Methodology

This page summarizes how hospital and surgeon data are constructed from 2018 Medicare inpatient claims.

Built on subsection of 2018 Medicare claims + NPPES + ICD-10-PCS/CM mappings

Data Sources

  • Sample of Medicare inpatient claims from 2018 (claim type 60): diagnoses, procedures, dates, discharge status, and payments.
  • NPPES registry: maps NPIs to hospital locations and surgeon names.
  • ICD-10-PCS procedure descriptions from CMS official order files.
  • ICD-10-CM diagnosis mapping for Elixhauser comorbidities.
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Links: CMS.gov, CMS ICD-10, NPPES.

How We Build Metrics

  • Primary operation: If ICD_PRCDR_CD1 is valid, use it; otherwise select the earliest surgical ICD-10-PCS code.
  • Complications: Flagged when ICD-10-CM codes match known complication prefixes (e.g., T80–T88, A41, R65, I97).
  • Readmissions: A new inpatient admission for the same beneficiary within 30 days.
  • Mortality: Based on discharge status = “expired”.
  • Costs: Uses Medicare-paid amount for the stay.
  • Length of stay: Discharge date minus admission date + 1.
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Hospitals and surgeons are given percentile ranks compared with all others in the dataset.

Privacy & Suppression Rules

  • Hospitals with fewer than 11 Medicare cases have all detailed metrics hidden.
  • Surgeon case counts shown only for high-volume surgeons (top ~10% at that hospital).
  • Procedure tables only list procedures with more than 10 cases.
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Small numbers swing rapidly. Interpret low-volume data with caution.

Important Limitations

  • Not risk-adjusted beyond simple comorbidity counts.
  • Medicare-only: excludes younger and privately insured patients.
  • ICD-10 coding can under- or over-capture complications.
  • Percentiles compare providers within this dataset, not all U.S. hospitals.
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This is not medical advice. Use as a starting point, not a determinant of care.