Number 57 n September 27, 2012

Comparability Between the Rates for All-listed
 

Inpatient Procedures Using National Hospital
 

Discharge Survey and Medicare Claims, 1999 and 2007
 by Yelena Gorina, M.S., M.P.H., Office of Analysis and Epidemiology; Maria Owings, Ph.D., Division of Health Care

Statistics; Nazik Elgaddal, M.S.; and Julie Weeks, Ph.D., Office of Analysis and Epidemiology

Abstract

Objectives—This report examines the comparability between the rates of

inpatient procedures for persons aged 65 and over using the National Hospital

Discharge Survey (NHDS) and Medicare claims data.

Methods—The estimates in this report are based on data from NHDS and

Medicare claims submitted by hospital providers for inpatient stays among Part A

fee-for-service Medicare beneficiaries aged 65 and over. The discharge rates,

selected procedures rates, and comparability ratios are reported for older men and

women, by age and sex, for 1999 and 2007.

Results—Between 1999 and 2007, observed decreases in discharge rates and

in all-listed procedure rates derived from NHDS were not significant, while

Medicare discharge rates decreased and procedure rates increased significantly. In

1999 and 2007, no statistically significant differences were found between NHDS

and Medicare estimates for discharge rates in the age-sex groups examined

except for those aged 85 and over. In both years, the comparability ratios

between Medicare and NHDS procedure rates were significantly different from

one for about 50% of selected procedures, and ranged from 1.12 to 1.26 in 1999

and from 1.16 to 1.41 in 2007. This reflects more procedures recorded in 1999

and 2007 in Medicare data per discharge. The comparability ratio was higher for

most of the cardiac procedures, and in general, was closer to one when fewer

procedures were performed per discharge and for procedures with lower

utilization rates.

Keywords: Centers for Medicare & Medicaid Services • administrative data

Introduction

The use of medical procedures

among older Americans has changed

markedly over the past decade.

Advances in anesthesia, new

developments in medical technologies,

improvements in patient safety, and

changes in settings where procedures are

performed, have contributed to increased

use among older patients. These trends

are evident in the rapidly increasing

number of surgeries performed in

ambulatory settings (1,2) with inpatient

operations generally reserved for more

complex procedures and for patients

with serious comorbid conditions who

are more likely to require postoperative

hospitalization (3–6).

Since 1965, the National Hospital

Discharge Survey (NHDS) has provided

data on trends in rates of major

procedures (up to four procedures per

discharge) performed in nonfederal

short-term hospitals in the United States

(7,8). In 2007, more than one-third of

all procedures and one-half of

operations on the cardiovascular and

digestive systems in these hospitals were

performed on inpatients aged 65 and

over (9). Medicare Part A covers

inpatient services for about 98% of the

U.S. population aged 65 and over (10)

and currently, researchers use Medicare

claims data for analysis of selected

procedures performed on Medicare

beneficiaries (11–13).

The purpose of this report is to help

researchers to compare long-term trends

using NHDS and Medicare claims data.

It reviews methods for calculating

procedure rates using these two data

sources and discusses benefits and

limitations for both of these approaches.

The report compares selected procedure

rates in 1999 and 2007 and presents the

comparability ratios for the 1999 and

2007 rates.

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES 

Centers for Disease Control and Prevention 

National Center for Health Statistics 
Page 2 National Health Statistics Reports n Number 57 n September 27, 2012

Data Sources

National Hospital Discharge

Survey

NHDS is a national probability

survey designed to meet the need for

information on characteristics of

inpatients discharged from nonfederal

short-stay hospitals in the United States.

NHDS has been conducted by the

Centers for Disease Control and

Prevention’s National Center for Health

Statistics (NCHS) annually since 1965

and collects medical and demographic

information on a sample of discharges

from about 500 sampled hospitals.

The current NHDS sampling frame

covers hospitals with an average length

of stay of less than 30 days for all

patients, as well as general hospitals and

children’s general hospitals regardless of

average length of stay. Federal, military,

and U.S. Department of Veterans Affairs

(VA) hospitals are excluded, as are

hospital units of institutions, such as

prison hospitals, and hospitals with

fewer than six beds staffed for inpatient

use. Hospitals specializing in psychiatric

care or rehabilitation are included in the

NHDS sample frame provided that their

average length of stay is less than 30

days. State, local, county, and other

nonfederal government hospitals are also

included.

