If you have not already, install R Commander by viewing the instructions below? This software is free to download and use and works best with a PC versus a Mac. If you use a Mac, you can find instruc

If you have not already, install R Commander by viewing the instructions below 

This software is free to download and use and works best with a PC versus a Mac. If you use a Mac, you can find instructions inside your textbook. You cannot use a Chromebook.

1. Download the data files found in Appendix B of your White Textbook. These can be found on the student resources website by using the access code provided in either your Vital Source Bookshelf or inside the front cover of your hard copy.

2. Download R Commander. The instructions can be found in Appendix B and is also demonstrated in this video: https://www.youtube.com/watch?v=BveZtZx3QhE

3. Import data files as you need them (you do not need to import all files). These instructions are also in Appendix B.

Part 1 Action Items for Analysis – Categorical Variables

  1. Review the reading materials in Module 3 Preparation. – See Attached file 
  2. Open R.
  3. Type: library(Rcmdr).
  4. Once R Commander opens, go to Data > Import data > from Excel file.
  5. Click ‘OK’ and select the CHF Data.xlsx file
  6. Select the ‘Data’ tab.
  7. Create a frequency distribution for the following variables:
    • Admission Source
    • Gender
    • Discharge Status
    • Age Category
    • Number of Diagnosis Codes
  8. All frequency distributions follow the same steps:
    1. Go to Statistics > Summaries > Frequency distribution
    2. Select variables
      1. Note that some variables may not appear in the list. R will only display categorical variables in the selection window. To let R know that other number variables are actually categories or ‘factors’, go to Data > Manage variables in active data set > Convert numeric variables to factors
      2. Select variables in the listing above (hold the ‘Ctrl’ key to select multiple variables)
      3. Select the ‘Use Numbers’ radio button and click ‘OK’
      4. The variables should now appear in the frequency

Part 2 Action Items for Analysis – Continuous Variables

  1. Review the reading materials in Module 3 Preparation – See Attached file 
  2. Upload the CHF file in R Commander.

Central Tendency

  • Calculate the mean, median and mode LOS.
  • Calculate the mean, median and mode LOS excluding the maximum value.
  • Did the mean, median and mode change more? Why?
  • What do you think is the best statistic to describe the typical:
    • LOS
    • Admission source
    • Gender

Spread

  1. Calculate the variance and range LOS.
  2. Calculate the variance and range LOS excluding the maximum value.
  3. Did the variance and range mean or median change more? Why?
  4. By Sunday, upload your completed assignment.

R Commander Tips

Mean and median

  1. Go to Statistics > Summaries > Numerical Summaries
  2. Select LOS in the Variables window
  3. Click on Statistics and select Mean and Quantiles

Mode – R does not have a built-in function for mode, but the following steps may be used to depict the mode using a bar chart:

  1. Go to Data > Manage variables in active dataset > Convert numeric variables to factors
  2. Select LOS in the Variables window and ‘Use numbers’ as the Factor levels. Use factor_LOS as the new variable name:
    1. Go to Graphs > Bar graph
    2. Select ‘factor_LOS’ in the Variable window
    3. Click ‘OK’

MedPAR Info

MEDPAR 'R2K' Limited Dataset Record Layout
MedPAR consolidates Inpatient Hospital or Skilled Nursing Facility (SNF) claims data from the National Claims History (NCH) files into stay level records.   The accumulation of claims submitted for the period commencing on a beneficiary's date of admission to an inpatient hospital or SNF and ending on the beneficiary’s date of discharge from that hospital or SNF represents one stay.  In the case of a SNF stay where the beneficiary has not yet been discharged and remains a patient, the claims submitted between the admission date to the SNF through the time of the MedPAR file creation, represent one stay. A stay record may represent one or more final action claims. 
NOTE:  Any given MedPAR file represents a static snapshot of a specific stay at the time the data was sourced from NCH.  As such, any given stay record on a specific update of MedPAR DOES NOT NECESSARILY represent the final coding and/or payment information for that stay because if subsequent adjustments to the claims that comprise the stay occur after MedPAR is run, they will not be reflected on the file.

