Centers for Medicare and Medicaid Services

Complications and Deaths - provider data. This data set includes provider data for 30-day death and readmission measures.

The Healthcare-Associated Infection (HAI) measures - provider data. These measures are developed by the Centers for Disease Control and Prevention (CDC) and collected through the National Healthcare Safety Network (NHSN). They provide information on infections that occur while the patient is in the hospital. These infections can be related to devices, such as central lines and urinary catheters, or spread from patient to patient after contact with an infected person or surface. Many healthcare-associated infections can be prevented when hospitals use CDC-recommended infection control steps.

A list of all Home Health Agencies that have been registered with Medicare. The list includes addresses, phone numbers, and quality measure ratings for each agency.

A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Care measures.

Hospital Value-Based Purchasing (HVBP) – Efficiency Scores

Hospital Value-Based Purchasing (HVBP) – Patient Experience of Care Domain Scores (HCAHPS)

A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Process of Care Pneumonia measures.

A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Preventive Care measure.

A list of hospitals participating in the Hospital VBP Program and their performance rates and scores for the Clinical Process of Care SCIP measures.

A list of hospitals participating in the Hospital VBP Program and their Clinical Process of Care domain scores, Patient Experience of Care dimension scores, and Total Performance Scores.

Referring Provider Last Name / Organization Name - When the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s last name. When the referring provider is registered as an organization (entity type code = ‘O’), this is the organization name. Referring Provider First Name - When the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s first name. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank. Referring Provider Middle Initial - When the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s middle initial. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank. Referring Provider Credentials - When the referring provider is registered in NPPES as an individual (entity type code=’I’), these are the referring provider’s credentials. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank. Referring Provider Gender - When the referring provider is registered in NPPES as an individual (entity type code=’I’), this is the referring provider’s gender. When the referring provider is registered as an organization (entity type code = ‘O’), this will be blank. Referring Provider Entity Code - Type of entity reported in NPPES. An entity code of ‘I’ identifies referring providers registered as individuals and an entity type code of ‘O’ identifies referring providers registered as organizations. Referring Provider Street 1 - The first line of the referring provider’s street address, as reported in NPPES. Referring Provider Street 2 - The second line of the referring provider’s street address, as reported in NPPES. Referring Provider City - The city where the referring provider is located, as reported in NPPES. "Referring Provider State - The state where the referring provider is located, as reported in NPPES. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation. The following values are used for other areas: 'XX' = 'Unknown' 'AA' = 'Armed Forces Central/South America' 'AE' = 'Armed Forces Europe' 'AP' = 'Armed Forces Pacific' 'AS' = 'American Samoa' 'GU' = 'Guam' 'MP' = 'North Mariana Islands' 'PR' = 'Puerto Rico' 'VI' = 'Virgin Islands' 'ZZ' = 'Foreign Country' " Referring Provider Zip - The referring provider’s zip code, as reported in NPPES. "Referring Provider Country - The country where the referring provider is located, as reported in NPPES. The country code will be ‘US’ for any state or U.S. possession. For foreign countries (i.e., state values of ‘ZZ’), the provider country values include the following: ‘AE’ = ‘United Arab Emirates’; ‘IL’= Israel’; ‘AR’= ‘Argentina’; ‘IN’= India’; ‘AU’= ‘Australia’; ‘IS’= Iceland; ‘BR’= ‘Brazil’; ‘IT’= Italy’; ‘CA’= ‘Canada’; ‘JP’= Japan’; ‘CH’= Switzerland’; ‘KR’= ‘Korea’; ‘CN’= China’; ‘NL’= ‘Netherlands’; ‘CO’= Colombia’; ‘PK’= ‘Pakistan’; ‘DE’= ‘Germany’; ‘SA’= ‘Saudi Arabia’; ‘ES’= ‘Spain’; ‘SY’= ‘Syria’; ‘FR’= France’; ‘TR’= ‘Turkey’; ‘GB’= Great Britain’; ‘VE’= ‘Venezuela’; ‘HU’= Hungary’ " Referring Provider Type - Derived from the Medicare provider/supplier specialty code reported on all of the NPI's Part B non-institutional claims (DMEPOS & non-DMEPOS). For referring providers that have more than one Medicare specialty code reported on their claims, the Medicare specialty code associated with the largest number of services was used. Where a prescriber's NPI did not have associated Part B claims, the taxonomy code associated with the NPI in NPPES was mapped to a Medicare specialty code using an external crosswalk published here: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/Taxonomy.html. For any taxonomy codes that could not be mapped to a Medicare specialty code, the taxonomy classification description was used. Referring Provider Type Flag - A flag variable that indicates the source of the Referring Provider Type: "S" = Medicare Specialty Code description "T" = Taxonomy Code Classification description Number of Suppliers - Number of suppliers rendering products/services billed through DMEPOS MACs. Number of Supplier HCPCS - Total number of unique DMEPOS product/service hcpcs codes billed by suppliers and ordered by the referring provider. Number of Supplier Beneficiaries - Total number of unique beneficiaries associated with DMEPOS claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. Number of Supplier Claims - Total number of DMEPOS claims submitted by suppliers, reflecting products/services ordered by the referring provider. Number of Supplier Services - Total DMEPOS products/services rendered by suppliers and ordered by the referring provider. Supplier Submitted Charges - The total charges that suppliers submitted for all DMEPOS products/services ordered by the referring provider. Supplier Medicare Allowed Amount - The Medicare allowed amount for all DMEPOS products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. Supplier Medicare Payment Amount - Amount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's DMEPOS line item products/services ordered by the referring provider. Durable Medical Equipment Suppression Indicator1 - A 