Data are collected either manually,

by transcription from the face sheet of

the medical record, or from electronic

medical records transmitted directly to

NCHS by commercial organizations,

state data systems, or the hospitals

themselves. Up to four procedures per

sampled discharge are coded using the

International Classification of Diseases,

9th Revision, Clinical Modification

(ICD–9–CM). Because NHDS is based

on a sample, the survey data must be

inflated or weighted to produce national

estimates. The estimation procedure

produces unbiased national estimates

and has three basic components:

inflation by reciprocals of the

probabilities of sample selection,

adjustment for nonresponse, and

population weighting ratio adjustments

(9). The survey samples discharges, not

patients, thus it is possible for some

patients who have multiple

hospitalizations in a given year to be

sampled more than once; however, it is

not possible to link these records

because NHDS does not collect any

personally identifying information.

Estimates reported here are for all-listed

procedure categories, which include all

occurrences of the procedures recorded

in NHDS regardless of the order in the

medical record.

This report presents NHDS data for

persons aged 65 and over at the time of

the admission. According to NHDS, in

2007 this group accounted for 37% of

the 34.4 million discharges (excluding

newborns) from nonfederal short-stay

hospitals (9).

NHDS rates are based on the U.S.

civilian population (Table 1). Rates are

computed for 1999 using civilian

population intercensal estimates for July

1, 1999, based on 1990 and 2000 census

data, and for 2007 using postcensal

estimates for July 1, 2007, based on the

2000 census.

Researchers may refer to the NHDS

website for more information on survey

methods and access to data: http://

www.cdc.gov/nchs/nhds.htm.

Medicare claims data

Medicare is the primary health

insurance program covering persons

aged 65 and over, persons under age 65

with certain disabilities, and persons of

all ages with end-stage renal disease

(ESRD). Nearly all Medicare

beneficiaries receive Part A (hospital

insurance) benefits, which helps cover

the costs of inpatient hospital care,

skilled nursing facility stays (not

custodial), and home health and hospice

care; however, the Centers for Medicare

& Medicaid Services (CMS) receive and

collect only claims submitted by health

care providers for services rendered for

fee-for-service (FFS) beneficiaries.

Medicare Part A FFS beneficiaries aged

65 and over account for about 80% of

the Medicare enrollment and U.S.

population in this age group.

This report presents estimates

derived from CMS’ 5% sample of

Medicare beneficiaries, which is a

sample of beneficiaries with 05, 20, 45,

70, or 95 in a specific position of their

unique Medicare identification number.

Demographic and enrollment data from

the Beneficiary Summary File (also

called the Denominator File) and the

core records for the inpatient claims in

the Part A Inpatient Base Claim file

were used. Both files are received

annually from CMS’ Research Data

Assistance Center (ResDAC, http://

www.resdac.org) as a part of the

interagency agreement between NCHS

and CMS.

The Beneficiary Summary File

contains data for all beneficiaries in the

5% sample who are alive and eligible

for Medicare for any part of a calendar

year. The data include information on

months with Medicare Part A coverage,

whether the beneficiary was enrolled in

a FFS Medicare or a Medicare

Advantage plan, the beneficiary’s age at

the end of the calendar year, and the

beneficiary’s place of residence. In

2007, 36.6 million persons aged 65 and

over were enrolled in Part A Medicare

for at least 1 month in a year, a 9%

increase from 33.5 million in 1999 (14).

The Part A inpatient file consists of

claims submitted to CMS by Medicarecertified hospitals for costs incurred by

the facility during inpatient stays by

beneficiaries enrolled in FFS Medicare.

The data in the inpatient base file

include the identifiers for the beneficiary

and provider (hospital), dates of service,

discharge date, ICD–9 diagnosis and

procedure codes, Diagnosis Related

Group (DRG) information, facility

charges, and Medicare reimbursement

amount. A system of payment for the

inpatient stays under Medicare Part A is

based on prospectively set rates with

each case categorized into a DRG (15).

Hospitals and other providers are

required by law to file Medicare claims

for covered services and supplies

received by Medicare beneficiaries but

may exclude procedures not covered by

Medicare (e.g., bariatric surgery prior to

2006). Adjustments to the DRG

classification are made annually and as

Medicare expands its coverage to new

inpatient procedures, these procedures

must be mentioned on the claims (e.g.,

bariatric surgery since 2006). In both

1999 and 2007, up to six procedures can
National Health Statistics Reports n Number 57 n September 27, 2012 Page 3

be recorded on one claim; however,

more than one claim can be submitted

by the provider for an uninterrupted

inpatient stay. Therefore, any number of

procedures may be recorded for a single

stay.

The hospital identification number

on the Medicare inpatient claim includes

a four-digit code for the type of facility.