LDS MedPAR

MEDPAR 'R2K' Limited Dataset Record Layout
FIELD POSITION Length DESCRIPTION DERIVATIONS CODE TABLE
NCH Claim Type Code 1 2 2 The code used to identify the type of claim record being processed in NCH. FFS CLAIM TYPE CODES DERIVED FROM: NCH CLM_NEAR_LINE_RIC_CD NCH PMT_EDIT_RIC_CD NCH CLM_TRANS_CD NCH PRVDR_NUM INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (Pre-HDC processing — AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD MCO_PRD_EFCTV_DT MCO_PRD_TRMNTN_DT NCH_CLM_TYPE_TB
Beneficiary Age Count 14 16 3 The beneficiary's age as of date of admission. This field is derived by subtracting the bene date of birth from the admission date, present on the first claim record included in the stay. Exception: If the resulting age is 64, and the MSC = 10 or 11, the age is changed to 65. MEDPAR Beneficiary Age
Beneficiary Sex Code 17 17 1 The sex of a beneficiary. BENE_SEX_IDENT_TB
Beneficiary Race Code 18 18 1 The race of a beneficiary. BENE_RACE_TB
Beneficiary Medicare Status Code 19 20 2 The CWF-derived reason for a beneficiary's entitlement to Medicare benefits, as of the reference date (CLM_THRU_DT). CWF derives MSC from the following: 1. Date of birth 2. Claim through date 3. Original/Current reasons for entitlement 4. ESRD indicator 5. Beneficiary claim number Items 1,3,4,5 come from the CWF beneficiary master record; Item 2 comes from the FI/Carrier claim record. BENE_MDCR_STUS_TB
Beneficiary Residence SSA Standard State Code 21 22 2 The SSA standard state code of a beneficiary's residence. GEO_SSA_STATE_TB
Admission Day Code 35 35 1 The code indicating the day of the week on which the beneficiary was admitted to a facility. This field is derived from the admission date that is present on the first claim record included in the stay. MEDPAR_ADMSN_DAY_TB
Beneficiary Discharge Status Code 36 36 1 The code used to identify the status of the patient as of the CLM_THRU_DT. This field is derived from the claim status code that is present on the last claim record included in the stay. MEDPAR_BENE_DSCHRG_STUS_TB
GHO Paid Code 37 37 1 The code indicating whether or not a GHO has paid the provider for the claim(s). MEDPAR_GHO_PD_TB
PPS Indicator Code 38 38 1 The code indicating whether or not the facility is being paid under the prospective payment system (PPS). If the condition code not equal 65 on all of the claims included in the stay and the third position of the provider number is numeric set MEDPAR_PPS_IND_CD to 2 (PPS). Otherwise set it to 0 (Non PPS.) MEDPAR_PPS_IND_TB
Organization NPI Number 39 48 10 ON AN INSTITUTIONAL CLAIM, THE NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER ASSIGNED TO UNIQUELY IDENTIFY THE INSTITUTIONAL PROVIDER CERTIFIED BY MEDICARE TO PROVIDE SERVICES TO THE BENEFICIARY.
Provider Number Group 49 54 6
Provider State Code 49 50 2 The first two positions of the provider number, identifying the state of the institutional provider that furnished services to the beneficiary during the stay. This field comes from positions 1 & 2 of the provider number that is present on the first claim record included in the stay. GEO_SSA_STATE_TB
Provider Number Third Position Code 51 51 1 The third position of the provider number, identifying the category of institutional provider that furnished services to the beneficiary during the stay. This field is position 3 of the provider number from the first claim record included in the stay modified as follows: Where position 3 is an alpha character (S, T, U, W or Y) move to the MEDPAR provider special unit code and replace with a '0'. Where position 3 is an alpha character (M or R) move to the MEDPAR provider special unit code and replace with a '1'.
Provider Number Serial Code 52 54 3 The last three positions of the provider number, identifying the specific serial numbers of the institutional provider that furnished services to the beneficiary during the stay. This field comes from positions 4 – 6 of the provider number on the first claim record included in the stay.
Provider Number Special Unit Code 55 55 1 The code identifying the special numbering system for units of hospitals that are excluded from PPS or hospitals with SNF swing-bed designation. If the third position of the provider number from the first claim record included in the stay equals 'M', 'R', 'S', 'T', 'U', 'W', 'Y' OR 'Z', it is moved to this field, otherwise it is blank.
Short Stay/Long Stay/SNF Indicator Code 56 56 1 The code indicating whether the stay is a short stay, long stay, or SNF. This field is derived from the third position of the provider number that is present on the first claim record included in the stay.
Stay Final Action Claims Count 57 59 3 The count of the number of claim records (final action) included in the stay. This field is derived by counting the number of final action claims used to create the stay.
Admission Date 88 94 7 The date the beneficiary was admitted for Inpatient care or the date that care started. This field specifies the date of the beneficiary's admission to the institution translated into the quarter of the year in which the admission occurred. Coding Scheme: QYY where: 1YY = First quarter of year; 2YY = Second quarter of yea; 3YY = Third quarter of year; 4YY = Fourth quarter of year
Discharge Date 95 101 7 The date on which the beneficiary was discharged or died. This field specifies the date of the beneficiary's death or discharge from the institution translated into the quarter of the year in which the admission occurred. Coding Scheme: QYY where: 1YY = First quarter of year; 2YY = Second quarter of yea; 3YY = Third quarter of year; 4YY = Fourth quarter of year