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with durable medical equipment HCPCS codes. A value of '*' means the suppressed information is based on a dme-specific claim count of 1 through 10. A value of '#' means the dme-specific information has been counter-suppressed. Counter-suppression is needed when the display of dme-specific data could be used to recalculate suppressed values in non-dme-specific columns. Number of Durable Medical Equipment Suppliers1 - Number of suppliers rendering durable medical equipment products/services. Number of Durable Medical Equipment Beneficiaries1 - Total number of unique beneficiaries associated with durable medical equipment claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. Number of Durable Medical Equipment HCPCS1 - Total number of unique durable medical equipment hcpcs codes billed by suppliers and ordered by the referring provider. Number of Durable Medical Equipment Claims1 - Total number of durable medical equipment claims submitted by suppliers, reflecting services ordered by the referring provider. Number of Durable Medical Equipment Services1 - Total durable medical equipment products/services rendered by suppliers and ordered by the referring provider. Durable Medical Equipment Submitted Charges1 - The total charges that suppliers submitted for all durable medical equipment products/services ordered by the referring provider. Durable Medical Equipment Medicare Allowed Amount1 - The Medicare allowed amount for all durable medical equipment products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. Durable Medical Equipment Medicare Payment Amount1 - Amount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's durable medical equipment line item products/services ordered by the referring provider. Prosthetic and Orthotic Suppression Indicator1 - A 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with prosthetic and orthotic HCPCS codes. A value of '*' means the suppressed information is based on a prosthetic and orthotic-specific claim count of 1 through 10. A value of '#' means the prosthetic and orthotic-specific information has been counter-suppressed. Counter-suppression is needed when the display of prosthetic and orthotic-specific data could be used to recalculate suppressed values in non-prosthetic and orthotic-specific columns. Number of Prosthetic and Orthotic Suppliers1 - Number of suppliers rendering prosthetic and orthotic products/services. Number of Prosthetic and Orthotic HCPCS1 - Total number of unique prosthetic and orthotic hcpcs codes billed by suppliers and ordered by the referring provider. Number of Prosthetic and Orthotic Beneficiaries1 - Total number of unique beneficiaries associated with prosthetic and orthotic claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. Number of Prosthetic and Orthotic Claims1 - Total number of prosthetic and orthotic claims submitted by suppliers, reflecting products/services ordered by the referring provider. Number of Prosthetic and Orthotic Services1 - Total prosthetic and orthotic products/services rendered by suppliers and ordered by the referring provider. Prosthetic and Orthotic Submitted Charges1 - The total charges that suppliers submitted for all prosthetic and orthotic products/services ordered by the referring provider. Prosthetic and Orthotic Medicare Allowed Amount1 - The Medicare allowed amount for all prosthetic and orthotic products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. Prosthetic and Orthotic Medicare Payment Amount1 - Amount that Medicare paid after deductible and coinsurance amounts have been deducted for all supplier's prosthetic and orthotic line item products/services ordered by the referring provider. Drug and Nutritional Suppression Indicator1 - A 1-byte value which defines the suppression, if needed, of the utilization, charge and payment information associated with drug and nutritional HCPCS codes. A value of '*' means the suppressed information is based on a drug and nutritional-specific claim count of 1 through 10. A value of '#' means the drug and nutritional-specific information has been counter-suppressed. Counter-suppression is needed when the display of drug and nutritional-specific data could be used to recalculate suppressed values in non-drug and nutritional-specific columns. Number of Drug and Nutritional Product Suppliers1 - Number of suppliers rendering drug and nutritional products/services. Number of Drug and Nutritional Product HCPCS1 - Total number of unique drug and nutritional product hcpcs codes billed by suppliers and ordered by the referring provider. Number of Drug and Nutritional Product Beneficiaries1 - Total number of unique beneficiaries associated with drug and nutritional product claims submitted by suppliers and ordered by the referring provider. Beneficiary counts fewer than 11 have been suppressed to protect the privacy of Medicare beneficiaries. Number of Drug and Nutritional Product Claims1 - Total number of drug and nutritional product claims submitted by suppliers, reflecting services ordered by the referring provider. Number of Drug and Nutritional Product Services1 - Total drug and nutritional products/services rendered by suppliers and ordered by the referring provider. Drug and Nutritional Product Submitted Charges - The total charges that suppliers submitted for drug and nutritional products/services ordered by the referring provider. Drug and Nutritional Product Medicare Allowed Amount - The Medicare allowed amount for drug and nutritional products/services ordered by the referring provider. This figure is the sum of the amount Medicare pays, the deductible and coinsurance amounts that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying. Drug and Nutritional Product Medicare Payment Amount - Amount that Medicare paid suppliers after deductible and coinsurance amounts have been deducted for drug and nutritional line item products/services ordered by the referring provider.

Payment measures and value of care displays – provider data. This data set includes provider data for the payment measures and value of care displays.

The data displayed here describes average spending levels during hospitals’ Medicare Spending per Beneficiary (MSPB) episodes by Medicare claim type. The data presented on Hospital Compare provide price-standardized, non-risk-adjusted values for hospital spending by claim type because risk adjustment is done at the episode level rather than at the service category/claim level. An MSPB episode includes all Medicare Part A and Part B claims paid during the period from 3 days prior to an inpatient hospital admission through 30 days after discharge.