The Healthcare Cost and Utilization Project (HCUP, pronounced "H-Cup") is a family of healthcare databases and related software tools and products from the United States that is developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality (AHRQ).
HCUP provides access to healthcare databases for research and policy analysis, as well as tools and products to enhance the capabilities of the data. HCUP databases combine the data collection efforts of State data organizations, hospital associations, private data organizations, and the Federal Government to create a national information resource of patient-level healthcare data. State organizations that provide data to HCUP are called Partners. HCUP includes multiyear hospital administrative (inpatient, outpatient, and emergency department) data in the United States, with all-payer, encounter-level information beginning in 1988. These databases enable research on health and policy issues at the national, State, and local levels, including cost and quality of health services, medical practice patterns, access to healthcare, and outcomes of treatments. AHRQ has also developed a set of software tools to be used when evaluating hospital data. These software tools can be used with the HCUP databases and with other administrative databases. HCUP’s Supplemental Files are only for use with HCUP databases. HCUP databases have been used in various studies on a number of topics, such as breast cancer, depression, and multimorbidity, incidence and cost of injuries, role of socioeconomic status in patients leaving against medical advice, multiple chronic conditions and disparities in readmissions, and hospitalization costs for cystic fibrosis.
The HCUP User Support website is the main repository of information for HCUP. It is designed to answer HCUP-related questions; provide detailed information on HCUP databases, tools, and products; and offer technical assistance to HCUP users. HCUP’s tools, publications, documentation, news, services, HCUP Fast Stats, and HCUPnet (the online data query system) may all be accessed through HCUP-US. HCUP-US is located at https://www.hcup-us.ahrq.gov.
HCUP has developed an interactive online course that provides an overview of the features, capabilities, and potential uses of HCUP. The course is modular, so users can either move through the entire course or access the resources in which they are most interested. The On-line HCUP Overview Course (https://www.hcup-us.ahrq.gov/overviewcourse.jsp) can work both as an introduction to HCUP data and tools and a refresher for established users.
The HCUP Online Tutorial Series (https://www.hcup-us.ahrq.gov/tech_assist/tutorials.jsp) is a set of interactive training courses that provide HCUP data users with information about HCUP data and tools, and training on technical methods for conducting research with HCUP data. The online courses are modular, so users can move through an entire course or access the sections in which they are most interested. Topics include loading and checking HCUP data, understanding HCUP’s sampling design, calculating standard errors, producing national estimates, conducting multiyear analysis, and using the Nationwide Readmissions Database (NRD).
HCUP databases bring together data from State data organizations, hospital associations, private data organizations, and the Federal Government to create an information resource of patient-level healthcare data. HCUP’s databases (https://www.hcup-us.ahrq.gov/databases.jsp) date back to 1988 data files. The databases contain encounter-level information for all payers compiled in a uniform format with privacy protections in place. Researchers and policymakers can use the records to identify, track, and analyze national trends in healthcare use, access, charges, quality, and outcomes. HCUP databases are released approximately 6 to 18 months after the end of a given calendar year, with State databases available earlier than the national or nationwide datasets. Currently, there are eight types of HCUP databases: four with national- and regional-level data and three with State- and local-level data.
HCUP provides a number of tools and software programs that can be applied to HCUP and other similar administrative databases.
HCUPnet (https://hcupnet.ahrq.gov/) is an online query system that provides healthcare statistics and information from the HCUP national (NIS, NEDS, KID, and NRD) and State (SID, SASD, and SEDD) databases for those States that have agreed to participate. HCUPnet can be used for identifying, tracking, analyzing, and comparing statistics on hospital inpatient stays, emergency care, and ambulatory surgery, as well as obtaining measures of quality-based information from the AHRQ Quality Indicators. Select statistics are available at a national- and county-level. HCUPnet can also be used for trend analysis with healthcare data available from 1993 forward. HCUPnet also includes a feature called hospital readmissions that provides users with some statistics on hospital readmissions within 7 and 30 days of hospital discharge.
