Intro to R - Final Project
Peggy Hung
June 29, 2015
The Dataset
The dataset used for this report is from Data.CMS.gov - Inpatient Prospective Payment System (IPPS) Provider Summary for the Top 100 Diagnosis-Related Groups (DRG) - FY2011. The data includes hospital-specific charges for the more than 3,000 US hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, all paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year 2011. This dataset has also been updated on 6/2/2014 to include “Average Medicare Payment.” For more information, please see CMS.gov.
Aims of this report
- Classification of hospital data by various variables to understand the data.
- Summarization of the data by using tables.
- Display of the patterns by using graphs.
DRG <- read.csv("~/Documents/Johns Hopkins/Summer Institute 2015/Intro to R/Final Project/Inpatient_Prospective_Payment_System__IPPS__Provider_Summary_for_the_Top_100_Diagnosis-Related_Groups__DRG__-_FY2011.csv", as.is = TRUE)Aim Number 1
This is a large dataset that lists the top 100 used DRG definitions by different provider names, or hospital names, and by state and regions within states. Each DRG per provider name also includes more information such as the number of discharges, the average covered charges, the average total payments, and average Medicare payments. Here is a basic summary of the classifications:
- We know that there are 100 unique, or different, DRG definitions from this dataset. The DRG that was coded the most is 194 - SIMPLE PNEUMONIA & PLEURISY W CC, at 3023 times.
- There are 3201 different provider names, or hospitals. CALIFORNIA has the most out of all the other states, with 13064 different hospitals.
- The overall average of all the Average Covered Charges is $36,133.95.
- The overall average of all the Average Total Payments is $9,707.474.
- And the overall average of all the Average Medicare Payments is $8,494.49.
- The hospital with the most number of hospital discharges is HOSPITAL FOR SPECIAL SURGERY in Manhattan, NY.
- The DRG with the most number of hospital discharges is 470 - MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC.
Aim Number 2
To summarize some of the information stated above, tables were created for visual summarization.
Table 1.
## Average.Covered.Charges Average.Total.Payments Average.Medicare.Payments
## Min. : 2459 Min. : 2673 Min. : 1149
## 1st Qu.: 15947 1st Qu.: 5234 1st Qu.: 4192
## Median : 25246 Median : 7214 Median : 6158
## Mean : 36134 Mean : 9707 Mean : 8494
## 3rd Qu.: 43233 3rd Qu.: 11286 3rd Qu.: 10057
## Max. :929119 Max. :156158 Max. :154621This table shows the overall averages of the three respective variables, Average Covered Charges, Average Total Payments, and Average Medicare Payments. The quartile summaries are also shown, demonstrating the lowest and highest amounts as well for each variable.
Table 2.
## DRG.Definition
## 39563 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 39530 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 151391 870 - SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS
## 151381 870 - SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS
## 40331 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## Provider.Name Provider.State Average.Covered.Charges
## 39563 STANFORD HOSPITAL CA 929118.9
## 39530 WASHINGTON HOSPITAL CA 918023.2
## 151391 STANFORD HOSPITAL CA 637377.7
## 151381 NORTHBAY MEDICAL CENTER CA 628730.4
## 40331 TEMPLE UNIVERSITY HOSPITAL PA 613926.6This table looks at the top 5 Average Covered Charges by DRGs with their corresponding hospital names.
Table 3.
## DRG.Definition
## 39563 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 150794 853 - INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC
## 109460 460 - SPINAL FUSION EXCEPT CERVICAL W/O MCC
## 39530 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 151893 870 - SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS
## Provider.Name Provider.State Average.Total.Payments
## 39563 STANFORD HOSPITAL CA 156158.2
## 150794 WESTCHESTER MEDICAL CENTER NY 140255.3
## 109460 PINNACLE HOSPITAL IN 131187.4
## 39530 WASHINGTON HOSPITAL CA 119113.0
## 151893 WESTCHESTER MEDICAL CENTER NY 119028.9This table looks at the top 5 Average Total Payments by DRGs with their corresponding hospital names.
Table 4.
## DRG.Definition
## 39563 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 150794 853 - INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC
## 109460 460 - SPINAL FUSION EXCEPT CERVICAL W/O MCC
## 39530 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS
## 151391 870 - SEPTICEMIA OR SEVERE SEPSIS W MV 96+ HOURS
## Provider.Name Provider.State Average.Medicare.Payments
## 39563 STANFORD HOSPITAL CA 154620.8
## 150794 WESTCHESTER MEDICAL CENTER NY 133177.3
## 109460 PINNACLE HOSPITAL IN 130466.6
## 39530 WASHINGTON HOSPITAL CA 113462.1
## 151391 STANFORD HOSPITAL CA 109303.2This table looks at the top 5 Average Medicare Payments by DRGs with their corresponding hospital names.