Length of Stay Day Count 124 128 5 The count in days of the total length of a beneficiary's stay in a hospital or SNF. This field is derived by subtracting the date of discharge (or thru date in SNF cases where beneficiary is still a patient) from the date of admission. If difference is '0,' the value becomes a '1.'
Outlier Day Count 129 131 3 The count of the number of days paid as outliers (either a day or cost outlier) under PPS beyond the DRG threshold. This field is derived by checking the MEDPAR utilization day count against the DRG threshold table (DRG weights file).
Utilization Day Count 132 136 5 The count of the number of covered days of care that are chargeable to Medicare utilization for the stay. This field is derived by accumulating the utilization day count that is present on any of the claim records included in the stay (i.e., the sum of utilization days reported on the claims that comprise the stay).
Beneficiary Total Coinsurance Day Count 137 139 3 The count of the total number of coinsurance days involved with the beneficiary's stay in a facility. For Inpatient services, the beneficiary is liable for a daily coinsurance amount after the 60th day and before the 91st day in a single spell of illness; for SNF services, the beneficiary is liable for a daily coinsurance amount after the 20th day and before the 101st day in a single spell of illness. This field is derived by accumulating the coinsurance day count that is present on any of the claim records included in the stay (i.e., the sum of coinsurance days reported on the claims that comprise the stay).
Beneficiary LRD Used Count 140 142 3 The count of the number of lifetime reserve days (LRD) used by the beneficiary for this stay. This field is derived by accumulating the lifetime reserve days used count that is present on any of the claim records included in the stay (i.e., the sum of LRD reported on the claims that comprise the stay).
Beneficiary Part A Coinsurance Liability Amount 143 151 9 The amount of money (rounded to whole dollars) identified as the beneficiary's liability for part A coinsurance for the stay.
Beneficiary Inpatient Deductible Liability Amount 152 160 9 The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the Inpatient deductible for the stay.
Beneficiary Blood Deductible Liability Amount 161 169 9 The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the blood deductible for the stay. This field is derived by accumulating the beneficiary blood deductible liability amount that is present on any of the claim records included in the stay (i.e., the sum of the blood deductibles reported on the claims that comprise the stay).
Beneficiary Primary Payer Amount 170 178 9 The amount of payment (rounded to whole dollars) made on behalf of the beneficiary by a primary payer other than Medicare, which has been applied to the covered Medicare charges for the stay. This field is derived by accumulating the beneficiary primary payer payment amount that is present on any of the claim records included in the stay (i.e., the sum of the primary payer amounts reported on the claims that comprise the stay).
DRG Outlier Approved Payment Amount 179 187 9 The amount of additional payment (rounded to whole dollars) approved due to an outlier situation over the DRG allowance for the stay. This field is derived by accumulating the DRG outlier approved payment amount (value code = 17 amount) that is present on any of the claim records included in the stay (i.e., the sum of outlier amounts reported on the claims that comprise the stay).
Inpatient Disproportionate Share Amount 188 196 9 The amount paid over the DRG amount (rounded to whole dollars) for the disproportionate share hospital for the stay. This field is derived by accumulating the value amount associated with value code = 18 that is present on any o the claim records included in the stay (i.e., the sum of value code 18 amounts reported on the claims that comprise the stay).
Indirect Medical Education (IME) Amount 197 205 9 The amount of additional payment (rounded to whole dollars) made to teaching hospitals for IME for the stay. This field is derived by accumulating the value amount associated with value code = 19 that is present on any of the claim records included in the stay (i.e., the sum of IME amounts – value code 19 amounts – reported on the claims that comprise the stay).
DRG Price Amount 206 214 9 The amount (called the 'DRG price' for purposes of MEDPAR analysis) that would have been paid if no deductibles, coinsurance, primary payers, or outliers were involved (rounded to whole dollars). This field is derived by accumulating the following amounts: MEDPAR Medicare payment amount, MEDPAR beneficiary primary payer payment amount, MEDPAR beneficiary coinsurance liability amount, MEDPAR beneficiary Inpatient deductible liability amount, MEDPAR beneficiary blood deductible amount; and then subtracting from the sum the MEDPAR DRG outlier approved payment amount.
Total Pass Through Amount 215 223 9 The total of all claim pass through amounts (rounded to whole dollars) for the stay. This field is derived by multiplying the pass thru per diem amount that is present on the last claim record included in the stay times the MEDPAR utilization day count (the sum of the utilization (covered) days reported on the claims that comprise the stay).
Total PPS Capital Amount 224 232 9 The total amount (rounded to whole dollars) that is payable for capital PPS (e.g., reimbursement for depreciation, rent, certain interest, real estate taxes for hospital buildings/equipment subject to PPS). This field is derived by accumulating the total PPS capital amount that is present on any of the claim records included in the stay (i.e., the sum of total PPS capital amounts reported on the claims that comprise the stay).