HCUP Fast Stats (https://www.hcup-us.ahrq.gov/faststats/landing.jsp) is a web-based tool that provides easy access to the latest HCUP-based statistics for healthcare information topics. HCUP Fast Stats uses visual statistical displays in standalone graphs, trend figures, or simple tables to convey complex information at a glance. Fast Stats topics are updated regularly (quarterly or annually, as newer data become available) for timely, topic-specific national and State-level statistics.
The following topics are available:
The HCUP software can be applied to HCUP databases, to systematically create new data elements from existing data, thereby enhancing a researcher's ability to conduct analyses. While designed to be used with HCUP databases, the analytic tools may be applied to other administrative databases.
The Clinical Classifications Software (CCS) provides a method for classifying diagnoses or procedures into clinically meaningful categories. These can be used for aggregate statistical reporting of a variety of topics, such as identifying populations for disease- or procedure-specific studies or developing statistical reports providing information (i.e., charges and length of stay) about relatively specific conditions. Four versions of the CCS Software are available:
The CCS versions and their user guides are available for download from the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
The Chronic Condition Indicator (CCI) facilitates health services research on diagnoses using administrative data. The CCI tools categorize ICD-9-CM/ICD-10-CM diagnoses codes into two classifications: chronic or not chronic. A chronic condition is defined as a condition that lasts 12 months or longer and meets one or both of the following tests: (a) it places limitations on self-care, independent living, and social interactions; and (b) it results in the need for ongoing intervention with medical products, services, and special equipment.
Two versions of the CCI software are available, CCI for ICD-9-CM and CCI for ICD-10-CM (beta version). The ICD-9-CM CCI was updated annually and is valid for codes from January 1, 1980, through September 20, 2015. The ICD-10-CM CCI is updated annually and is valid for codes from October 1, 2015, forward. The CCI Software is available for download on the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
Elixhauser Comorbidity Software assigns variables that identify comorbidities in hospital discharge records using ICD-9-CM or ICD-10-CM diagnosis coding. Two versions of the Elixhauser Comorbidity Software are available: Elixhauser Comorbidity Software for ICD-10-CM (beta version) and Elixhauser Comorbidity Software for ICD-9-CM. The Elixhauser Software for ICD-9-CM was updated annually from January 1, 1980, through September 30, 2015. The Elixhauser Comorbidity Software for ICD-10-CM (beta version) is updated annually and based on the ICD-10-CM and MS-DRG codes that are valid through September 30 of the designated fiscal year after October 1, 2015. The Elixhauser Comorbidity Software is available for download on the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
Procedure Classes facilitate research on hospital services using administrative data by identifying whether an ICD-9-CM or ICD-10-CM procedure is (a) diagnostic or therapeutic, and (b) minor or major in terms of invasiveness and/or resource use. There are two versions of Procedure Classes tools, Procedure Classes for ICD-9-CM and Procedure Classes for ICD-10-PCS (beta version). The Procedure Classes can be used to categorize procedure codes into one of four broad categories: minor diagnostic, minor therapeutic, major diagnostic, and major therapeutic.
