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

The Vermont Association of Hospitals and Health Systems (VAHHS) collects data on ambulatory surgery and other outpatient services such as observation services and emergency department visits. VAHHS began collecting ambulatory surgery and emergency department data in 1989. Since 2004, their outpatient data collection efforts have expanded to include the following types:

• Ambulatory surgery
  • Beginning 2014, defined only as having revenue center codes in the range of 360-369 (operating room services), 370-379 (anesthesia), or 490-499 (ambulatory surgical care)
  • Prior to 2014, defined as having an International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure code in the range 01.00-86.99 or revenue center codes in the range of 360-369 (operating room services), 370-379 (anesthesia), or 490-499 (ambulatory surgical care)
• Emergency department, defined by revenue codes in the range of 450-459
• Observation services, defined by revenue codes 760 or 762 (starting in 2004)
• Cancelled procedures (starting in 2011).

Beginning in data year 2011, VAHHS has created five separate indicator flags that identify the following:

1. Ambulatory surgery based on ICD-9-CM codes (type A), available only from 2011-2013
2. Ambulatory surgery based on revenue center codes (type AS)
3. Observation services (type O)
4. Cancelled procedures (type cancelled PX)
5. Emergency department visits (type E).

One outpatient record can indicate multiple types of outpatient services.

Outpatient Data File Provided to HCUP by the Partner

VAHHS provides their complete outpatient file to HCUP. Beginning in data year 2011, VAHHS has provided their outpatient and inpatient records in separate data files.

Prior to 2011, VAHHS provided a combined inpatient and outpatient source file to HCUP. Outpatient records for these early files were identified by having a bill type not equal to 111 and 121, which are specific to inpatient services. Any interim records (defined by a bill type of 133 or 853) or erroneous records (defined by the bill type 001) were excluded from any of the HCUP State databases.

Selection of Records for Inclusion in the SASD

The identification of records to include in the SASD varies by data year:

Beginning in 2014, all records marked by VAHHS as ambulatory surgery are included in the SASD (STATE_AS=1 based on indicator flag TYPE_AS).

From 2011 through 2013, STATE_AS was set to 1 based on either the indicator flag TYPE_AS or TYPE_A.

From 2006 through 2010, no outpatient record type indicator was provided by VAHHS. All outpatient records without an indication of ED services based on revenue codes in the range 450-459 were included in the SASD.

Prior to 2006, VHHS included an indication of the type of outpatient record. Records marked by VAHHS as outpatient surgery (type A) were included in the SASD.

In all years, any other nonemergent outpatient records (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

VAHHS collects data on ambulatory surgery and other outpatient services performed in hospital-owned facilities. VAHHS does not collect data from ambulatory surgery facilities that are not owned by a hospital.

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.