Burton is combined with Other Adjustments and Allowances.
The difference between gross patient revenue (based on full established charges) for services rendered to
patients who are unable to pay for all or part of the services provided, and the amount paid by or on behalf of
the patient. Includes charity care provided by non-county hospitals to indigent patients who are not the
responsibility of the county.
The Chief Executive Officer (CEO) of the hospital, or the person in charge of day-to-day operations of the
hospital.
The city in which the hospital is located.
Unique to the University of California Hospitals, Clinical Teaching Support funds cover the cost of treating
certain cases that provide educational benefit as well as the exploration of current medical technology and
techniques. Patients are typically unable to pay for all or part of these services. These funds are not
considered compensation for bad debts. Also known as CTS funds.
The difference between billings at full established rates and amounts received or receivable from third-party
payers under formal contract agreements. See Payer Category.
The County Indigent Programs – Managed Care category includes indigent patients covered under Welfare and
Institutions Code Section 17000 and are covered by a managed care plan funded by a county. This category
was previously reported in the Other Third Parties category.
1
Quarterly_Glossary_2015 After.xls
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
Definition
COUNTY INDIGENT PROGRAMS TRADITIONAL
The County Indigent Programs – Traditional category includes indigent patients covered under Welfare and
Institution Code Section 17000 and was previously reported in the County Indigent Programs category. Also
included are patients paid for in whole or in part by the County Medical Services Program (CMSP), California
Health Care for Indigent Program (CHIP or tobacco tax funds), and other funding sources whether or not a bill
is rendered. This category also includes indigent patients who are provided care in county hospitals, or in
certain non county hospitals where no county-operated hospital exists, whether or not a bill is rendered.
COUNTY NUMBER
The County in which the hospital is located. There are 58 counties in California. Please note that no hospitals
are located in the County of Alpine.
The difference between gross patient revenue (charges based at full established rates) and amounts received
from patients or third-party payers for services performed. Includes contractual adjustments, charity care,
provisions for bad debts, and other adjustments and allowances which reduce gross patient revenue.
Capitation premium revenue is reported separately from deductions from revenue. Each deduction from
revenue category is defined separately in this glossary.
A discharge is the formal release of a formally admitted inpatient from the hospital, including deaths at the
hospital. Also counted is the transfer (discharge) of an inpatient from one type of care (Acute Care, Psychiatric
Care, Chemical Dependency Care, Rehabilitation Care, Long-Term Care, and Residential Care) to another type
of care within the hospital. Excludes nursery discharges; service discharges, which are transfers within a type
of care; and purchased inpatient discharges. See Payer Category.
The amount of Medi-Cal disproportionate share payments provided by SB 855 and/or SB 1255, SB 1732,
and/or Graduate Medical Education that were transferred from the hospital to a related public entity. Only
county, district, and University of California hospitals will report this item. This is an optional data field on the
Quarterly Report..
Supplemental payments received by hospitals serving a high percentage of Medi-Cal and other low income
patients. Authorized under Senate Bill 855 (Chapter 279,1991) these payments are funded from
intergovernmental transfers from public agencies (counties, hospital districts, and the University of California
system ) to the State and from federal matching funds.
The facility Doing Business As (DBA) name
Net fixed assets are the historical cost of land, plus the cost of land improvements, building and improvements,
leasehold improvements, equipment, and construction-in-progress, less accumulated depreciation and
amortization.
Total inpatient charges at the hospital’s full established rates for daily hospital services, inpatient ambulatory
services, and inpatient ancillary services before deductions from revenue are applied. See Payer Category.
DEDUCTIONS FROM REVENUE
DISCHARGES
DISPROPORTIONATE SHARE FUNDS
TRANSFERRED TO RELATED PUBLIC
ENTITY
DISPROPORTIONATE SHARE PAYMENTS
FOR MEDI-CAL PATIENT DAYS (SB 855)
FACILITY DBA NAME
FIXED ASSETS (Net of Accumulated
Depreciation)
GROSS INPATIENT REVENUE
GROSS OUTPATIENT REVENUE
January 2016
Total outpatient charges at the hospital’s full established rates for outpatient ambulatory and outpatient ancillary
services rendered and goods sold. See Payer Category.
2
Quarterly_Glossary_2015 After.xls
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
Definition
HEALTH FACILITY PLANNING AREA (HFPA) A numeric code denoting the Health Facility Planing Area (HFPA) in which the hospital is located. The HFPA is
a geographic subdivision of a Health Service Area (HSA) and is defined by OSHPD for evaluating existing and
required hospitals and services.
A numeric code denoting the HSA in which the hospital is located. The HSA’s geographic area, consisting of
HEALTH SERVICE AREA (HSA)
one or more contiguous counties, is designated by the Federal Department of Health and Human Services for
health planning on a regional basis. There are 14 HSAs in California.
HOSPITAL DISCHARGES
See Discharges.
The number of licensed beds (excluding beds placed in suspense and nursery bassinets) stated on the hospital
LICENSED BEDS
license at the end of the reporting period.
The formal release of a formally admitted LTC patient from the hospital, including deaths at the hospital. Also
LONG-TERM CARE (LTC) DISCHARGES
counted is the transfer (discharge) of a LTC patient to another type of care. (See Discharges for more
information.) On the Quarterly Report, this is an optional data field.
Hospitals which provide skilled nursing care, intermediate care, sub acute care, and other long-term care
LONG-TERM CARE (LTC) PATIENT DAYS
services are encouraged to report this item. Also included are patient days of skilled nursing care provided in
swing beds. This is an optional data field on the Quarterly Report.
Managed care patients are patients enrolled in a managed care plan to receive health care from providers on a
MANAGED CARE
pre-negotiated or per diem basis, usually involving utilization review (includes Health Maintenance Organizations
(HMO), Health Maintenance Organizations with Point-of-Service option (POS) Preferred Provider Organizations
(PPO), Exclusive Provider Organizations (EPO), Exclusive Provider Organizations with Point-of- Service
option, etc.).
The Medi-Cal Managed Care category includes patients covered by a managed care plan funded by Medi-Cal
MEDI-CAL – MANAGED CARE
and was previously reported in the Other Third Parties category. See Managed Care.
The Medi-Cal-Traditional category includes patients who are qualified as needy under state laws and was
MEDI-CAL – TRADITIONAL
previously reported in the Medi-Cal category.
The Medicare – Managed Care category includes patients who are qualified as needy under state laws and was
MEDICARE – MANAGED CARE
previously reported in the Medi-Cal category. See Managed Care.
The Medicare – Traditional category includes patients covered under the Social Security Amendments of 1965
MEDICARE – TRADITIONAL
and was previously reported in the Medicare category. These patients are primarily the aged and needy.
NET PATIENT REVENUE
NON-OPERATING REVENUE NET OF NONOPERATING EXPENSES
OPERATING STATUS (CURRENT)
January 2016
Gross patient revenue less deductions from revenue. This amount is more comparable than gross patient
revenue because it indicates the actual amount received from patients and third party payers. Includes
disproportionate share payments (before any transfers to related entities) and capitation premium revenue.
See Payer Category.
If non-operating expenses are greater than non-operating revenue, the amount is entered as a negative number
(with brackets). Non operating items are those revenue and expenses that do not related directly tot he
provision of health care services.
Indicates whether a hospital is open or closed at the end of the quarter.
3
Quarterly_Glossary_2015 After.xls
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
OSHPD FACILITY NO.
OTHER ADJUSTMENTS AND
ALLOWANCES
OTHER INDIGENT
OTHER OPERATING REVENUE
OTHER PAYERS
OTHER THIRD PARTIES- MANAGED CARE
OTHER THIRD PARTIES-TRADITIONAL
OUTPATIENT VISITS
PATIENT (CENSUS) DAYS
January 2016
Definition
A nine-digit hospital identification number assigned by OSHPD for reporting purposes. OSHPD facility numbers
are typically based on a facility’s operating license.
Includes policy discounts, administrative adjustments, and other deductions from revenue that are not included
elsewhere.
The Other Indigent category includes indigent patients who are being provided charity care by the hospital and
U.C. teaching hospital patients who are provided care with Support for Clinical Teaching funds. It excludes
patients who are recorded in the Count Indigent Programs category. This category was previously reported the
Other Payers category.
Revenue generated by health care operations from non-patient care services to patients and others. Examples
include non-patient food sales, refunds and rebates, supplies sold to non-patients, and Medical Records
abstract sales. Does not include interest income.
The Other Payers category includes all patients who do not belong in the other categories, such as those
designated as self-pay.
The Other Third Parties – Managed Care category includes patients covered by managed care plans other than
those funded by Medicare, Medi-Cal, or a county; and was previously reported in the Other Third Parties
category. Patients enrolled in the Healthy Families program are reported here. See Managed Care.