The Procedure Classes for ICD-9-CM were updated annually from January 1, 1980, through September 30, 2015. The Procedure Classes for ICD-10-PCS (beta version) are updated annually and valid for codes from October 1, 2015, forward. Procedure Classes are available for download from the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
Utilization Flags combine information from Uniform Billing (UB-04) revenue codes and ICD-9-CM or ICD-10-PCS procedure codes to create flags—or indicators—of utilization of services rendered in healthcare settings such as hospitals, emergency departments, and ambulatory surgery centers. The Utilization Flags can be used to study a broad range of services, including simple diagnostic tests and resource-intense procedures, such as use of intensive care units. They can also be used to more reliably examine utilization of diagnostic and therapeutic services. There are two types of Utilization Flags, Utilization Flags for ICD-9-CM and Utilization Flags for ICD-10-CM/PCS (beta version). The Utilization Flags for ICD-9-CM were updated annually from January 1, 2003, through September 30, 2015. The Utilization Flags for ICD-10-CM/PCS (beta version) are updated annually and valid for codes from October 1, 2015, forward. The Utilization Flags are available for download from the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
Surgery Flag Software classifies procedures and encounters in ICD-9-CM or CPT-based inpatient and ambulatory surgery into two types of surgical categories: NARROW and BROAD. NARROW surgery is based on a narrow, targeted, and restrictive definition and includes invasive surgical procedures. An invasive therapeutic surgical procedure involves incision, excision, manipulation, or suturing of tissue that penetrates or breaks the skin; typically requires use of an operating room; and requires regional anesthesia, general anesthesia, or sedation to control pain. BROAD surgery includes procedures that fall under the NARROW category but adds less invasive therapeutic surgeries and diagnostic procedures often performed in surgical settings. Users must agree to a license agreement with the American Medical Association to use the Surgery Flags before accessing the software. The Surgery Flags are available for download from the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
The AHRQ Quality Indicators (QIs) (https://www.qualityindicators.ahrq.gov/) are standardized, evidence-based measures of healthcare quality that can be used with readily available hospital inpatient administrative data to measure and track clinical performance and outcomes. The AHRQ QIs consist of four modules measuring various aspects of quality:
The HCUP Supplemental Files augment applicable HCUP databases with additional data elements or analytically useful information that is not available when the HCUP databases are originally released. They cannot be used with other administrative databases. The HCUP Supplemental Files are available for download from the HCUP-US website: https://www.hcup-us.ahrq.gov/tools_software.jsp.
The Cost-to-Charge Ratio (CCR) Files (https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp) are hospital-level files designed to convert the hospital total charge data to total cost estimates for services when merged with data elements exclusively in the HCUP NIS, KID, NRD, and SID. HCUP databases are limited to information on total hospital charges, which reflect the amount billed to the payer per patient encounter. Total charges do not reflect the actual cost of providing care or the payment received by the hospital for services provided. This total charge data can be converted into cost estimates using the CCR Files, which include hospital-wide values of the all-payer inpatient cost-to-charge ratio for nearly every hospital in the participating NIS, KID, NRD, and SID. The CCR Files are updated annually and available for the HCUP inpatient databases beginning with 2001 data. CCR Files for use with the HCUP emergency department databases (NEDS and SEDD) are under development.
The Hospital Market Structure (HMS) Files (https://www.hcup-us.ahrq.gov/toolssoftware/hms/hms.jsp) are hospital-level files designed to supplement the data elements in the NIS, KID, and SID databases. The HMS Files contain various measures of hospital market competition. Hospital market definitions were based on hospital locations, and in some cases, patient ZIP Codes. Hospital locations were obtained from the American Hospital Association (AHA) Annual Survey Database, Area Resource File (ARF), HCUP Historical Urban/Rural – County (HURC) file, and ArcView GIS. Patient ZIP Codes were obtained from the SID.
HMS Files are useful for performing empirical analyses that examine the effects of hospital competition on the cost, access, and quality of hospital services. The HCUP HMS Files are available for the 1997, 2000, 2003, 2006, and 2009 data years.
The HCUP Supplemental Variables for Revisit Analyses (https://www.hcup-us.ahrq.gov/toolssoftware/revisit/revisit.jsp) allow users to track sequential visits for a patient within a State and across facilities and hospital settings (inpatient, emergency department, and ambulatory surgery) while adhering to strict privacy guidelines. Users can use the available clinical information to determine if sequential visits are unrelated, an expected followup, complications from a previous treatment, or an unexpected revisit or rehospitalization. The supplemental files must be merged with the corresponding SID, SASD, or SEDD for any analysis. Beginning with 2009 data, the revisit variables are included in the Core file of the HCUP State Databases when possible.
The NIS-Trends (https://www.hcup-us.ahrq.gov/db/nation/nis/nistrends.jsp) and KID-Trends (https://www.hcup-us.ahrq.gov/db/nation/kid/kidtrends.jsp) files are available to help researchers conduct longitudinal analyses. They are discharge-level files that provide researchers with the trend weights and, in the case of the NIS-Trends, data elements that are consistently defined across data years.