Inpatient Low Volume Payment Amount 233 241 9 The amount field used to identify a payment adjustment given to hospitals to account for the higher costs per discharge for low income hospitals under the Inpatient Prospective Payment System (IPPS). This field is derived by accumulating the IP Low Volume Amount that is present on any of the claim records included in the stay (i.e. the sum of the low volume amounts re- ported on the claims that comprise the stay).
Total Charge Amount 242 250 9 The total amount (rounded to whole dollars) of all charges (covered and noncovered) for all services provided to the beneficiary for the stay. This field is derived by accumulating the total charge amount from all claim records included in the stay (i.e. the sum of total charges reported on the claims that comprise the stay).
Total Covered Charge Amount 251 259 9 The portion of the total charges amount (rounded to whole dollars) that is covered by Medicare for the stay. This field is derived by calculating the covered charges from all claim records included in the stay (i.e., subtract the revenue center noncovered charge amount from the revenue center total charge amount for revenue center code = 0001 that is reported on the claims that comprise the stay; sum the results). Exception: if there exists an erroneous condition relative to revenue center code 0001, the calculation will be made for each revenue center code included on the claims that comprise the stay with the results summed to create the total.
Medicare Payment Amount 260 268 9 Amount of payment made from the Medicare trust fund for the services covered by the claim record. Generally, the amount is calculated by the fi; and represents what was paid to the institutional provider, with the exceptions noted below. **Note: in some situations, a negative claim payment amount May be present; e.g., (1) when a beneficiary is charged the full deductible during a short stay and the deductible exceeded the amount Medicare pays; or (2) when a beneficiary is charged a coinsurance amount during a long stay and the coinsurance amount exceeds the amount Medicare pays (most prevalent situation involves psych hospitals who are paid a daily per diem rate no matter what the charges are.) Under ip PPS, Inpatient hospital services are paid based on a predetermined rate per discharge, using the DRG patient classification system and the pricer program. On the ip PPS claim, the payment amount includes the DRG outlier approved payment amount, disproportionate share (since 5/1/86), in- direct medical education (since 10/1/88), total PPS capital (since 10/1/91). It does not include the pass thru amounts (i.e., capital-related costs, direct medical education costs, kidney acquisition costs, bad debts); or any beneficiary-paid amounts (i.e., deductibles and coinsurance); or any other payer reimbursement. Under SNF PPS, SNFs will classify beneficiaries using the patient classification system known as rugs III. For the SNF PPS claim, the SNF pricer will calculate/return the rate for each revenue center line item with revenue center code = '0022'; multiply the rate times the units count; and then sum the amount payable for all lines with revenue center code '0022' to determine the total claim payment amount. Exceptions: For claims involving demos and bba encounter data, the amount reported in this field May not just represent the actual provider payment. For demo ids '01','02','03','04' — claims contain amount paid to the provider, except that special 'differentials' paid outside the normal payment system are not included. For demo ids '05','15' — encounter data 'claims' contain amount Medicare would have paid under ffs, instead of the actual pay- ment to the MCO. For demo ids '06','07','08' — claims contain actual provider payment but represent a special negotiated bundled payment for both part a and part B services. To identify what the conventional provider part a payment would have been, check value code = 'y4'. For bba encounter data (non-demo) — 'claims' contain amount Medicare would have paid under ffs, instead of the actual payment to the bba plan. This field is derived by accumulating the payment amount that is present on all of the claim records included in the stay (i.e, the sum of payment (reimbursement) reported on the claims that comprise the stay).
All Accommodations Total Charge Amount 269 277 9 The total charge amount (rounded to whole dollars) for all accommodations (routine hospital room and board charges for general care, coronary care and/or intensive care units) related to a beneficiary's stay. This field is the sum of MEDPAR private room charge amount, MEDPAR semiprivate room charge amount, MEDPAR ward charge amount, MEDPAR intensive care charge amount, and MEDPAR coronary care charge amount (i.e., the accumulation of the revenue center total charge amount associated with revenue center codes 0100 – 0219 from all claim records included in the stay).
Departmental Total Charge Amount 278 286 9 The total charge amount (rounded to whole dollars) for all ancillary departments (other than routine room and board, CCU, and ICU) related to a beneficiary's stay. This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 0220 – 0999 from all claim records included in the stay (i.e, the sum of charges for all revenue centers other than accommodations 0100 – 0219).
Private Room Day Count 287 289 3 The count of the number of private room days used by the beneficiary for the stay. This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 011x and 014x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9033-9044 series.
Semiprivate Room Day Count 290 292 3 The count of the number of semi-private room days used by the beneficiary for the stay. This field is derived by accumulating the revenue center unit count associated with accommodation revenue ce

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