HCRIS Data

Ian McCarthy | Emory University

Understanding HCRIS Data

What is HCRIS?

Healthcare Cost Report Information System (‘cost reports’)

• Nursing Homes (SNFs)
• Hospice
• Home Health Agencies
• Hospitals

Hospital Cost Reports

The Data

Let’s work with the HCRIS GitHub repository.

• Database structure (alphanumeric, numeric, report info)
• Understanding where to find variables of interest
• Quirks in versions and duplicate reports

The Data

R Code

hcris.data %>% 
  ggplot(aes(x=as.factor(year))) + 
  geom_bar() +
  labs(
    x="Year",
    y="Number of Hospitals",
    title="Number of Hospitals per Year"
  ) + theme_bw() +
  theme(axis.text.x = element_text(angle = 90, hjust=1))

Estimating hospital prices

hcris.data <- hcris.data %>%
  mutate( discount_factor = 1-tot_discounts/tot_charges,
          price_num = (ip_charges + icu_charges + ancillary_charges)*discount_factor - tot_mcare_payment,
          price_denom = tot_discharges - mcare_discharges,
          price = price_num/price_denom)

Estimating hospital prices

R Code

hcris.data %>% group_by(year) %>% 
  filter(price_denom>10, !is.na(price_denom), 
         price_num>0, !is.na(price_num)) %>%  
  select(price, year) %>% 
  summarize(mean_price=mean(price, na.rm=TRUE)) %>%
  ggplot(aes(x=as.factor(year), y=mean_price)) + 
  geom_line(aes(group=1)) +
  labs(
    x="Year",
    y="Average Hospital Price",
    title="Hospital Prices per Year"
  ) + scale_y_continuous(labels=comma) +
  theme_bw() + theme(axis.text.x = element_text(angle = 90, hjust=1))

Removing very high prices

R Code

hcris.data %>% group_by(year) %>% 
  filter(price_denom>100, !is.na(price_denom), 
         price_num>0, !is.na(price_num),
         price<100000) %>%   #<<
  select(price, year) %>% 
  summarize(mean_price=mean(price, na.rm=TRUE)) %>%
  ggplot(aes(x=as.factor(year), y=mean_price)) + 
  geom_line(aes(group=1)) +
  labs(
    x="Year",
    y="Average Hospital Price",
    title="Hospital Prices per Year"
  ) + scale_y_continuous(labels=comma) +
  theme_bw() + theme(axis.text.x = element_text(angle = 90, hjust=1))