For consistency with the selection frame

in NHDS, claims from short-term

hospitals, rehabilitation hospitals,

alcohol and drug treatment hospitals,

psychiatric hospitals, rural primary care

hospitals, and children’s hospitals were

identified and selected. The provider’s

state code was used to select claims

submitted by the hospitals located in the

50 states and the District of Columbia

(DC) (Table 2). Of all inpatient claims

for Medicare FFS beneficiaries aged 65

and over, 97.4% (10.1 million claims) in

1999 and 98.5% (10.2 million claims) in

2007 were submitted from the selected

hospitals. During both years, selected

hospitals accounted for 98% of all

procedures recorded on the claims for

these beneficiaries. Claims data do not

allow identification and exclude claims

submitted by federal hospitals; that is,

standalone hospitals funded by the U.S.

government within the Department of

Defense, VA, Public Health Services,

and the Department of Justice, which

are excluded from the NHDS sample

frame (16). Only 0.6% of discharges

(56,160) in 1999 and 0.1% (9,660) in

2007 had more than one claim

submitted per discharge. A small number

of claims (0.13% in 1999 and 0.03% in

2007) were submitted in the current year

for patients not discharged by December

31.

Choice of the denominator

for rates calculation

Because enrollment characteristics

for Medicare beneficiaries may change

on a monthly basis [e.g., a person may

switch from an FFS Medicare plan to a

Medicare health maintenance

organization (HMO) plan during one

month and back to FFS in the next

month], some researchers use personyears of enrollment as a denominator for

calculation of rates. To be consistent

with NHDS methodology, which uses a

midyear civilian population as a

denominator for rate calculation,

midyear (July) enrollment in Part A FFS

Medicare among beneficiaries aged 65

and over who resided in the 50 states

and DC, was selected (Table 1).

The Medicare 5% sample data and

more information on the Medicare

claims and beneficiary summary data

are available from the Research Data

Assistance Center (ResDAC) at

http://www.resdac.org.

Methods

Discharge rates using NHDS data

(subsequently called NHDS rates) were

calculated by dividing the number of

discharges by the U.S. civilian

population and then multiplying by

10,000. Procedure rates were calculated

by dividing the number of all-listed

procedures by the U.S. civilian

population and then multiplying by

10,000. ‘‘All-listed’’ procedure estimates

included all mentions of procedures,

regardless of the order of listing in the

medical record. Rates for 2007 were

computed using adjustments made after

the 2000 census (postcensal estimates)

of the U.S. civilian population aged 65

and over as of July 1, 2007. Rates for

1999 were computed using intercensal

estimates of July 1, 1999 civilian

population. The population data were

from the tabulations provided by the

U.S. Census Bureau (Table 1).

NHDS estimates are based on a

sample survey and therefore the

standard error is primarily a measure of

sampling variability that occurs by

chance because only a sample rather

than an entire universe is surveyed.

Standard errors for the estimates from

NHDS were calculated with SAScallable SUDAAN 10.0.1 software,

which takes into account the complex

sample design.

Discharge rates using the Medicare

data (subsequently called Medicare

rates) were calculated by dividing the

number of claims with discharge date

mentioned and appropriate patient

discharge status code by the number of

U.S. Medicare beneficiaries aged 65 and

over enrolled in FFS Medicare Part A in

July of 1999 and 2007. Procedure rates

were calculated by dividing the number

of all-listed procedures mentioned on

the claims by the number of U.S.

Medicare beneficiaries aged 65 and over

enrolled in FFS Medicare Part A in July

of 1999 and 2007. ‘‘All-listed’’

procedure estimates include all mentions

of procedures, regardless of the order of

listing on the Medicare claim (or

multiple claims) submitted per

discharge. Nonsampling standard errors

for the Medicare rates were calculated

using the properties of the Poisson

distribution.

This report compares the rates for

selected all-listed procedures that were

performed most often on older persons.

The ICD–9 CM code for the list of

selected procedures is presented in

Table 3. Changes in the ICD–9 CM

codes for angioplasty and pacemakerrelated procedures between 1999 and

2007 reflect improvements in

technology and changes in medical

practice.