The Other Third Parties – Traditional category includes all other forms of health coverage excluding managed
care plans. Examples include Short-Doyle, CHAMPUS, IRCA/SLIAG, California Children’s Services, indemnity
plans, fee-for-service plans, and Workers’ Compensation. This category was previously reported in the Other
Third Parties category.
A visit is an appearance of an outpatient in the hospital for ambulatory services or the appearance of a private
referred outpatient in the hospital for ancillary services. In both instances, the patient is typically treated and
released the same day, and is not formally admitted as an inpatient, even though occasional overnight stays
may occur. Included are outpatient emergency room visits, outpatient clinic visits, referred ancillary service
visits, home health contact, and day care days, where the outpatient is treated and released the same day.
Also included are outpatient chemical dependency visits, hospice outpatient visits, and adult day health care
visits. See Payer Category.
The number of census days that all formally admitted inpatients spent in the hospital during the reporting
period. Patient days include the day of admission, but not the day of discharge. If both admission and
discharge occur on the same day, one patient day is counted. Nursery days and purchased inpatient days are
excluded. See Payer Category.
4
Quarterly_Glossary_2015 After.xls
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
Definition
PAYER CATEGORY
Annual and Quarterly Reports include financial and utilization data by payer category, which is defined as the
third-party or individual who is responsible for the predominant portion of a patient’s bill. For 2000 Annual and
Quarterly Reports, the Office has established 10 payer categories: Medicare – Traditional, Medicare – Managed
Care, Medi-Cal – Traditional, Medi-Cal – Managed Care, County Indigent Programs – Traditional, County
Indigent Programs – Managed Care, Other Third Parties – Traditional, Other Third Parties – Managed Care,
Other Indigent, and Other Payers. Definitions of these payer categories are included in thie glossary.
PHONE NUMBER
PHYSICIAN PROFESSIONAL COMPONENT
(PPC) EXPENSES
The main business phone number of the hospital.
Expense included in the physicians’ total compensation. This includes all amounts paid or to be paid to hospital
based physicians and residents for patient care and recorded as an expense of the hospital for the reporting
period. PPC expenses are an optional reporting item on Quarterly Reports.
Accounts receivable which are determined to be uncollectible due to the patient’s unwillingness to pay and are
charged as a credit loss against gross patient revenue. Bad debts are classified as deductions from revenue,
and not included in operating expenses.
Inpatient services purchased under contract from another hospital on an arranged basis for patients who are not
formally admitted as inpatients of the purchasing hospital. This situation may arise due to managed care
contract requirements of the lack of appropriate hospital technology at the purchasing hospital. The reporting of
these data is optional on the Quarterly Report.
Number of discharges related to inpatient care services purchased from and provided by another hospital. This
situation may arise when the hospital is unable to provide services on-site and may be contractually obligated to
seek such services elsewhere. Purchased inpatient discharges are excluded from Discharges. This is an
optional reporting item on the Quarterly Report.
Expenses incurred by the purchasing hospital when inpatient services, including ancillary services, are provided
by another hospital for patients who are the responsibility of the purchasing hospital. The reporting of this data
element is optional on the Quarterly Report.
Number of inpatient days of care (census days) for patients whose inpatient care was purchased from and
provided by another hospital. This situation may arise when the hospital is unable to provide services on-site
and may be contractually obligated to seek such services elsewhere. Purchased inpatient days are not
included in Patient Days, and are optional on the Quarterly Report..
Expenses incurred by the purchasing hospital when outpatient services, including ancillary services, are
provided by another hospital for patients who are the responsibility of the purchasing hospital. On the Quarterly
Report, the reporting of this data element is optional.
The first day of the reporting period.
The last day of the reporting period.
The four digit calendar yearend quarter which denotes the report period.
Donations, grants, or subsidies voluntarily provided for the care of medically indigent patients. Includes
discretionary and/or formula tobacco tax funds provided by a county to a non-county hospital.
PROVISION FOR BAD DEBTS
PURCHASED INPATIENT SERVICES
PURCHASED INPATIENT SERVICES DISCHARGES
PURCHASED INPATIENT SERVICES EXPENSES
PURCHASED INPATIENT SERVICES PATIENT DAYS
PURCHASED OUTPATIENT SERVICES EXPENSES
REPORT PERIOD BEGIN DATE
REPORT PERIOD END DATE
REPORT PERIOD YEAR_QUARTER
RESTRICTED DONATIONS & SUBSIDIES
FOR INDIGENT CARE
January 2016
5
Quarterly_Glossary_2015 After.xls
Office of Statewide Health Planning and Development
Glossary for Quarterly Financial and Utilization Report Data File
Quarters Ended 2015 and After
Data Item
STAFFED BEDS
STREET ADDRESS
TEACHING ALLOWANCE
TEACHING OR SMALL/RURAL HOSPITAL
Definition
The average daily complement of beds (excluding nursery bassinets) that are set-up, staffed, and equipped,
and in all respects, ready for use by patients remaining in the hospital overnight.
The street address where the facility is located.
The amount of charges written-off when it is determined by the teaching hospital that the selected patient does
not have the ability to pay but whose case would benefit the teaching mission of the hospital. This reporting
item is used only by the University of California hospitals.
Indicates if the hospital is a teaching hospital or considered a small and rural hospital.
TOTAL OPERATING EXPENSES
Total costs incurred by revenue-producing and non-revenue producing cost centers for providing patient care at
the hospital. Excludes non-operating expenses, provisions for income taxes, and provisions for bad debts.
TYPE OF CONTROL
Denotes the type of ownership and/or legal organization of a hospital licensee. The following five types of
control are reported; District-Includes District hospitals; County/City-Includes hospitals operated by a County,
County/City or City; Investor-Includes hospitals operated by an Investor-Individual, Investor-Partnership, or
Investor-Corporation; Non Profit-Includes hospitals operated by a Church, Non-Profit Corporation, or NonProfit Other; State, Includes State hospitals.
Indicates if a hospital’s report contains comparable data, or if the data are considered non-comparable due to
reporting modifications granted by OSHPD or the hospital’s unique operating characteristics. There are six
types of hospitals: COMPARABLE-Includes hospitals whose data and operating characteristics are comparable
with other hospitals, KAISER-Includes hospitals operated by Kaiser Hospital Foundation, Also includes the two
regional Kaiser organization entities, which report consolidated financial data for all the hospitals in the regions.,
LTC Emphasis- Includes large hospitals which emphasize long-term care (LTC) services, PHF-Includes
hospitals licensed as Psychiatric Healthy Facilities, which provide mental health services, SHRINERS-Includes
hospitals operated by Shirners Hospitals for Crippled Children which do not charge for services provided.
STATE-Includes State hospitals, which provide care to the mentally disordered and developmentally disabled.
TYPE OF HOSPITAL
ZIP CODE
January 2016
The zip code in which the hospital is located.
6
Quarterly_Glossary_2015 After.xls
OSHPD Use Only
HOSPITAL QUARTERLY
FINANCIAL AND UTILIZATION REPORT
1. Facility DBA (Doing Business As) Name:
3. Street Address:
4. City:
8. Chief Executive Officer (Administrator):
19.
20.
21.
(1)
Report Period
106
PM
FAX
2. OSHPD Facility No.:
5. Zip Code:
6. Report Prepared By:
Line
No.
15.
16.
17.
18.
Quarter: 2015
Filed Date:
9. Main Hospital Phone:
(
)
Report Due Date
7. Preparer’s Phone:
(
)
Ext:
10. Disaster Coordinator’s Phone:
(
)
Ext:
(2)
Original
(3)
Revised
(Check One)
January 1 – March 31, 2015
May 15, 2015
April 1 – June 30, 2015
August 14, 2015
July 1 – September 30, 2015
November 16, 2015
October 1 – December 31, 2015
February 16, 2016
Other (Specify: Month/Day/Year)
Within 45 days of the end
Begin Date:
/
/
of the corresponding
End Date:
/
/
calendar quarter.
Is this report based on a 13-period accounting cycle?
[ ] Yes [ ] No
2015
QUARTER
UTILIZATION DATA ITEMS
25.
Licensed Beds (end of report period – excluding bassinets and beds in suspense)
30.
Available Beds (average for report period – excluding bassinets and beds in suspense)
35.
Staffed Beds (average for report period – excluding bassinets and beds in suspense)
Hospital Discharges (excluding nursery discharges)
50.
Medicare – Traditional
55.
Medicare – Managed Care
60.
Medi-Cal – Traditional
65.
Medi-Cal – Managed Care
70.
County Indigent Programs – Traditional
75.
County Indigent Programs – Managed Care
80.
Other Third Parties – Traditional
85.
Other Third Parties – Managed Care
90.
Other Indigent
95.
Other Payors
100.
Total Hospital Discharges (sum of lines 50 thru 95)
105.
