This section summarizes adjustments in Medicare rulemaking that effect hospital Medicare revenue. Unless otherwise indicated, all information in this section is based on hospital data contained in the CMS Impact File. This file corresponds to the Final Rule and Correction Notice and contains data elements by provider used in calculating rates and impacts for a federal fiscal year.

Wage Index

The wage index indicates the relative hospital wage level in a geographic area (i.e. a Core-Based Statistical Area) compared to the national average hospital wage level. A hospital may sometimes be reclassified to a different labor market. The wage index is updated annually and is used in determining payment (i.e. the labor portion of the standardized amounts).

DSH Adjustment

The estimated Operating Disproportionate Share Hospital (DSH) adjustment. It reflects a 75% reduction to the DSH adjustment required under Section 3333 of the Affordable Care Act

Capital DSH Adjustment

The Capital Disproportionate Share (DSH) adjustment.

Uncompensated Care per Claim

The Uncompensated Care per Claim Amount is based on a hospital's assigned Uncompensated Care Payment amount divided by a 3 year claims average. The per Claim Amount is used in the determination of outliers and used in to determine if a sole community hospital (SCH) is paid on a hospital specific rate or federal rate on a per claim basis.

Operating IME Adjustment

The Indirect Medical Education (IME) adjustment factor for Operating IPPS.

Capital IME Adjustment

The Indirect Medical Education (IME) adjustment factor for Capital IPPS.

HAC Adjustment

Payment adjustments related to the Hospital-Acquired Conditions (HAC) Reduction Program are obtained from Hospital Compare, a website created through the efforts of CMS along with the Hospital Quality Alliance (HQA). CMS reduces Medicare payments for IPPS hospitals based on the frequency of HACs, a group of reasonably preventable conditions that patients did not have upon admission to a hospital, but which developed during the hospital stay.

Quality Reduction

"Yes" indicates a hospital that was found not to have submitted quality data in the form and manner based in the prior year update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the current market basket index.

EHR Reduction

"Yes" indicates a hospital that was found not to be a meaningful electronic health record (EHR) user for the applicable EHR reporting period and did not receive an exception based on a subsequent update of the Provider Specific File (PSF), and therefore was modeled as receiving a reduction to the percentage increase in the market basket index.