The latter three tables indicate that Stanford Hospital has the highest average covered charges, average total payments, and average Medicare payments. In addition, the DRG 207 - RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT 96+ HOURS had the highest cost for all three variables.
Aim Number 3
The following graphs demonstrate the patterns of the top DRGs for the highest average covered charges, total payments, and Medicare payments, respectively, that were coded and their total discharges per hospital.
AVERAGE COVERED CHARGES
Out of the top 10 highest average covered charges, the following two DRGs made up the list for different hospitals, and therefore, only two plots are shown.
Graph 1a.
DRG 207 - Respiratory System Diagnosis with Ventilator Support 
This plot shows the total discharges per hospital for DRG 207, which had the highest average covered charge among all the other DRGs.
Graph 1b.
DRG 870 - Septicemia or Severe Sepsis 
This plot shows the total discharges per hospital for DRG 870, which had the second highest average covered charge among all the other DRGs.
AVERAGE TOTAL PAYMENTS
Out of the top 10 highest average total payments, the following six DRGs made up the list with the total discharges per hospital.
Graph 2a.
DRG 207 - Respiratory System Diagnosis With Ventilator Support 
This graph shows the total discharges per hospital for DRG 207, which had the highest average total payment among all the other DRGs.
Graph 2b.
DRG 853 - Infectious & Parasitic Disease SW O.R. Procedure 
This graph shows the total discharges per hospital for DRG 853, which had the second highest average total payment out of all DRGs.
Graph 2c.
DRG 460 - Spinal Fusion Except Cervical 
This graph shows the total discharges per hospital for DRG 460, which had the third highest average total payment out of all DRGs.
Graph 2d.
DRG 870 - Septicemia or Severe Sepsis 
This graph shows the total discharges per hospital for DRG 870, which had the fourth highest average total payment out of all DRGs.
Graph 2e.
DRG 329 - Major Small & Large Bowel Procedures 
This graph shows the total discharges per hospital for DRG 329, which had the fifth highest average total payment out of all DRGs.
Graph 2f.
DRG 469 - Major Joint Replacement or Reattachment of Lower Extremity 
This graph shows the total discharges per hospital for DRG 469, wich had the sixth highest average total payment out of all DRGs.
AVERAGE MEDICARE PAYMENTS
Out of the top 10 highest average Medicare payments, the following six DRGs made up the list with the total discharges per hospital.
Graph 3a.
DRG 207 - Respiratory System Diagnosis with Ventilator Support 
This graph shows the total discharges per hospital for DRG 207, which had the highest average Medicare payment compared to all DRGs.
Graph 3b.
DRG 853 - Infectious & Parasitic Disease Procedure 
This graph shows the total discharges per hospital for DRG 853, which had the second highest average Medicare payment compared to all DRGs.
Graph 3c.
DRG 460 - Spinal Fusion Except Cervical 
This graph shows the total discharges per hospital for DRG 460, which had the third highest average Medicare payment compared to all DRGs.
Graph 3d.
DRG 870 - Septicemia or Severe Sepsis 
This graph shows the total discharges per hospital for DRG 870, which had the fourth highest average Medicare payment compared to all DRGs.
Graph 3e.
DRG 329 - Major Small & Large Bowel Procedures 
This graph shows the total discharge per hospital for DRG 329, which had the fifth highest average Medicare payment compared to all DRGs.
Graph 3f.
DRG 469 - Major Joint Replacement or Reattachment of Lower Extremity 
This graph shows the total discharge per hospital for DRG 469, which had the sixth highest average Medicare payment compared to all other DRGs.
Conclusion
The top 6 highest average total payments and Medicare payments appear to be the same for the following DRGs used by the corresponding hospital: Respiratory System Diagnosis With Ventilator Support, Infectious & Parasitic Diseases With O.R. Procedure, Spinal Fusion Except Cervical, Septicemia or Severe Sepsis, Major Small & Large Bowel Procedures, and Major Joint Replacement or Reattachment of Lower Extremity. The highest average covered charge also appears to be for the Respiratory System Diagnosis with Ventilator Support DRG. However, for this group, there was only one other DRG that made up the top 10 highest averages - Septicemia Or Severe Sepsis. This information can be used to identify certain DRGs that are being coded the most by hospital, by state, and by regions within states. It can also be used to help with financial management of inpatient hospital procedures and assess which procedures are being covered by the IPPS and Medicare.
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Date this report was generated: 2015-06-29 09:49:28.