Provision of Uncompensated Care by Rural Hospitals: A Preliminary Look at Medicare Cost Report Worksheet S-10
Abstract
Purpose: To conduct a preliminary assessment of the quality of uncompensated care data included in Medicare Cost Report (MCR) Worksheet S-10 for rural hospitals and to identify the implications of data quality issues for research and policy decisions.
Methods: 2011 MCR Worksheet S-10 data for all rural hospitals were collected from the Healthcare Cost Reporting Information System (HCRIS). Rural hospitals were partitioned into two sub-groups: CAHs and all other rural hospitals (ORHs.) Two tests of data quality were undertaken. First, for each study variable, we counted the number of hospital cost reports where the value was positive, zero, or negative. Second, we calculated the percentile values of study variables that were positive.
Findings: Several data quality issues in Worksheet S-10 were identified: 1) large numbers of zero values, particularly among Medicaid and SCHIP programs; 2) possible incomplete capture of the total initial obligation of patients approved for charity care, and; 3) zero and negative values for charity care, bad debt, total uncompensated cost and the grand total. Conclusions: There are several implications of the study. First, use of these data for policy making and research at this point in time could be imprecise. Second, consistency with other data sources could improve the quality of data in Worksheet S-10. Third, revisions to Worksheet S-10 may be needed.