Long-term Care (LTC) Discharges (included in lines 50 thru 100) (Optional)**
Patient (Census) Days (excluding nursery patient (census) days)
150.
Medicare – Traditional
155.
Medicare – Managed Care
160.
Medi-Cal – Traditional
165.
Medi-Cal – Managed Care
170.
County Indigent Programs – Traditional
175.
County Indigent Programs – Managed Care
180.
Other Third Parties – Traditional
185.
Other Third Parties – Managed Care
190.
Other Indigent
195.
Other Payors
200.
Total Patient (Census) Days (sum of lines 150 thru 195)
205.
Long-term Care (LTC) Patient (Census) Days (included in lines 150 thru 200) (Optional)**
Continued on Next Page
** The reporting of this item is optional.
OSHPD 2015-1 (Rev. 1/16)
Facility DBA Name:
Line
No.
250.
255.
260.
265.
270.
275.
280.
285.
290.
295.
300.
HOSPITAL QUARTERLY FINANCIAL AND UTILIZATION REPORT (Cont’d)
2015 Quarter Ending:
OSHPD Facility No.:
2015
QUARTER
UTILIZATION DATA ITEMS (Cont’d)
Outpatient Visits (including ER, Clinic, Referred, Home Health Visits, and Day Care Days)
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payors
Total Outpatient Visits (sum of lines 250 thru 295)
FINANCIAL DATA ITEMS
Gross Inpatient Revenue (including PPC charges)
350.
Medicare – Traditional
355.
Medicare – Managed Care
360.
Medi-Cal – Traditional
365.
Medi-Cal – Managed Care
370.
County Indigent Programs – Traditional
375.
County Indigent Programs – Managed Care
380.
Other Third Parties – Traditional
385.
Other Third Parties – Managed Care
390.
Other Indigent
395.
Other Payors
400.
Total Gross Inpatient Revenue (sum of lines 350 thru 395)
Gross Outpatient Revenue (including PPC charges)
450.
Medicare – Traditional
455.
Medicare – Managed Care
460.
Medi-Cal – Traditional
465.
Medi-Cal – Managed Care
470.
County Indigent Programs – Traditional
475.
County Indigent Programs – Managed Care
480.
Other Third Parties – Traditional
485.
Other Third Parties – Managed Care
490.
Other Indigent
495.
Other Payors
500.
Total Gross Outpatient Revenue (sum of lines 450 thru 495)
Deductions from Revenue
545.
Provision for Bad Debts (including bad debt recoveries)
550.
Medicare – Traditional Contractual Adjustments
555.
Medicare – Managed Care Contractual Adjustments
560.
Medi-Cal – Traditional Contractual Adjustments
565.
Medi-Cal – Managed Care Contractual Adjustments
566.
Disproportionate Share Payments for Medi-Cal Patient Days (SB 855)
570.
County Indigent Programs – Traditional Contractual Adjustments
575.
County Indigent Programs – Managed Care Contractual Adjustments
580.
Other Third Parties – Traditional Contractual Adjustments
585.
Other Third Parties – Managed Care Contractual Adjustments
590.
Charity – Hill-Burton
595.
Charity – Other
600.
Restricted Donations and Subsidies for Indigent Care
605.
Teaching Allowance (for U.C. teaching hospitals only)
610.
Clinical Teaching Support (for U.C. teaching hospitals only)
615.
Other Adjustments and Allowances
620.
Total Deductions from Revenue (sum of lines 545 thru 615)
Continued on Next Page
$
$
$
$
$
(
)
(
)
(
)
$
OSHPD 2000-2 (Rev. 10/98)
HOSPITAL QUARTERLY FINANCIAL AND UTILIZATION REPORT (Cont’d)
Facility DBA Name:
Line
No.
650.
660.
670.
680.
700.
750.
755.
760.
765.
770.
775.
780.
785.
790.
795.
800.
810.
830.
835.
840.
850.
855.
860.
870.
880.
885.
900.
2015 Quarter Ending:
OSHPD Facility No.:
FINANCIAL DATA ITEMS (Cont’d)
Capitation Premium Revenue
Capitation Premium Revenue – Medicare
Capitation Premium Revenue – Medi-Cal
Capitation Premium Revenue – County Indigent Programs
Capitation Premium Revenue – Other Third Parties
Total Capitation Premium Revenue (sum of lines 650 thru 680)
Net Patient Revenue (Gross Patient Revenue less Deductions from Revenue plus
Capitation Revenue)
Medicare – Traditional
Medicare – Managed Care
Medi-Cal – Traditional
Medi-Cal – Managed Care
County Indigent Programs – Traditional
County Indigent Programs – Managed Care
Other Third Parties – Traditional
Other Third Parties – Managed Care
Other Indigent
Other Payors
Total Net Patient Revenue (sum of lines 750 thru 795) (Line 400 + line 500 – line 620
+ line 700)
Other Operating Revenue
Total Operating Expenses (including PPC expenses reported in line 840)
Physician Professional Component Expenses (PPC)**
Nonoperating Revenue Net of Nonoperating Expenses
Purchased Inpatient Services
Discharges (Not included in lines 50 thru 100)**
Patient Days (Not included in lines 150 thru 200)**
Expenses (included in line 830)**
Purchased Outpatient Services
Expenses (included in line 830)**
Total Capital Expenditures (excluding disposal of assets)
Fixed Assets Net of Accumulated Depreciation (including construction-in-progress)
Disproportionate Share Funds Transferred to Related Public Entity**
** The reporting of this item is optional.
QUESTIONS
Please contact us at the following address, phone
number, or FAX number:
Carol Covington
Office of Statewide Health Planning and Development
Accounting and Reporting Systems Section
400 R Street, Room 263
Sacramento, CA 95811
Phone: (916) 326-3830 FAX No: (916) 323-0377
E-mail: carol.covington@oshpd.ca.gov
2015
QUARTER
$
$
$
$
$
$
$
$
$
$
$
$
$
CERTIFICATION
I,
, certify under penalty of
perjury that to the best of my knowledge and information, the
information reported is true and correct.
By:
Title:
Date:
OSHPD 2015-1 (Rev. 1/16)
Note: All hospitals are required to prepare this quarterly report using the Office’s SIERA Reporting System and to submit
the report to the Office’s Internet web-site https://siera.oshpd.ca.gov/, unless the Office has granted approval in writing to
submit this report using this standard report form.
STATE OF CALIFORNIA
OFFICE OF STATEWIDE HEALTH PLANNING AND DEVELOPMENT
Patient Discharge Data
File Documentation
January-December 2004
PUBLIC VERSION
COMMA-DELIMITED TEXT FORMAT
CD-ROM
July 2005
CONTENTS
Introduction
Masked Variables …………………………………………………………………………………………………………. 1
Importing Notes…………………………………………………………………………………………………………….. 3
Facility Exceptions ………………………………………………………………………………………………………… 4
Variable Changes Over Time………………………………………………………………………………………….. 5
Missing/Invalid Data Values……………………………………………………………………………………………. 6
Data Element Field Descriptions
Hospital Identification Number ………………………………………………………………………………………… 7
Type of Care ………………………………………………………………………………………………………………… 8
Age in Years ………………………………………………………………………………………………………………… 9
Age (20 Age Categories) …………………………………………………………………………………………….. 10
Age (5 Age Categories) ……………………………………………………………………………………………….. 11
Sex……………………………………………………………………………………………………………………………. 12
Ethnicity …………………………………………………………………………………………………………………….. 13
Race………………………………………………………………………………………………………………………….. 14
Patient Zip Code …………………………………………………………………………………………………………. 15
County of Patient’s Residence ………………………………………………………………………………………. 16
Length of Stay…………………………………………………………………………………………………………….. 17
Admission – Quarter …………………………………………………………………………………………………….. 18
Admission – Year…………………………………………………………………………………………………………. 19
Source of Admission ……………………………………………………………………………………………………. 20
Type of Admission ………………………………………………………………………………………………………. 21
Disposition of Patient …………………………………………………………………………………………………… 22
Pre-hospital Care and Resuscitation (Do Not Resuscitate) ……………………………………………….. 23
Expected Source of Payment – Payer Category ………………………………………………………………. 24
Expected Source of Payment – Payer Type of Coverage ………………………………………………….. 25
Expected Source of Payment – Payer Plan Code Number ………………………………………………… 26
Total Charges …………………………………………………………………………………………………………….. 27
External Cause of Injury – Principal E-Code ……………………………………………………………………. 28
External Cause of Injury -Other E-Codes ………………………………………………………………………. 29
Major Diagnostic Category (MDC) …………………………………………………………………………………. 30
Diagnosis Related Group (DRG) …………………………………………………………………………………… 31
Principal Diagnosis ……………………………………………………………………………………………………… 32
Condition Present at Admission (Principal Diagnosis)………………………………………………………. 33
Principal Procedure……………………………………………………………………………………………………… 34
Days from Admission to Principal Procedure…………………………………………………………………… 35
Other Diagnoses …………………………………………………………………………………………………………. 36
Condition Present at Admission (Other Diagnoses) …………………………………………………………. 37
Other Procedures………………………………………………………………………………………………………… 38
Days from Admission to Other Procedures……………………………………………………………………… 39
Appendices
Appendix A
Appendix B
Appendix C
Appendix D
Appendix E
Appendix F
Appendix G
Appendix H
Appendix I
County Names and Codes………………………………………………………………….. A – 1
Major Diagnostic Categories (MDCs) ………………………………………………….. B – 1
Diagnosis Related Groups (DRGs)………………………………………………………. C – 1
Data Exceptions (as reported) …………………………………………………………….. D – 1
Plan Codes, Expected Source of Payment……………………………………………. E – 1
Hospital Listing………………………………………………………………………………….. F – 1
Manual Abstract Reporting Form ………………………………………………………….G – 1
Comma-Delimited Field List………………………………………………………………… H – 1
Masked Variable Frequencies ……………………………………………………………… I – 1
i
CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
INTRODUCTION
Patient Discharge Data: Public Patient-Level Dataset
The California Office of Statewide Health Planning and Development (OSHPD) provide a public dataset
of the Patient Discharge Database available for purchase on compact disc (CD). The data is made
available by OSHPD once it has been screened by the automated reporting software and corrected by
the individual hospitals. The public patient-level dataset includes patient zip code, demographic
variables and clinical information.