To compare numbers of procedures

listed per discharge, the percentage of

discharges with none, one to three, four

and more, and five and more (for CMS

data only) procedures mentioned per

discharge were calculated. A two-tailed

Z test (p = 0.05) was used to assess

whether the difference between NHDS

and Medicare rates was statistically

significant. When multiple comparisons

were required, the Bonferroni test was

used. To assess how Medicare rates

differ from NHDS estimates,

comparability ratios were calculated by

dividing the Medicare rate by the NHDS

rate. Standard error for the ratio was

approximated using the following

formula (17,18):

SERATIO = RATIO * RSERATIO = RATIO *

Y 2 2 SE CMS /RateCMS + SE2

NHDS /RateNHDS , 2

with the condition that

RSENHDS < 0.05 or

max (RSENHDS,RSECMS) < 0.10,

where RATIO = RateCMS/RateNHDS–

comparability ratio,

SERATIO is standard error for the ratio,
Page 4 National Health Statistics Reports n Number 57 n September 27, 2012

RSERATIO is relative standard error for the ratio,

RATECMS is Medicare rate,

SECMS is standard error for Medicare rate,

RSECMS is relative standard error for Medicare

rate,

RateNHDS is NHDS rate,

SENHDS is standard error for NHDS rate,

RSENHDS is relative standard error for NHDS

rate.

Results

Number of discharges and

procedures

Medicare estimates for the number

of discharges aged 65 and over

increased 2.9% from 9.7 million in 1999

to 10.0 million in 2007, and the number

of procedures increased 13% from 13.4

million to 15.1 million, respectively

(Table 4). The observed increase in

NHDS estimates between 1999 and

2007 for the number of discharges and

number of procedures in this age group

was not significant possibly due to the

larger NHDS standard errors. Total

number of inpatient discharges and

procedures derived from the Medicare

data represent hospital utilization by

about 80% of the persons aged 65 and

over and are lower than national

estimates derived from NHDS in each

age and sex group.

In both data systems, similar

distributions of the number of

discharges by age group were observed

(35% for ages 65–74, 40% for ages

75–84, and 25% for ages 85 and over).

About 55% of discharges had at least

one procedure recorded, and of those,

women accounted for about 55%.

Discharge rates

Among inpatients aged 65 and over,

the observed decrease by 8% in the

NHDS discharge rates between 1999

and 2007 was not significant possibly

due to the larger NHDS standard errors.

The Medicare discharge rates during this

time decreased for beneficiaries aged 65

and over by 4%, from 3,683 to 3,554

discharges per 10,000 beneficiaries

(Table 5).

No statistically significant

differences between NHDS and

Medicare estimates for discharge rates

were observed in age-sex groups

younger than age 85 in 1999 and 2007,

for men aged 85 and over in 1999, and

for women aged 85 and over in 2007.

Among women aged 85 and over in

1999, the NHDS discharge rate was

higher than the Medicare rate. Among

men aged 85 and over in 2007, the

NHDS discharge rate was lower than

the Medicare rate.

The NHDS discharge rate for

women aged 85 and over decreased

14% from 6,217 in 1999 to 5,320

discharges per 10,000 women in 2007.

The observed decrease in NHDS

discharge rates by about 10% for those

aged 65–74, 8% for those aged 75–84,

and 12% for men aged 85 and over

between the two years was not

significant possibly due to the larger

NHDS standard errors. For men,

Medicare discharge rates decreased 10%

among those aged 65–74, and 5% for

those aged 75–84 and 85 and over. For

women, Medicare discharge rates

decreased 7% for those aged 65–74, and

slightly increased (about 1%) for those

aged 75–84 and 85 and over.

Procedure rates

The observed decrease in the NHDS

all-listed procedure rate between 1999

and 2007 was not significant, whereas

the Medicare all-listed procedure rate

increased 6% between those years

(Table 6).

In 1999, the Medicare all-listed

procedure rate was 12% higher than the

NHDS all-listed procedure rate

(comparability ratio of 1.12). In 2007,

the Medicare rate was 27% higher than

the NHDS rate (comparability ratio of

1.27).

In 2007, the comparability ratio for

all-listed procedures was 1.23 for those

aged 65–74, 1.29 for those aged 75–84,

1.30 for those aged 85 and over

(Table 7), 1.28 for men aged 65 and

over, and 1.25 for women aged 65 and

over (Table 8).

Individual comparisons for each

procedure in 2007 showed that Medicare

rates differed significantly from NHDS

rates in each age group for all-listed

angioplasty, cardiac catheterization, and

pacemaker-related procedures. Individual

comparisons of NHDS rates with

Medicare rates for all-listed operations

on the nose, mouth, and pharynx;

endarterectomy of vessels of head and

neck, except intracranial; shunt or

vascular bypass; hemodialysis;

gastrostomy; prostatectomy; endoscopy;

and continuous mechanical ventilation,

differed for some age groups but not for

others, but no consistent pattern was

observed (Table 7). No significant

difference in any age group was

observed between Medicare and NHDS

rates for all-listed thoracentesis,

coronary artery bypass graft surgery,

gall bladder removal, oophorectomy,

reduction of fracture, excision or

destruction of intervertebral disc and

spinal fusion, total hip replacement, total

knee replacement, amputation of lower

limb, and mastectomy.

