Cost-to-Charge Ratio for Inpatient Files

The HCUP Cost-to-Charge Ratio for Inpatient Files (CCR for Inpatient Files) are hospital-level files designed to supplement the data elements in the SID, NIS, KID, and NRD. HCUP Cost-to-Charge Ratio for Emergency Department Files (CCR for ED Files) are also available. The CCR Files are part of a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. HCUP databases, tools, and software inform decision making at the national, State, and community levels.

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The HCUP Inpatient databases - the SID, NIS, KID, and NRD - contain data on total charges for each hospital discharge in the databases. Charges represents the amount that hospitals billed for services; this differs from costs, or the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility. HCUP total charges exclude professional (physician) fees.

The HCUP CCR for Inpatient Files provide users with ratios that will allow the conversion of the HCUP charges into cost estimates. Each file contains hospital-specific cost-to-charge ratios based on all-payer inpatient cost for nearly every hospital in the corresponding SID, NIS, KID, and NRD. Cost information was obtained from the hospital accounting reports collected by the Centers for Medicare & Medicaid Services (CMS). Some imputations for missing values were necessary.

Users can merge the data elements from the appropriate CCR File onto the corresponding NIS, KID, NRD, or SID by the HCUP hospital identification number (HOSPID, and beginning with the 2012 databases, HOSP_NIS, HOSP_KID, or HOSP_NRD). The cost of inpatient care for a discharge can be estimated by multiplying the HCUP total charges data element (TOTCHG) by the appropriate cost-to-charge ratio.

HCUP CCR for Inpatient Files are designed to be used exclusively with the HCUP NIS, KID, NRD, or SID. The CCR files are unique by year and database.
 
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The HCUP CCR for Inpatient Files are used to estimate the cost of resource use for inpatient hospital stays and its variation across hospitals and conditions based on the reported total charge and the cost ratios provided in the supplemental files. Costs reflect the actual expenses incurred in the production of hospital services, such as wages, supplies, and utility costs; charges represent the amount a hospital billed for the case.

The CCR for Inpatient Files allow researchers to obtain costs using hospital-specific ratios, where provided, or by weighted average ratios for hospitals in peer groups defined by hospital characteristics and state.
 
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The HCUP CCR for Inpatient Files are available for the HCUP inpatient databases beginning with 2001 data. Files for linkage to the following years and types of data are currently available:
  • CCR for Central Distributor SID: 2001 to 2018
  • CCR for NIS: 2001 to 2017
  • CCR for KID: 2003, 2006, 2009, 2012, 2016
  • CCR for NRD: 2010 to 2017
The 2010 CCR-NIS and CCR-SID were revised in August 2013.

 
Previous Versions of CCR Files

  • 2010 CCR Files Two versions of the 2010 CCR for Inpatient Files were released: an initial version in August 2012; and a revised version 2 in August 2013.

    Cost estimates using the initial August 2012 file may differ somewhat from estimates generated with the revised file. The initial version contained usable accounting reports for about 61% of HCUP hospitals. The revised 2010 CCR for Inpatient File contains usable 2010 accounting reports for 89% of HCUP hospitals. For hospitals with no usable report in each version, the CCR was imputed from a weighted average for a peer group within the state (GAPICC). For hospitals that were missing accounting reports in the initial files, the APICC was calculated from the updated reports. In addition, several HCUP states had a particularly high proportion of hospitals with missing reports in the initial version, which results in a smaller number of hospitals used for imputation. GAPICC was recalculated using the updated weighted average for a peer group within the state. Additional information is provided in the CCR User Guides for the 2010 NIS and SID.
 
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The HCUP CCR for Inpatient Files are available in ASCII comma-separated values (CSV) format. The NIS, KID, NRD, and SID files require a statistical software package such as SAS, SPSS, or Stata to use for analytic purposes.
 
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The User Guides for the HCUP CCR for Inpatient Files contain:
  • A more detailed description of the file's purpose, usage, and format
  • Instructions for linking the files to the NIS, KID, NRD, or SID
  • A summary of State participation
  • A description of internal validation methods
  • Descriptions of key data elements
User Guides for CCR for Inpatient Files
 
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HCUP CCR for Inpatient Files are provided as separate files available with the HCUP Central Distributor SID, NIS, KID, and NRD. These supplemental files are available free of charge from the HCUP Central Distributor.

The CCR for Inpatient Files are provided as complimentary files that are automatically included with download orders for the NIS, KID, and NRD databases. The CCR files for the SID can be added to an order for the accompanying SID - they are not automatically included with the order.
 
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Internet Citation: Cost-to-Charge Ratio for Inpatient Files. Healthcare Cost and Utilization Project (HCUP). August 2020. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/ccr/ip-ccr/ip-ccr.jsp.
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Last modified 8/3/20