The public dataset is comprised of a record for each inpatient discharged from a licensed acute care
hospital. This includes: General Acute Care Hospitals, Acute Psychiatric Hospitals, Chemical
Dependency Recovery Hospitals, and Psychiatric Health Facilities. (Note: the only exceptions are
records not reported by some California State Hospitals; see the State Hospitals discussion on page
four.)
The patient discharge dataset is available for discharges in each calendar year. The data on CD-ROM are
stored on one CD containing three zipped data files and a full set of documentation files. The discharge
records are divided into three sets by the geography of the reporting hospitals. One file contains discharge
records from hospitals in Los Angeles County, another file contains discharges from the seven other counties
in Southern California and the third file contains discharges from hospitals in the remaining 50 Northern
California Counties.
MASKED VARIABLES
To protect patient confidentiality, those records with unique combinations of a select set of demographic
variables will have one or more of those variables masked to make sure the files are de-identified. Each
unique record will have the minimum number of fields masked to ensure it is no longer unique. The
variable masking will occur in the following order:
ORDER OF
MASKING
1st
2nd
3rd
4th
5th
6th
7th
8th
9th
10th
DATA FIELDS SUBJECT TO MASKING
Age in years (at admission)
Ethnicity
Race
Sex
Age Category 20 (20 Age Categories)
Age Category 5 (5 Age Categories)
Small County Groups*
Admit Quarter
Patient Zip Code **
OSHPD ID
*Small counties with total populations of 30,000 or less are grouped into 3
categories: Central (CE), Northeastern (NE), and Northwestern (NW). Ten
counties were grouped in 2003: Central: Alpine, Inyo, Mariposa, Mono;
Northeastern: Modoc, Plumas, Sierra; Northwestern: Colusa, Glenn, and Trinity.
**Five-digit zip will be masked to three-digits; if record is still unique, zip will be
totally masked with an asterisk.
General assistance is available by calling OSHPD’s Healthcare Information Resource Center at
(916) 322-2814.
July 2005
1
2004 Public Patient Discharge Data
CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
Public Discharge Dataset
Data Fields in 2004 Public Discharge Dataset
Hospital Identification Number
Percent Remaining
Unmasked
For Variables
Subject to Masking
100.0%
Type (level) of Care
Age in Years
53.7%
Age (20 Categories)
86.6%
Age (5 Categories)
93.2%
Sex
81.7%
Ethnicity
69.9%
Race
73.8%
Zip Code (5 digits masked to 3 digits)
98.3%
Zip Code (3 digits masked to 0 digits)
99.6%
County of Patient’s Residence (or Small County Groups)
100.0%
Length of Stay
Quarter Admitted
96.6%
Year Admitted
Source of Admission
Type of Admission
Disposition of Patient
Pre-hospital Care and Resuscitation (Do Not Resuscitate Order)
Expected Principal Source of Payment – Payer Category
Expected Principal Source of Payment – Type of Coverage
Expected Principal Source of Payment – Plan Code Number
Total Charges
Principal External Cause of Injury (E-Code)
Other External Cause of Injuries (up to 4 Other E-Codes)
Major Diagnostic Category
Diagnosis Related Group
Principal Diagnosis
Condition Present at Admission (for Principal Diagnosis)
Principal Procedure
Days from Admission to Principal Procedure
Other Diagnoses (24 Other Diagnoses)
Condition Present at Admission (for Other Diagnoses)
Other Procedures (20 Other Procedures)
Days From Admission to Other Procedures
July 2005
2
2004 Public Patient Discharge Data
CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
IMPORTING NOTES
The fields listed below contain numeric codes, which are not numeric values; most PC software will treat
these fields as numeric values unless formatted otherwise. Thus, when importing the data into your software,
these fields should be formatted as text or alphanumeric to retain the leading and trailing zeros. Also, when
a text variable is masked, the field value is an asterisk, which may cause errors if imported as numeric.
•
•
•
•
•
•
•
•
•
•
•
•
•
OSHPD-Hospital Identification Number
5 Age Category and 20 Age Category Fields
Sex
Ethnicity
Race
Patient Zip Code
County of Patient’s Residence
Admission Quarter
Expected Principal Source of Payment – Plan Code Number
MDC
DRG
All diagnosis code fields (principal and other)
All procedure code fields (principal and other)
It is especially important that all Diagnosis and Procedure code fields be formatted as “text.” These fields are
comprised of ICD-9-CM codes, some of which begin with alpha characters that cannot be read if not
formatted as text. Also, many ICD-9-CM codes have leading and/or trailing zeros. For example, the ICD-9CM code for Salmonella Gastroenteritis is “003.0”. If it is not formatted as text, it will appear as “3”, which is
the numeric value, but is not the valid diagnostic code for Salmonella Gastroenteritis.
It is not absolutely essential but is recommended, to maintain leading zeros in the other codes that contain
leading zeros (Hospital Identification Number, Patient’s County of Residence, MDC, DRG, and Payer Plan
Code Number). When these fields are formatted as “text,” the number of digits in each respective field will
then remain constant. For example, Alameda County will then appear as “01”, rather than “1”, and will
contain two digits like the other 2-digit county codes (Fresno through Yuba, 10 through 58, respectively).
Comma Delimited Data Format:
In the comma-delimited set, the length of each field and the length of each record will vary according
to the data reported. To assist you in using the comma delimited patient discharge data sets, a
header row identifying each data element is provided in the position of the first record.
Each data element is separated by a comma and is defined and described in this documentation. In
Appendix H, there is a table listing the Field Label (used in the header row), Field Name, Field Type
(format), and Maximum Number of Characters.
Fields with no data will have consecutive delimiters (commas). Most PC software will have no difficulty
with consecutive delimiters. However, some software packages may handle consecutive delimiters as a
single delimiter and adjustments will need to be made.
Note: It is possible for some invalid values to remain in the database “as reported” by the hospital, due to
a lack of database enforced integrity. This means that for some observations, you may find blank values,
invalid alpha characters in numeric fields, out-of-range numeric values, etc.
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CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
FACILITY EXCEPTIONS
State Hospitals:
Through the first half of 1989, the database included twelve state hospitals. As of July 1989, the eleven
operated by the Department of Mental Health or the Department of Developmental Services, serving
mentally disordered and developmentally disabled patients, no longer report discharge data. The twelfth,
the Veterans Home of California, Nelson M. Holderman Memorial Hospital, in Yountville has continued to
report discharge data. Records from this hospital can be located using the Hospital Identification
Number “281297.”
Psychiatric Health Facilities:
Psychiatric Health Facilities, which provide care in licensed Acute Psychiatric beds, are subject to the
same reporting requirements as other California hospitals. This type of hospital was first licensed in
California in 1988. Patient discharge data for 1989 and for January through June 1990 included data
from six Psychiatric Health Facilities; data for July through December 1990 include data from all but one
of the 16 licensed Psychiatric Health Facilities. All of these facilities started reporting their patient
discharge data beginning in 1991.
Modifications and Non-Compliant Facilities:
Some hospitals have applied for and been granted “modifications” to standard Patient Discharge Data
reporting requirements. Other hospitals were unable to complete specific fields as required and were
deemed “non-compliant” at the time of reporting. See Appendix D (Data Exceptions) for a listing of all
non-compliant hospitals and those with approved modifications and their affected variables.
