Common use of Imputation Methodology for Emergency Room Visits Clause in Contracts

Imputation Methodology for Emergency Room Visits. Facility expenditures for emergency room services were developed in a sequence of logical edits and imputations. “Household” edits were applied to sources and amounts of payment for all events reported by HC respondents. “MPC” edits were applied to provider-reported sources and amounts of payment for records matched to household-reported events. Both sets of edits were used to correct obvious errors in the reporting of expenditures. After the data from each source were edited, a decision was made as to whether household- or MPC-reported information would be used in the final editing and hot-deck imputations for missing expenditures. The general rule was that MPC data would be used where a household reported event corresponded to a MPC reported event (i.e., a matched event), since providers usually have more complete and accurate data on sources and amounts of payment than households. One of the more important edits separated flat fee events from simple events. This edit was necessary because groups of events covered by a flat fee (i.e., a flat fee bundle) were edited and imputed separately from individual events covered by a single charge (i.e., simple events). Most emergency room events were imputed as simple events because hospital facility charges are rarely bundled with other events. (See Section 2.5.5 for more details on flat fee groups). However, some emergency room visits were treated as free events because the respondent was admitted to a hospital through its emergency room. In these cases, emergency room charges are included in the charge for an inpatient hospital stay. Logical edits also were used to sort each event into a specific category for the imputations. Events with complete expenditures were flagged as potential donors for the hot-deck imputations, while events with missing expenditure data were assigned to various recipient categories. Each event was assigned to a recipient category based on its pattern of missing data. For example, an event with a known total charge but no expenditures information was assigned to one category, while an event with a known total charge and some expenditures information was assigned to a different category. Similarly, events without a known total charge were assigned to various recipient categories based on the amount of missing data. The logical edits produced eight recipient categories in which all events had a common pattern of missing data. Separate hot-deck imputations were performed on events in each recipient category, and the donor pool was restricted to events with complete expenditures from the MPC. The donor pool restriction was used even though some unmatched events had complete household-reported expenditures. These events were not allowed to donate information to other events because the MPC data were considered to be more reliable. The donor pool included “free events” because, in some instances, providers are not paid for their services. These events represent charity care, bad debt, provider failure to bill, and third party payer restrictions on reimbursement in certain circumstances. If free events were excluded from the donor pool, total expenditures would be over-counted because the cost of free care would be implicitly included in paid events and explicitly included in events that should have been treated as free from provider. Expenditures for some emergency room visits are not shown because the person was admitted to the hospital through the emergency room. These emergency room events are not free, but the expenditures are included in the inpatient stay expenditures. The variable ERHEVIDX can be used to differentiate between free emergency room care and situations where the emergency room charges have been included in the inpatient hospital charges. Expenditures for services provided by separately billing doctors in hospital settings were also edited and imputed. These expenditures are shown separately from hospital facility charges for hospital inpatient, outpatient, and emergency room care.

Imputation Methodology for Emergency Room Visits. Facility expenditures for emergency room services were developed in a sequence of logical edits and imputations. “Household” edits were applied to sources and amounts of payment for all events reported by HC respondents. “MPC” edits were applied to provider-reported sources and amounts of payment for records matched to household-reported events. Both sets of edits were used to correct obvious errors in the reporting of expenditures. After the data from each source were edited, a decision was made as to whether household- or MPC-reported information would be used in the final editing and hot-deck imputations for missing expenditures. The general rule was that MPC data would be used where a household reported event corresponded to a MPC reported event (i.e., a matched event), since providers usually have more complete and accurate data on sources and amounts of payment than households. One of the more important edits separated flat fee events from simple events. This edit was necessary because groups of events covered by a flat fee (i.e., i.e. a flat fee bundle) were edited and imputed separately from individual events covered by a single charge (i.e., simple events). Most emergency room events were imputed as simple events because hospital facility charges are rarely bundled with other events. (See Section 2.5.5 2.5.7 for more details on flat fee groups). However, some emergency room visits were treated as free events because the respondent was admitted to a hospital through its emergency room. In these cases, emergency room charges are included in the charge for an inpatient hospital stay. Logical edits also were used to sort each event into a specific category for the imputations. Events with complete expenditures were flagged as potential donors for the hot-deck imputations, while events with missing expenditure data were assigned to various recipient categories. Each event was assigned to a recipient category based on its pattern of missing data. For example, an event with a known total charge but no expenditures information was assigned to one category, while an event with a known total charge and some expenditures information was assigned to a different category. Similarly, events without a known total charge were assigned to various recipient categories based on the amount of missing data. The logical edits produced eight recipient categories in which all events had a common pattern of missing data. Separate hot-deck imputations were performed on events in each recipient category, and the donor pool was restricted to events with complete expenditures from the MPC. The donor pool restriction was used even though some unmatched events had complete household-reported expenditures. These events were not allowed to donate information to other events because the MPC data were considered to be more reliable. The donor pool included “free events” because, in some instances, providers are not paid for their services. These events represent charity care, bad debt, provider failure to bill, and third party payer restrictions on reimbursement in certain circumstances. If free events were excluded from the donor pool, total expenditures would be over-counted because the cost of free care would be implicitly included in paid events and explicitly included in events that should have been treated as free from provider. Expenditures for some emergency room visits are not shown because the person was admitted to the hospital through the emergency room. These emergency room events are not free, but the expenditures are included in the inpatient stay expenditures. The variable ERHEVIDX can be used to differentiate between free emergency room care and situations where the emergency room charges have been included in the inpatient hospital charges. Expenditures for services provided by separately billing doctors in hospital settings were also edited and imputed. These expenditures are shown separately from hospital facility charges for hospital inpatient, outpatient, and emergency room care.

