Identifying cost drivers, inefficiencies, and opportunities for healthcare cost
Dataset Description
This dataset is sourced from the Centers for Medicare and Medicaid Services, the United States federal agency responsible for administering Medicare and Medicaid programs. The data is publicly released as part of healthcare price transparency and hospital quality accountability initiatives.
Direct Source
data.cms.gov
Provider Data Catalog Medicare Hospital Spending by Claim
https://data.cms.gov/provider-data/dataset/nrth-mfg3
Full Official Name
Medicare Hospital Spending by Claim
Published By
Centers for Medicare and Medicaid Services
U.S. Department of Health and Human Services
Washington, D.C., United States
What This Dataset Measures
This dataset measures Medicare spending per episode of care at each U.S. hospital. Spending is broken down by care type and timing relative to hospital admission.
An episode of care represents the full patient journey across three time windows:
Pre admission period covering physician visits, lab tests, and emergency visits
During admission covering inpatient stay, surgery, nursing care, and medications
Post discharge period covering follow up care, rehabilitation, readmissions, and nursing facilities
The dataset compares each hospital’s spending against state and national benchmarks, enabling multi level analysis of cost efficiency.
Dataset Specifications
| Attribute | Detail |
|---|---|
| File Name | Medicare_Hospital_Spending_by_Claim.csv |
| File Format | CSV |
| Total Rows | 63,647 |
| Total Columns | 13 |
| Hospitals Covered | 2,893 |
| Geographic Coverage | All 50 U.S. states and District of Columbia |
| Reporting Period | January 1, 2024 to December 31, 2024 |
| Data Granularity | Hospital level by claim type and care period |
| Cost Metric | Average spending per episode of care |
| Update Frequency | Annual |
| License | Public domain U.S. government data |
Column Descriptions
| Column Name | Data Type | Description |
|---|---|---|
| Facility Name | Text | Name of the hospital |
| Facility ID | Number | Unique CMS identifier |
| State | Text | State abbreviation |
| Period | Text | Care window |
| Claim Type | Text | Type of Medicare service |
| Avg Spndg Per EP Hospital | Number | Average hospital spending |
| Avg Spndg Per EP State | Number | State average spending |
| Avg Spndg Per EP National | Number | National benchmark spending |
| Percent of Spndg Hospital | Percentage | Share of hospital spending |
| Percent of Spndg State | Percentage | Share of state spending |
| Percent of Spndg National | Percentage | Share of national spending |
| Start Date | Date | Start of reporting period |
| End Date | Date | End of reporting period |
Understanding the Period Column
The period column defines when costs occur within the patient journey.
| Period | Time Window | Description | Key Insight |
|---|---|---|---|
| Period 1 Prior to Admission | 1 to 3 days before admission | Physician visits, emergency care, outpatient testing | High cost indicates severe pre admission condition |
| Period 2 During Admission | Hospital stay | Inpatient care including surgery and nursing | Largest cost component |
| Period 3 Post Discharge | 30 days after discharge | Readmissions, rehabilitation, follow up care | Indicates care transition quality |
| Period 4 Complete Episode | Full episode | Total combined cost | Used for benchmarking |
Understanding the Claim Type Column
Claim types represent categories of healthcare services within each period.
| Claim Type | Care Phase | Description | Relative Cost | Key Insight |
|---|---|---|---|---|
| Inpatient | During and Post | Hospital stays and readmissions | Highest | Core cost driver |
| Outpatient | Pre and Post | Same day procedures and emergency visits | Medium | Not present during admission |
| Carrier | All periods | Physician and specialist fees | Medium to high | Present throughout the episode |
| Skilled Nursing Facility | Post only | Nursing facility care after discharge | High | Largest post discharge cost |
| Home Health Agency | Post only | In home care services | Medium | Alternative to facility care |
| Hospice | Post only | End of life care | Low | Small cost share |
| Durable Medical Equipment | Post only | Equipment for home use | Lowest | Minimal cost impact |
Claim Type by Period Matrix
| Claim Type | Pre Admission | During Admission | Post Discharge |
|---|---|---|---|
| Inpatient | Minor | Primary | Readmission |
| Outpatient | Active | None | Active |
| Carrier | Active | Active | Active |
| Skilled Nursing Facility | None | None | Primary |
| Home Health Agency | None | None | Active |
| Hospice | Minor | None | Minor |
| Durable Medical Equipment | Minor | Minor | Active |
Claim Type Summary
| Claim Type | Care Phase | Relative Cost | Key Insight |
|---|---|---|---|
| Inpatient | During and Post | Highest | Main cost driver |
| Outpatient | Pre and Post | Medium | Not active during admission |
| Carrier | All periods | Medium to high | Continuous cost component |
| Skilled Nursing Facility | Post only | High | Major post discharge driver |
| Home Health Agency | Post only | Medium | Substitute for facility care |
| Hospice | Post only | Low | Limited usage |
| Durable Medical Equipment | Post only | Lowest | Minimal impact |
How the Benchmarks Work
- Each row contains three spending values representing different comparison levels.
- Hospital spending reflects the performance of an individual hospital
- State spending reflects the average performance within the state
- National spending represents the overall U.S. benchmark
This structure allows analysis at multiple levels:
- Is the hospital an outlier within its state
- Is the state an outlier nationally
- Is the hospital efficient compared to the entire system
The national benchmark is a fixed reference value for each claim type and period and is repeated across rows.
Related Datasets
-
Medicare Spending By Claim
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