Formerly Freestanding Facilities on Parent Facility Licenses (Consolidated Licensure):
Beginning in the mid-1980s, via the Consolidated Licensure Act, the Department of Health Services
began merging formerly separately licensed hospitals and nursing homes onto the licenses of
“parent” hospitals. To become “Consolidated,” certain conditions had to be met, including common
ownership and medical staff, and the locations had to be within 15 miles. Beginning in the 1990s,
formerly separately licensed locations (including some existing consolidated satellite locations) now
appear as “Distinct Part Facilities” on their parent facility’s license.
Appendix F, Hospital Listing, lists all patient discharge data “reporting entities.” For “Consolidated”
reporting entities, the “Facility Name” is plural (e.g., Medical Centers, Hospitals), and the numbers of
consolidated locations are displayed. (The ZIP codes and counties noted each belong to the Parent
location. Some “Consolidations” cross county boundaries.)
As each set of consolidated locations shares the same license, they also share the same license
number. To view specific licenses, on the Internet, go to the OSHPD ALIRTS page,
www.alirts.oshpd.ca.gov. At the first ALIRTS screen, enter the license number, facility name, or
OSHPD_ID number in the search window and click “Search.” At the next screen, click on “View
License.” (Also, at this screen you can click on “View Reports” to see their most recent Annual
Utilization data submitted.)
The discharges reported for each single, parent, and satellite facility is unique to that location. The
only merged sets of discharges are those noted as from “Consolidated Facilities.”
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VARIABLE CHANGES OVER TIME
Hospital Identification Number:
The first six characters of each record contain the “Hospital Identification Number”. Beginning with data
reported for 1995, this former nine-digit hospital identification number was shortened to six digits. The
former first digit, that indicated the type of care reported, has been made a separate data element (Type
of Care) and is described below. The former filler number “06” (2nd and 3rd digits) has been dropped.
Thus the hospital identification number now consists of six digits. The first two indicate the county
number and the last four are unique to a facility within each county.
Type of Care:
The second field on each record is a single digit field that describes the “Type of Care” (“Level of Care” in
1995 and 1996) from which the patient was discharged. See Type of Care codes and labels on page 7.
Beginning with 1997 data, hospitals were required to report one of five Types of Care for each discharge.
For the 1995 and 1996 data years, hospitals were required to assign, to each discharge, one of three
Levels of Care (“3” for Long Term Care, “6” for Rehabilitation Care and “1” for all other types of care).
Prior to 1995, discharges were optionally reported in sets, by one of the five Types of Care. Most
hospitals chose to include all discharges, regardless of the type of care, in one set (usually acute care).
Note: there has never been a Type of Care or Level of Care code “2”.
HISTORICAL SUMMARY OF FORMAT AND CONTENT CHANGES
PATIENT DISCHARGE DATA COLLECTION PROGRAM
DATA ITEM:
ACTION / EFFECTIVE DATE:
E-Code
Added – July 1990
Social Security Number
Added – July 1990
Record Linkage Number (Encrypted SSN)
Added – July 1990
Zip Code for Homeless (ZZZZZ)
Added – November 1993
Hospital Identification Number (from 9 to 6 digits)
Changed – January 1995
Level of Care (see Type of Care, below)
Added – January 1995
Ethnicity/Race
Changed – January 1995
Source of Admission
Expanded – January 1995
Type of Admission
Changed – January 1995
Procedure Dates (for all reported procedures)
Added – January 1995
Patient Disposition
Expanded – January 1995
Changed – January 1995
Expected Source of Payment:
Expanded – January 1999
Principal Diagnosis-Condition Present at Admission
Added – January 1996
Other Diagnoses-Condition Present at Admission
Added – January 1996
Type of Care (formerly Level of Care)
Changed – January 1997
Pre-hospital Care & Resuscitation (Do Not Resuscitate Order)
July 2005
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Added – January 1999
2004 Public Patient Discharge Data
CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
MISSING/INVALID DATA VALUES
Invalid or missing values (submitted below the error tolerance level) are defaulted to “unknown.” The
table below displays default numbers and percentages.
Default
Status
Numbers of
Records
Not Defaulted
One Variable Defaulted
Multiple Variables Defaulted
3,948,168
9,195
277
Percent of
Records
99.76%
.23%
.01%
Other data exceptions are listed by hospital in Appendix D, Data Exceptions.
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HOSPITAL IDENTIFICATION NUMBER
FIELD NAME
:
OSHPD_ID
DEFINITION
:
A unique six-digit identifier assigned to each facility by the Office of Statewide
Health Planning and Development. The first two digits indicate the county in
which the hospital is located. The last four digits are unique within each
county.
CODES, CATEGORIES AND COMMENTS:
A – 99
B – 9999
=
=
01-58 = County Codes (see Appendix A)
0001-9999 = Unique Hospital Identifier (within county)
OSHPD Facility ID Number will be the 9th variable masked if necessary to de-identify unique patient records
by replacing code with an asterisk.
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TYPE OF CARE
FIELD NAME
:
TYP_CARE
DEFINITION
:
Defined by the California Health and Safety Code, this refers to the licensure of the
bed occupied by an inpatient. The types of care are documented on the official
license issued by Licensing and Certification of the California State Department of
Health Services.
CODES, CATEGORIES AND COMMENTS:
Code Category
1 = Acute Care
3 = Skilled Nursing/Intermediate Care
4 = Psychiatric Care
5 = Chemical Dependency Recovery Care
6 = Physical Rehabilitation Care
Licensed Bed Classification/Designation
General Acute Care
Skilled Nursing/Intermediate Care (a.k.a. Long Term
Care)
Acute Psychiatric Care
Chemical Dependency Recovery Hospital/Service
Rehabilitation Center, a bed designation within the
General Acute Care classification.
All other values for Type of Care are not considered valid.
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January-December 2004
AGE IN YEARS (at Admission)
FIELD NAME
:
AGE_YRS
DEFINITION
:
Age of patient at time of admission.
CODES, CATEGORIES AND COMMENTS:
Age = Blank indicates age has been masked or is unknown (the year of birth is incomplete or unknown
and an age of 0 has been assigned).
Newborns are identified with a code 7 in Source of Admission or infants (less than 24 hours old) are
coded with a 3 in Type of Admission.
To reduce the need for masking to protect patient confidentiality; all patients older than 85 will be
coded as “85” years of age. This can be considered “85 and older.”
If necessary, Age in Years will be the first variable masked to de-identify unique patient records, by
blanking-out reported age. This is the only numeric data element that will be masked; all other variables
subject to masking are text variables and contain an asterisk when masked.
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January-December 2004
AGE 20 CATEGORY
FIELD NAME
:
AGECAT20
DEFINITION
:
Age range categories based on the patient’s age at the time of admission.
Twenty age categories; mostly 5-year increments.
CODES, CATEGORIES AND COMMENTS:
The following age breakdown was provided in public version B for 1999 and 2000.
CATEGORY
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
00
AGE
under 1 year
1-4 years
5-9 years
10-14 years
15-19 years
20-24 years
25-29 years
30-34 years
35-39 years
40-44 years
45-49 years
50-54 years
55-59 years
60-64 years
65-69 years
70-74 years
75-79 years
80-84 years
85 years & over
unknown (0)
DEFINITION
under 1 year
366 days through 4 years
5 years through 9 years
10 years through 14 years
15 years through 19 years
20 years through 24 years
25 years through 29 years
30 years through 34 years
35 years through 39 years
40 years through 44 years
45 years through 49 years
50 years through 54 years
55 years through 59 years
60 years through 64 years
65 years through 69 years
70 years through 74 years
75 years through 79 years
80 years through 84 years
85 years or greater
Year of birth incomplete or unknown
Age Category (20) will be the 5th variable masked if necessary to de-identify unique patient records by
replacing age category code with an asterisk.
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January-December 2004
AGE 5 CATEGORY
FIELD NAME
:
AGECAT5
DEFINITION
:
Five age categories; Random year increments.
CODES, CATEGORIES AND COMMENTS:
CATEGORY
01
02
03
04
05
00
AGE
Under 1 year
1-17 years
18-34 years
35-64 years
65years & over
Unknown (0)
DEFINITION
Under 1 year
1 year through 17 years
18 years through 34 years
35years through 64 years
65 years or greater
Year of birth incomplete or unknown
Age Category (5) will be the 6th variable masked if necessary to de-identify unique patient records by
replacing age category code with an asterisk.
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January-December 2004
SEX
FIELD NAME
:
SEX
DEFINITION
:
This is the gender of the patient.
CODES, CATEGORIES AND COMMENTS:
Code
1
2
3
4
Category
Male
Female
Other
Unknown
All other values for Sex are not considered valid.
“Other” includes sex changes, undetermined sex, and live births with congenital abnormalities that
obscure sex identification. “Unknown” indicates that the patient’s sex was not available from the
medical record.