The American Hospital Association (AHA) Linkage Files (https://www.hcup-us.ahrq.gov/db/state/ahalinkage/aha_linkage.jsp) are hospital-level files that contain a small number of data elements that allow researchers to supplement the HCUP State Databases with information from the AHA Annual Survey Databases (https://www.ahadata.com/aha-annual-survey-database). The files are designed to support richer empirical analysis where hospital characteristics may be important factors. Linkage is only possible in States that allow the release of hospital identifiers and are unique by State and year.
HCUP produces material to report new findings based on HCUP data and to announce HCUP news.
The International Classification of Diseases (ICD) is a globally used diagnostic tool for epidemiology, health management and clinical purposes. The ICD is maintained by the World Health Organization (WHO), which is the directing and coordinating authority for health within the United Nations System. The ICD is originally designed as a health care classification system, providing a system of diagnostic codes for classifying diseases, including nuanced classifications of a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or disease. This system is designed to map health conditions to corresponding generic categories together with specific variations, assigning for these a designated code, up to six characters long. Thus, major categories are designed to include a set of similar diseases.
Surgery is a medical or dental specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pathological condition such as a disease or injury, to help improve bodily function, appearance, or to repair unwanted ruptured areas.
Diagnosis-related group (DRG) is a system to classify hospital cases into one of originally 467 groups, with the last group being "Ungroupable". This system of classification was developed as a collaborative project by Robert B Fetter, PhD, of the Yale School of Management, and John D. Thompson, MPH, of the Yale School of Public Health. The system is also referred to as "the DRGs", and its intent was to identify the "products" that a hospital provides. One example of a "product" is an appendectomy. The system was developed in anticipation of convincing Congress to use it for reimbursement, to replace "cost based" reimbursement that had been used up to that point. DRGs are assigned by a "grouper" program based on ICD diagnoses, procedures, age, sex, discharge status, and the presence of complications or comorbidities. DRGs have been used in the US since 1982 to determine how much Medicare pays the hospital for each "product", since patients within each category are clinically similar and are expected to use the same level of hospital resources. DRGs may be further grouped into Major Diagnostic Categories (MDCs). DRGs are also standard practice for establishing reimbursements for other Medicare related reimbursements such as to home healthcare providers.
Case mix, also casemix and patient mix, is a term used within healthcare as a synonym for cohort; essentially, a case mix groups statistically related patients. An example case mix might be male patients under the age of 50, who present with a myocardial infarction and also undergo emergency coronary artery bypass surgery.
Medical billing is a payment practice within the United States health system. The process involves a healthcare provider obtaining insurance information from a patient, filing a claim, following up on, and appealing claims with health insurance companies in order to receive payment for services rendered; such as testing, treatments, and procedures. The same process is used for most insurance companies, whether they are private companies or government sponsored programs: Medical coding reports what the diagnosis and treatment were, and prices are applied accordingly. Medical billers are encouraged, but not required by law, to become certified by taking an exam such as the CMRS Exam, RHIA Exam, CPB Exam and others. Certification schools are intended to provide a theoretical grounding for students entering the medical billing field. Some community colleges in the United States offer certificates, or even associate degrees, in the field. Those seeking advancement may be cross-trained in medical coding or transcription or auditing, and may earn a bachelor's or graduate degree in medical information science and technology.
A children's hospital is a hospital that offers its services exclusively to infants, children, adolescents, and young adults. In certain special cases, they may also treat adults. The number of children's hospitals proliferated in the 20th century, as pediatric medical and surgical specialties separated from internal medicine and adult surgical specialties.
A medical classification is used to transform descriptions of medical diagnoses or procedures into standardized statistical code in a process known as clinical coding. Diagnosis classifications list diagnosis codes, which are used to track diseases and other health conditions, inclusive of chronic diseases such as diabetes mellitus and heart disease, and infectious diseases such as norovirus, the flu, and athlete's foot. Procedure classifications list procedure code, which are used to capture interventional data. These diagnosis and procedure codes are used by health care providers, government health programs, private health insurance companies, workers' compensation carriers, software developers, and others for a variety of applications in medicine, public health and medical informatics, including:
Medical practice management software (PMS) is a category of healthcare software that deals with the day-to-day operations of a medical practice including veterinarians. Such software frequently allows users to capture patient demographics, schedule appointments, maintain lists of insurance payors, perform billing tasks, and generate reports.