Imputation Methodology for Emergency Room Visits. Facility expenditures for emergency room services were developed in a sequence of logical edits and imputations. “Household” edits were applied to sources and amounts of payment for all events reported by HC respondents. “MPC” edits were applied to provider-reported sources and amounts of payment for records matched to household-reported events. Both sets of edits were used to correct obvious errors in the reporting of expenditures. After the data from each source were edited, a decision was made as to whether household- or MPC-reported information would be used in the final editing and hot-deck imputations for missing expenditures. The general rule was that MPC data would be used where a household reported event corresponded to a MPC reported event (i.e., a matched event), since providers usually have more complete and accurate data on sources and amounts of payment than households. One of the more important edits separated flat fee events from simple events. This edit was necessary because groups of events covered by a flat fee (i.e., i.e. a flat fee bundle) were edited and imputed separately from individual events covered by a single charge (i.e., simple events). Most emergency room events were imputed as simple events because hospital facility charges are rarely bundled with other events. (See Section 2.5.5 section 2.5.10 for more details detail on flat fee groups). However, some emergency room visits were treated as free events because the respondent was admitted to a hospital through its emergency room. In these cases, emergency room charges are included in the charge for an inpatient hospital stay. Logical edits also were used to sort each event into a specific category for the imputations. Events with complete expenditures were flagged as potential donors for the hot-deck imputations, while events with missing expenditure data were assigned to various recipient categories. Each event was assigned to a recipient category based on its pattern of missing data. For example, an event with a known total charge but no expenditures information was assigned to one category, while an event with a known total charge and some expenditures information was assigned to a different category. Similarly, events without a known total charge were assigned to various recipient categories based on the amount of missing data. The logical edits produced eight recipient categories in which all events had a common pattern of missing data. Separate hot-deck imputations were performed on events in each recipient category, and the donor pool was restricted to events with complete expenditures from the MPC. The donor pool restriction was used even though some unmatched events had complete household-reported expenditures. These events were not allowed to donate information to other events because the MPC data were considered to be more reliable. The donor pool included “free events” because, in some instances, providers are not paid for their services. These events represent charity care, bad debt, provider failure to bill, and third party payer restrictions on reimbursement in certain circumstances. If free events were excluded from the donor pool, total expenditures would be over-counted because the cost of free care would be implicitly included in paid events and explicitly included in events that should have been treated as free from provider. Expenditures for some emergency room visits are not shown because the person was admitted to the hospital through the emergency room. These emergency room events are not free, but the expenditures are included in the inpatient stay expenditures. The variable ERHEVIDX can be used to differentiate between free emergency room care and situations where the emergency room charges have been included in the inpatient hospital charges. Flat Fee Expenditures The approach used to count expenditures for services provided flat fees was to place the expenditure on the first visit of the flat fee group. The remaining visits have zero payments. Thus, if the first visit in the flat fee group occurred prior to 1996, all of the events that occurred in 1996 will have zero payments. Conversely, if the first event in the flat fee group occurred at the end of 1996, the total expenditure for the entire flat fee group will be on that event, regardless of the number of events it covered after 1996. Zero Expenditures There are some medical events reported by separately billing doctors in hospital settings respondents where the payments were also edited and imputedzero. These expenditures are shown separately from hospital facility charges This could occur for hospital inpatientseveral reasons including (1) free care was provided, outpatient, and emergency room care.(2) bad debt was incurred,