Sex (gender of the patient) will be the 4th variable masked if necessary to de-identify unique patient
records by replacing code with an asterisk.
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January-December 2004
ETHNICITY
FIELD NAME
:
ETHNCTY
DEFINITION
:
This code indicates whether or not the patient’s ethnicity is Hispanic.
CODES, CATEGORIES AND COMMENTS:
The single code digit indicates ethnicity and includes:
Code
1
2
3
Category
Hispanic
Non-Hispanic
Unknown
All other values for Ethnicity are not considered valid.
Both ethnicity and race are self-reported by the patient.
Ethnicity will be the 2nd variable masked if necessary to de-identify unique patient records by replacing
code with an asterisk.
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January-December 2004
RACE
FIELD NAME
:
RACE
DEFINITION
:
This code indicates the patient’s racial background.
CODES, CATEGORIES AND COMMENTS:
Code
1
Category
White – A person having origins in or who identifies with any of the original
Caucasian peoples of Europe, North Africa, or the Middle East.
2
Black – A person having origins in or who identifies with any of the black
racial groups of Africa.
3
Native American/Eskimo/Aleut – A person having origins in or who identifies
with any of the original peoples of North America, and who maintains cultural
identification through tribal affiliation or community recognition.
4
Asian/Pacific Islander – A person having origins in or who identifies with any
of the original oriental peoples of the Far East, Southeast Asia, the Indian
subcontinent, or the Pacific Islands. Includes Hawaii, Laos, Vietnam,
Cambodia, Hong Kong, Taiwan, China, India, Japan, Korea, the Philippine
Islands, and Samoa.
5
Other – Any possible options not covered in the above categories.
6
Unknown
All other values for Race are not considered valid.
Both ethnicity and race are self-reported by the patient.
Race will be the 3rd variable masked if necessary to de-identify unique patient records by replacing code
with an asterisk.
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CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
PATIENT ZIP CODE
FIVE DIGIT / THREE DIGIT
FIELD NAME
:
PATZIP
DEFINITION
:
The ZIP Code of the patient’s residence (all five digits). This is a unique code
assigned to a specific geographic area by the U.S. Postal Service for the
patient’s usual residence.
CODES, CATEGORIES AND COMMENTS:
The five digits of the ZIP Code of the patient’s residence.
If the field is coded with XXXXX, the ZIP Code is unknown.
If it is coded with YYYYY, the patient is from an area outside the United States.
If it is coded with ZZZZZ, the patient has no residence (homeless).
If the city of residence is known but not the street address, or if the first three digits are the only
digits reported, then it is a partial ZIP Code. It will be shown as a 5-digit ZIP code—the first three
digits plus ‘00’. Example: Sacramento, CA 95800. There are no partial ZIP codes in the 2001 or
2002 data.
The reported ZIP Code will be the 8th variable masked if necessary to de-identify unique patient records
to protect patient confidentiality. The Patient ZIP Code can be masked sequentially from 5-digits to 3digits, then from 3-digits to just an asterisk, if required to de-identify the record.
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January-December 2004
COUNTY OF PATIENT’S RESIDENCE
FIELD NAME
:
PATCNTY
DEFINITION
:
The county of residence code is assigned based on the reported patient’s
ZIP code.
CODES, CATEGORIES AND COMMENTS:
Codes: 00-58, CE, NE and NW
01-58 indicates a county in California (see list in Appendix A); 00 indicates that the patient’s zip
code was unknown, outside California, outside the U.S., homeless, or partial.
The data for 2001 is the only data in which some records have a blank patient county, which
indicates the patient’s ZIP Code was unreported or partial.
To protect patient confidentiality, those counties with populations less than 30,000 are assigned
to one of three groups of small counties to de-identify unique patient records. The groups and
counties included are:
GROUP
CE (Central)
NE (Northeastern)
NW (Northwestern)
COUNTIES
Alpine, Inyo, Mariposa and Mono
Modoc, Plumas and Sierra
Colusa, Glenn and Trinity
Note – Using the reported ZIP Code, OSHPD assigns the patient’s county of residence. ZIP Codes
are designed for mail delivery, not to identify political boundaries. Therefore, some ZIP Codes cross
county boundaries. For such ZIP Codes, OSHPD assigns the county with the greatest population in
the respective ZIP Code.
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CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
LENGTH OF STAY (Days)
FIELD NAME
:
LOS
DEFINITION
:
Total number of days from admission date to discharge date of each patient.
CODES, CATEGORIES AND COMMENTS:
The days are calculated by subtracting the Admission Date from the Discharge Date. The length of
stay for patients admitted on day one and discharged on day two is counted as one day.
Patients admitted and discharged on the same day yield a calculated length of stay of “0” days. This
requires changing those (same-day admits and discharges) zeros to “ones” before performing
average length of stay calculations to achieve more meaningful average length of stay calculations.
The number of days is right justified and zero filled (for fixed-length data format).
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January-December 2004
ADMISSION: QUARTER
FIELD NAME
:
ADM_QTR
DEFINITION
:
Quarter the patient was admitted to the hospital.
CODES, CATEGORIES AND COMMENTS:
One-digit quarter
Code
1
2
3
4
Quarter
January-March
April-June
July-September
October-December
Quarter admitted will be the 7th variable masked if necessary to de-identify unique patient records by
replacing code with an asterisk.
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January-December 2004
ADMISSION: YEAR
FIELD NAMES
:
ADM_YR
DEFINITION
:
Year the patient was admitted to the hospital.
CODES, CATEGORIES AND COMMENTS:
Four-digit year – This is comprised of first two digits century and last two digits year.
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CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
SOURCE OF ADMISSION
FIELD NAME
:
ADM_SRC
DEFINITION
:
Effective with discharges on January 1, 1995, the source of admission
describes three aspects of the source:
The first digit describes the site from which the patient originated.
The second digit describes the license of site from which the patient
originated.
The third digit describes the route by which the patient was admitted.
CODES, CATEGORIES AND COMMENTS:
Site:
Code
Category
1
Home
2
Residential Care Facility
3
Ambulatory Surgery
4
Skilled Nursing/Intermediate Care
5
Acute Inpatient Hospital Care
6
Other Inpatient Hospital Care
7
Newborn*
8
Prison/Jail
9
Other
All other values for “Site” are not considered valid.
*”Newborn” source of admission is defined as a “baby born alive in this hospital.”
Licensure of Site:
Category
Code
1
This Hospital
2
Another Hospital
3
Not a Hospital
All other values for “Licensure of Site” are not considered valid.
Route:
Category
Code
1
Your ER
2
Not Your ER (or no ER)
All other values for “Route” are not considered valid.
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January-December 2004
TYPE OF ADMISSION
FIELD NAME
:
ADM_TYPE
DEFINITION
:
Effective with discharges on January 1, 1995, the patient’s type of admission
was reported using one of the categories listed below. The critical distinction
is not how but when the admission was arranged.
CODES, CATEGORIES AND COMMENTS:
Code
1
2
3
4
Category
Scheduled (Scheduled in advance, at least of 24 hours or more prior to admission)
Unscheduled (Not scheduled within 24 hours or more prior to admission)
Infant, less than 24 hrs old
Unknown (Does not include stillbirths)
All other values for Type of Admission are not considered valid.
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DISPOSITION OF PATIENT
FIELD NAME
:
DISP
DEFINITION
:
The consequent arrangement or event ending a patient’s stay in the reporting
facility. Effective with discharges beginning January 1, 1995, the codes are as
follows:
CODES, CATEGORIES AND COMMENTS:
Disposition of Patient:
Code
01
Category
Routine (Home)
Within this Hospital:
Code
Category
02
Acute Care
03
Other Care
04
Skilled Nursing/Intermediate Care
To Another Hospital:
Category
Code
05
Acute Care
06
Other Care (not Skilled Nursing/Intermediate Care)
07
08
09
10
11
12
13
Skilled Nursing/Intermediate Care
Residential Care Facility
Prison/Jail
Against Medical Advice
Died
Home Health Service
Other
All other values for Disposition are not considered valid.
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CALIFORNIA PATIENT DISCHARGE DATA
January-December 2004
PREHOSPITAL CARE AND RESUSCITATION
FIELD NAME
:
DNR
DEFINITION
:
This code indicates whether or not there was a “Do Not Resuscitate” order
upon admission or within 24 hours of admission from a physician.
CODES, CATEGORIES AND COMMENTS:
A “Do Not Resuscitate” (DNR) order is a directive from a physician in a patient’s current inpatient
medical record instructing that the patient is not to be resuscitated in the event of a cardiac or
pulmonary arrest. In the event of a cardiac or pulmonary arrest, resuscitative measures include, but
are not limited to, the following: cardiopulmonary resuscitation (CPR), intubation, defibrillation,
cardioactive drugs, or assisted ventilation.