The Agency for Healthcare Research and Quality is one of twelve agencies within the United States Department of Health and Human Services (HHS). The agency is headquartered in North Bethesda, Maryland, a suburb of Washington, D.C.. It was established as the Agency for Health Care Policy and Research (AHCPR) in 1989 as a constituent unit of the Public Health Service (PHS) to enhance the quality, appropriateness, and effectiveness of health care services and access to care by conducting and supporting research, demonstration projects, and evaluations; developing guidelines; and disseminating information on health care services and delivery systems.
The Current Procedural Terminology (CPT) code set is a procedural code set developed by the American Medical Association (AMA). It is maintained by the CPT Editorial Panel. The CPT code set describes medical, surgical, and diagnostic services and is designed to communicate uniform information about medical services and procedures among physicians, coders, patients, accreditation organizations, and payers for administrative, financial, and analytical purposes. New editions are released each October, with CPT 2021 being in use since October 2021. It is available in both a standard edition and a professional edition.
Outpatient surgery, also known as ambulatory surgery, day surgery, day case surgery, or same-day surgery, is surgery that does not require an overnight hospital stay. The term “outpatient” arises from the fact that surgery patients may enter and leave the facility on the same day. The advantages of outpatient surgery over inpatient surgery include greater convenience and reduced costs.
A patient safety organization (PSO) is a group, institution, or association that improves medical care by reducing medical errors. Common functions of patient safety organizations are data collection and analysis, reporting, education, funding, and advocacy.
ICD-10 is the 10th revision of the International Statistical Classification of Diseases and Related Health Problems (ICD), a medical classification list by the World Health Organization (WHO). It contains codes for diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases. Work on ICD-10 began in 1983, became endorsed by the Forty-third World Health Assembly in 1990, and was first used by member states in 1994. It was replaced by ICD-11 on January 1, 2022.
Inpatient care is the care of patients whose condition requires admission to a hospital. Progress in modern medicine and the advent of comprehensive out-patient clinics ensure that patients are only admitted to a hospital when they are extremely ill or have severe physical trauma.
Health information technology (HIT) is health technology, particularly information technology, applied to health and health care. It supports health information management across computerized systems and the secure exchange of health information between consumers, providers, payers, and quality monitors. Based on an often-cited 2008 report on a small series of studies conducted at four sites that provide ambulatory care – three U.S. medical centers and one in the Netherlands – the use of electronic health records (EHRs) was viewed as the most promising tool for improving the overall quality, safety and efficiency of the health delivery system.
The Veterans Health Information Systems and Technology Architecture (VISTA) is a health information system deployed across all veteran care sites in the United States. VISTA provides clinical, administrative, and financial functions for all of the 1700+ hospitals and clinics of the Veterans Health Administration VISTA consists of 180 clinical, financial, and administrative applications integrated within a single transactional database.
ECRI is an independent nonprofit organization improving the safety, quality, and cost-effectiveness of care across all healthcare settings worldwide.
The Medical Expenditure Panel Survey (MEPS) is a family of surveys intended to provide nationally representative estimates of health expenditure, utilization, payment sources, health status, and health insurance coverage among the noninstitutionalized, nonmilitary population of the United States. This series of government-produced data sets can be used to examine how individuals interact with the medical care system in the United States.
In the United States, the chargemaster, also known as charge master, or charge description master (CDM), is a comprehensive listing of items billable to a hospital patient or a patient's health insurance provider. In practice, it usually contains highly inflated prices at several times that of actual costs to the hospital. The chargemaster typically serves as the starting point for negotiations with patients and health insurance providers of what amount of money will actually be paid to the hospital. It is described as "the central mechanism of the revenue cycle" of a hospital.
Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.