Types of Ambulatory Surgery and Other Outpatient Services Collected by the Partner

The Maryland Health Services Cost Review Commission (HSCRC) collects data on ambulatory surgery and other outpatient services such as outpatient clinic and emergency department visits. HSCRC uses the following hierarchy to identify each outpatient record with an encounter type:

• Clinic services (value 01)
• Emergency services (value 02)
• Labor and delivery (value 03)
• Outpatient surgery (value 04)
• All other outpatient (value 05)
• Greenbaum Cancer Center (value 80) (valid from 2007-2011)
• University of Maryland Medical Center Shock Trauma (81) (valid from 2007-2011)

Facilities reporting data to HSCRC assign an encounter type to the outpatient record based on the rate center code on the record. A rate center code is an HSCRC code that identifies the rate center to which the related revenue center code and charges are mapped. Because of the hierarchical assignment for the encounter type, an outpatient encounter that involved ambulatory surgery and emergency services is only flagged as emergency services.

Outpatient Data File Provided to HCUP by the Partner

Beginning in 2007, HSCRC has provided their complete outpatient file to HCUP with the type of outpatient service identified by encounter type. The encounter type is stored in the HCUP data element OPservice.

Prior to 2007, Maryland only included outpatient records with encounter types 01-04 in the file provided to HCUP.

Selection of Records for Inclusion in the SASD

All records identified by HSCRC as ambulatory surgery are included in the SASD (STATE_AS=1 based on encounter type value 04. Any other nonemergent outpatient services (STATE_ED not equal to 1) also are included in the SASD.

Additionally, any record in the SASD that also have evidence of ED services based on the HCUP criteria (HCUP data element HCUP_ED > 0), are also included in the HCUP State Emergency Department Databases (SEDD). These records will have the same value for the HCUP data element KEY.

Types of Facilities Included in the Files Provided to HCUP by the Partner

HSCRC has been setting hospital rates in Maryland since 1974. All payers pay Maryland hospitals on the basis of the rates established by the HSCRC. The Commission's rate-setting authority applies to acute general, specialty, and private psychiatric hospitals in the State. The HSCRC's rate regulatory authority applies to inpatient services and outpatient and emergency services at a hospital. HSCRC collects data from facilities owned by these hospitals, whether they are physically attached to the hospital or stand-alone facilities. HSCRC does not collect information from nonregulated facilities or nonregulated areas (e.g., dialysis) of Maryland hospitals. In addition, HSCRC does not collect information from nonhospital-owned facilities.

Identification of Hospital-Owned Ambulatory Surgery and Other Types of Outpatient Facilities in the SASD

The designation of a facility as hospital-owned is specific to its financial relationship with a hospital that provides inpatient care and not related to its physical location. Hospital-owned ambulatory surgery and other outpatient care facilities may be contained within the hospital, physically attached to the hospital, or located in a different geographic area. The designation as hospital-owned means that HCUP can identify that the hospital is billing for this service.

Starting in data year 2018, the HCUP data element HOSPITAL_OWNED can be used to identify hospital-owned facilities with ambulatory surgery and possibly other outpatient care data in the SASD. A facility is considered hospital-owned (HOSPITAL_OWNED = 1) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (HOSPITAL_OWNED = 0). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with HOSPITAL_OWNED=0 are hospital-owned.

From data year 1998-2018, the HCUP data element was called FREESTANDING. A facility is considered hospital-owned (FREESTANDING = 0) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (FREESTANDING = 1). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with FREESTANDING=1 are hospital-owned.

Exclusion of Records During HCUP Processing

Beginning with 2016 data, records with a discharge disposition of "still a patient" are retained in the HCUP SASD. Prior to 2016 data, these records were excluded.

Beginning in 2010, records with a designation of "admitted as an inpatient" are retained in the SASD, even though this rarely occurs. Prior to 2010, records with a designation of "admitted as an inpatient" were excluded from the files.

Additional SASD Notes

As of July 17, 2019, skinny files containing the patient's ZIP Code (HCUP data element ZIP) are available for the Central Distributor SASD for data years 2008 through 2017. Users can link the year-specific skinny ZIP Code files to the same year Core file by using data elements YEAR and KEY. Starting in data year 2018, the data element ZIP is stored on the Core file.