Code
Y =
Category
Yes – a DNR order was written at the time of or within the first 24 hours of patient’s
admission to the hospital.
N
No – a DNR order was not written at the time of or within the first 24 hours of the patient’s
admission to the hospital.
=
All other values for Prehospital Care and Resuscitation are not considered valid.
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January-December 2004
EXPECTED SOURCE OF PAYMENT
PAYER CATEGORY
FIELD NAME
:
PAY_CAT
DEFINITION
:
This code indicates the category of payer (type of entity or organization) who
is expected to pay or did pay the greatest share of the patient’s bill.
CODES, CATEGORIES AND COMMENTS:
Expected Payer Categories
Code
Category
Code
Category
01
02
03
04
05
Medicare
Medi-Cal
Private Coverage
Workers’ Compensation
County Indigent Programs
06
07
08
09
00
Other Government
Other Indigent
Self Pay
Other Payer
Not reported or reported in error
All other values for Payer Category are not considered valid.
•
Medicare – A federally administered third party reimbursement program authorized by Title XVIII of the Social
Security Act. Includes crossovers to secondary payers.
•
Medi-Cal – A state administered third party reimbursement program authorized by Title XIX of the Social
Security Act.
•
Private Coverage – Payment covered by private, non-profit, or commercial health plans, whether insurance
or other coverage, or organizations. Included are payments by local or organized charities, such as the
Cerebral Palsy Foundation, Easter Seals, March of Dimes, or Shriners.
•
Workers’ Compensation – Payment from workers’ compensation insurance, government or privately
sponsored.
•
County Indigent Programs – Patients covered under Welfare and Institutions Code Section 17000. includes
programs funded in whole or in part by County Medical Services Program (CMSP), California Healthcare for
Indigents Program (CHIP), and/or other Realignment Funds whether or not a bill is rendered.
•
Other Government – Any form of payment from government agencies, whether local, state, federal or foreign,
except those listed above. Includes funds received through California Children Services (CCS), the Civilian
Health and Medical Program of the Uniformed Services (TRICARE), and the Veterans Administration.
•
Other Indigent – Patients receiving care pursuant to Hill-Burton obligations or who meet the standards for
charity care pursuant to the hospital’s established charity care policy.
•
Self Pay – Payment directly by the patient, personal guarantor, relatives, or friends. The greatest share of
patient’s bill is not expected to be paid by any form of insurance or other health plan.
•
Other Payer – Any third party payment not included above. Included are cases where no payment will be
required by the facility, such as special research or courtesy patients.
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January-December 2004
EXPECTED SOURCE OF PAYMENT
PAYER TYPE OF COVERAGE
FIELD NAME:
:
PAY_TYPE
DEFINITION
:
This code indicates the type of coverage for the following: Medicare, MediCal, Private Coverage, Workers’ Compensation, County Indigent Programs,
and Other Government.
CODES, CATEGORIES AND COMMENTS:
Codes
1
2
3
0
=
=
=
=
Category
Managed Care – Knox-Keene/MCOHS
Managed Care – Other
Traditional Coverage
Payer Type field is not considered applicable for payer categories other than:
Medicare, Medi-Cal, Private Coverage, Worker’s Compensation, County
Indigent or Other Government.
All other values of Payer Type are not considered valid.
Managed Care – Knox/Keene-Medi-Cal County Organized Health System. Healthcare service plans,
including Health Maintenance Organizations (HMO), licensed by the Department of Corporations under the
Knox-Keene Healthcare Service Plan Act of 1975. Includes Medi-Cal County Organized Health Systems
(MCOHS).
Managed Care-Other. – Healthcare plans, except those above, which provide managed care to enrollees
through a panel of providers on a pre-negotiated or per diem basis, usually involving utilization review.
Includes Preferred Provider Organization (PPO), Exclusive Provider Organization (EPO), Exclusive Provider
Organization with Point-of-Service option (POS).
Traditional Coverage. – All other forms of healthcare coverage, including the Medicare prospective payment
system, indemnity or fee-for-service plans, or other fee-for-service payers.
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January-December 2004
EXPECTED SOURCE OF PAYMENT
PAYER PLAN CODE
FIELD NAME:
:
PAY_PLAN
DEFINITION
:
This four-digit code number refers to the name of those plans which are
licensed under the Knox-Keene Healthcare Service Plan Act of 1975 or
designated as a Medi-Cal County Organized Health System (MCOHS).
CODES, CATEGORIES AND COMMENTS:
The Plan code number represents the name of the Knox-Knee licensed plan or the Medi-Cal County
Organized Health System. See Appendix E for the plan code names and numbers.
If the Payer Plan Code field is not applicable, determined by Type of Coverage, the Plan Code is zero
filled (i.e. assigned a value of “0000”).
Only values for Payer Plan, listed in Appendix E, are considered valid.
If the plan code numbers are the same and the plan names are different, it means they belong to
the same “parent” plan.
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January-December 2004
TOTAL CHARGES
FIELD NAME
:
CHARGE
DEFINITION
:
Total Charges include all charges for services rendered during the length of
stay for patient care at the facility, based on the hospital’s full established
rates.
CODES, CATEGORIES AND COMMENTS:
Charges include, but are not limited to, daily hospital services, ancillary services and any patient care
services. Hospital-based physician fees are excluded. Prepayment (e.g. deposits and prepaid
admissions) are not deducted from Total Charges.
If a patient’s length of stay is more than 1 year (365 days), Total Charges are reported for the
last year (365 days) of stay only. To calculate Adjusted Total Charges for stays over one year use
the following formula:
(Total Charges / 365 days) x Length of Stay = Adjusted Total Charges
Total Charges are expressed in whole dollars. However, there is a specific meaning attached to the
three values of “total charges,” below:
Where total charges equal 1 – the “1” is a code meaning that there were no ($0) charges generated
for the hospital stay (and was verified by the hospital). (Prior to 2004, all discharges from
Shriners Hospital – Los Angeles were coded as “1” because they did not charge their patients.
Programming note – the “1” allows the aggregation of all discharges with “valid total charges” by
selecting those with total charges greater than zero.
Where total charges equal 0 – the “0” is a code meaning that there was a charge, but that the
amount of the charge could not be reported by the hospital. This frequently means the reported
values were blank or otherwise invalid. This includes all Kaiser Foundation Hospitals which
report a “0” for Total Charges as they are exempted from reporting total charges because they do
not charge specifically for an inpatient stay. Rather, they receive a constant monthly (capitated)
payment from each member, whether or not that member is hospitalized, or received outpatient
care or no care at all.
Where total Charges equal 9999999 -The total charge of “9999999” indicates the actual charges
exceed the seven digit field size utilized by the hospital or designated agent.
Note – Beginning in 2002, Shriners Hospital – Northern California began coding all Total Charges
as $0, to note that they do not charge their patients. Beginning in 2004, Shriners Hospital – Los
Angeles did the same. Unfortunately, this is inconsistent with the coding scheme. Their Total
Charges now appear as invalid or missing data.
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EXTERNAL CAUSE OF INJURY — PRINCIPAL E-CODE
FIELD NAME
:
ECODE_P
DEFINITION
:
The external cause of injury consists of the ICD-9-CM codes E800-E999 (ECodes), that are used to describe the external cause of injuries, poisonings,
and adverse effects. If the information is available in the medical record, ECodes sufficient to describe the external cause are reported for discharges
with a principal and/or other diagnoses classified as injuries or poisonings in
Chapter 17 of the ICD-9-CM (800-999), or where a code from Chapters 1-16
of the ICD-9-CM (001-799) indicates that an additional E-code is applicable.
The reporting of E-Codes in the range E870-E879 (misadventures and
abnormal reactions) is not required. The principal E-Code is reported only for
the inpatient hospitalization during which the injury, poisoning, and/or adverse
effect was first diagnosed and/or treated.
To assure uniform reporting of E-Codes, when multiple codes are required to
completely classify the cause, the first (principal) E-code will describe the
mechanism that resulted in the most severe injury, poisoning, or adverse
effect.
CODES, CATEGORIES AND COMMENTS:
The valid E-Codes are specified in Chapter 17 of the ICD-9-CM codebook. External cause of injury
was not required for discharges before July 1, 1990.
CODE STRUCTURE (examples):
Content of Field: E9068 Would be read as: E906.8
Content of Field: E899 Would be read as: E899.
(Implied decimal is read after the first four positions.)
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EXTERNAL CAUSE OF INJURY – OTHER E-CODES
FIELD NAME
:
ECODE1, ECODE2, ECODE3, and ECODE4
DEFINITION
:
The external cause of injury consists of the ICD-9-CM codes E800-E999 (ECodes), that are used to describe the external cause of injuries, poisonings,
and adverse effects. If the information is available in the medical record, Ecodes sufficient to describe the external cause are reported for discharges
with a principal and/or other diagnoses classified as injuries or poisonings in
Chapter 17 of the ICD-9-CM (800-999), or where a code from Chapters 1-16
of the ICD-9-CM (001-799) indicates that an additional E-code is applicable.
The reporting of E-Codes in the range E870-E879 (misadventures and
abnormal reactions) is not required. An E-Code is reported only for the
inpatient hospitalization during which the injury, poisoning, and/or adverse
effect was first diagnosed and/or treated.
If the principal E-Code does not include a description of the place of
occurrence of the most severe injury, or poisoning, an additional E-Code is
reported to designate the place of occurrence, if available in the medical
record. Place of occurrence is coded as E849.0 – E849.9. Up to three
additional E-codes will be reported, if necessary to completely describe the
mechanism(s) that contributed to, or the causal events surrounding, any injury
or poisoning, or adverse effect first diagnosed and/or treated during the
current inpatient hospitalization.
CODES, CATEGORIES AND COMMENTS:
The valid E-Codes specified in Chapter 17 of the ICD-9-CM codebook. External cause of injury was
not required for discharges before July 1, 1990.
CODE STRUCTURE (examples):
Content of Field: E9068 Would be read as: E906.8
Content of Field: E899 Would be read as: E899.
(Implied decimal is read after the first four positions.)
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January-December 2004
MAJOR DIAGNOSTIC CATEGORY
(MDC)
FIELD NAME
:
MDC
DEFINITION
:
MDCs are mutually exclusive categories containing all possible principal
diagnosis areas. The diagnoses in each MDC correspond to a single major
organ system or etiology, and in general are associated with a particular
medical specialty. Some MDCs are residual categories containing diseases
or disorders that could not be assigned to an organ system-based MDC.
OSHPD purchases the DRG Grouper software from Centers for Medicare and
Medicaid Services (CMS) contractor, 3M® Health Information Systems. CMS
implements revisions to the DRG Grouper software effective October 1, the
start of the Federal fiscal year for the Medicare Prospective Payment System.
The Office implements the same software effective with discharges from the
beginning of the following calendar year. DRG Grouper Version 18.0, which
was implemented by CMS on October 1, 2000, is the DRG Grouper applied to
the Office’s calendar year 2001 patient discharge data.
The MDC is based on the principal diagnosis. The MDC is given “00” for
records where the principal diagnosis is not an existing ICD-9-CM code.
Beginning with 1993 data, new codes after October 1, are “mapped” by
OSHPD’s own mapping logic system to the closest equivalent code
recognized by the DRG Grouper Version for that calendar year and assigned
to an MDC based on that DRG Grouper Version’s logic.
CODES, CATEGORIES AND COMMENTS:
Codes: 00-25
MDC 00 is the label for records that could not be assigned to MDCs 1-25 by the DRG grouper
(e.g. some records from DRG 470 (ungroupable).
Appendix B displays the MDC descriptions.
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January-December 2004
DIAGNOSIS RELATED GROUP
(DRG)
FIELD NAME
:
DRG
DEFINITION
:
DRGs are case-mix assignments grouping hospital patients to categories
based on diagnostic, therapeutic and demographic characteristics for the
purpose of reimbursement. OSHPD purchases the DRG Grouper software
from Centers for Medicare and Medicaid Services (CMS) contractor, 3M®
Health Information Systems. CMS implements revisions to the DRG Grouper
software every October 1, the start of Federal fiscal year for the Medicare
Prospective Payment System. The Office implements the same software
effective with discharges from the beginning of the following calendar year.
Special note – New codes after October 1, are “mapped” by OSHPD’s own
mapping logic system to the closest equivalent code recognized by the DRG
Grouper Version for that calendar year and assigned to a DRG based on that
DRG Grouper Version’s logic.
CODES,CATEGORIES AND COMMENTS:
Codes: 001-511
Appendix C displays the DRG descriptions.
The following indicates the DRG Grouper Version used during recent years:
Calendar Year 1995 = Version 12.0 HCFA DRG Grouper
Calendar Year 1996 = Version 13.0 HCFA DRG Grouper
Calendar Year 1997 = Version 14.0 HCFA DRG Grouper
Calendar Year 1998 = Version 15.0 HCFA DRG Grouper
Calendar Year 1999 = Version 16.0 HCFA DRG Grouper
Calendar Year 2000 = Version 17.0 HCFA DRG Grouper
Calendar Year 2001 = Version 18.0 HCFA DRG Grouper
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PRINCIPAL DIAGNOSIS
FIELD NAME
:
DIAG_P
DEFINITION
:
The condition established, after study, to be the chief cause of the admission
of the patient to the facility for care.
CODES, CATEGORIES AND COMMENTS:
The appropriate codes to be entered for this data element are specified in the International
Classification of Diseases, 9th Revision, Clinical Modification, U.S. Department of Health and Human
Services, Washington D.C. (ICD-9-CM).
Beginning with 1999, the psychiatric codes from the Diagnostic and Statistical Manual of Mental
Disorders (DSM), by American Psychiatric Association, Washington, D.C. are not accepted by
OSHPD.
Note: Morphology codes are not accepted by OSHPD. SNODO codes are not accepted by OSHPD.
Codes from the Supplementary Classification of External causes (E-Code) of Injury and Poisoning
are not accepted in the Principal Diagnosis field. Italicized ICD-9-CM codes are not accepted in the
Principal Diagnosis field.
CODE STRUCTURE (examples):
Content of Field: V5781 Would be read as: V57.81
Content of Field: 3441 Would be read as: 344.1
(Implied decimal is read after the first three character positions.)
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CONDITION PRESENT AT ADMISSION
(for the Principal Diagnosis)
FIELD NAME
:
CPOA_P
DEFINITION
:
The indicator for whether or not the condition was present at admission by
reporting Yes, No, or Uncertain for the Principal Diagnosis.
CODES, CATEGORIES AND COMMENTS:
The indicator for the principal diagnosis is defaulted to Yes (present at admission), unless reported
otherwise.
Code
Y
N
U
=
=
=
Category
Yes
No
Uncertain
All other values of Condition Present At Admission are not considered valid.
Detailed parameters for reporting Condition Present At Admission are available in the California
Patient Discharge Data Reporting Manual, Third Edition.
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January-December 2004
PRINCIPAL PROCEDURE
FIELD NAME
:
PROC_P
DEFINITION
:
The principal procedure is one which was performed for definitive treatment
rather than one performed for diagnostic or exploratory purposes, or which
was necessary to take care of a complication.
The principal procedure is the procedure most related to the principal
diagnosis.
If only non-therapeutic procedures were performed, then a significant nontherapeutic procedure should be reported. A significant procedure is one that
is surgical in nature, or carries a procedural risk, or carries an anesthetic risk,
or affects DRG assignment.
CODES, CATEGORIES AND COMMENTS:
The appropriate codes to be entered are specified in the International Classification of Diseases, 9th
Revision, Clinical Modification (ICD-9-CM), U.S. Department of Health and Human Services,
Washington, D.C.
Note: HCPCS and CPT codes are not accepted by OSHPD.
CODE STRUCTURE (examples):
Content of Field: 022 Would be read as: 02.2
Content of Field: 0293 Would be read as: 02.93
(Implied decimal is read after the first two positions.)
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DAYS FROM ADMISSION TO PRINCIPAL PROCEDURE
FIELD NAME
:
PROC_PDY
DEFINITION
:
The number of days between the patient’s admission date and the date of the
Principal Procedure.
CODES, CATEGORIES AND COMMENTS:
If the Principal Procedure was performed prior to admission, this numeric value will be prefixed with
a minus (-) sign. The days are calculated by subtracting the date of admission from the date of the
Principal Procedure. If the Principal Procedure was performed on the day of admission, the number
of days will be zero. If no Principal Procedure or date is reported, the days are shown as zero. The
maximum value is 9999, which means that the procedure was performed more than 9998 days after
admission.
Through 2000, if no procedure was performed, the days to procedure were shown as -999. For
procedures performed on the same day as admission, the days were displayed as zero.
Some hospitals report procedures performed on their inpatients, on an outpatient basis by another
facility, during the patient’s stay at the reporting hospital. Therefore, not all procedures reported by a
hospital were necessarily performed by and at that hospital.
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January-December 2004
OTHER DIAGNOSES (24 Other Diagnoses)
FIELD NAME
:
ODIAG1 to ODIAG24
DEFINITION
:
Conditions that coexist at the time of admission, develop subsequently during
the hospital stay, affect the treatment received, or affect the length of stay.
CODES, CATEGORIES AND COMMENTS:
Beginning with 1999, the psychiatric codes from Diagnostic and Statistical Manual of Mental Disorders
(DSM), by American Psychiatric Association, Washington D.C., are not accepted by OSHPD.
The appropriate codes to be entered are specified in the International Classification of Diseases 9th
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