Medicare comparability ratios for

selected procedures performed on those

aged 65 and over ranged between 0.98

(prostatectomy) and 1.26 (continuous

mechanical ventilation) in 1999 and

between 1.06 (reduction of fracture) and

1.41 (pacemaker procedures) in 2007

(Table 6). In 2007, operations on the

nose, mouth, and pharynx;

endarterectomy of vessels of head and

neck, except intracranial; insertion,

replacement, removal, and revision of

pacemaker leads or devices;

hemodialysis; cardiac catheterization;

and gastrostomy, had the highest

comparability ratios between 1.31 and

1.41.

In 2007, the comparability ratios for

about 50% of selected procedures were

significantly different from one ranging

from 1.16 to 1.41. This reflects more

procedures recorded in Medicare data.

The comparability ratio was higher for

most of the cardiac procedures, and in

general, was closer to one when fewer

procedures were performed per

discharge and for procedures with lower

utilization rates.

Procedure mentions per

discharge

In both years, no difference

between the NHDS and Medicare

estimates for the percentage of
National Health Statistics Reports n Number 57 n September 27, 2012	 Page 5

discharges with no procedures or with

one to three procedures was observed

(Table 9). The percentage of Medicare

discharges with five or more procedures

recorded on the claim increased from

8.3% in 1999 to 10.4% in 2007.

Discussion

The fact that there was no

significant difference between NHDS

and Medicare discharge rates and in

general, that the estimates changed over

time in the same direction despite

different methods of data collection,

processing, and analysis, suggests a high

degree of comparability between the two

data sources with respect to coverage of

the target population (i.e., hospitalized

patients aged 65 and over).

An increase in the comparability

ratio for all-listed procedures rates

between 1999 and 2007 may be

explained by an increase in the total

number of procedures per discharge on

Medicare claims. This in turn may be

explained by changes in Medicare

payment policies that may require more

procedures included in the DRG that

define Medicare payment to the

providers of inpatient services. This

analysis cannot be performed for

specific procedures because NHDS

collects only the first four procedures

listed on the discharge summary,

whereas any number of procedures in no

particular order can be mentioned on the

multiple Medicare claims per discharge.

Even the equal portion of discharges

with less than four procedures

mentioned found in NHDS and

Medicare data does not necessarily

mean that the same procedures were

mentioned in both data systems.

If the performance of a procedure

can be captured on a claim or medical

record in a single ICD–9–CM code, the

Medicare and NHDS procedure rates are

more likely to be comparable (i.e., to

have a comparability ratio closer to

one). For example, larger comparability

ratios were found for cardiac

procedures, such as a pacemaker-related

procedure or angioplasty (comparability

ratios of 1.41 and 1.24 in 2007,

respectively) for which numerous codes

are required to describe one operative

event; whereas hip replacement and

hysterectomy are more likely to be

recorded as a single code, and therefore

have comparability ratios closer to one

(1.10 and 1.08 in 2007, respectively).

The difference in the number of

procedures listed on the NHDS

discharge record (four) and on the

Medicare claim (six in 1999 and 2007,

with a possible extension on another

claim) may contribute to the difference

in the rates of procedures that require

multiple coding. In the case of a

procedure not listed among first four

procedures on discharge medical record,

it would not be collected by NHDS.

The FFS Medicare inpatient claims

data provide unique opportunities for

health care research including Medicare

costs analysis, longitudinal analysis of

health care utilization by Medicare

beneficiary, chronic conditions research,

and data linkage across the continuum

of health care covered by Medicare.

Recently, Medicare claims data became

more available for researchers through

ResDAC (available from http://www.

resdac.org), and more hospital-use

estimates are and will be based on the

claims data.

NHDS, conducted since 1965, was

the longest continuous nationally

representative survey of hospital

inpatient care and provided unbiased

national estimates widely used by policy

makers and researchers, as well as by

the hospital industry and state health

departments. The design and operation

of NHDS is currently undergoing a

major transformation. A new larger

survey (National Hospital Care Survey)

will incorporate inpatient data formerly

collected by NHDS, as well as

ambulatory care data from the same

hospitals. Beginning in 2011, all data

collection for the inpatient component of

the survey will be based on claims data.

This comparability study may help

to understand and evaluate possible

shifts in the trend statistics not only for

the traditional Medicare population but

also for inpatients of all ages.

Study limitations

While NHDS samples discharges

for all inpatients, Medicare inpatient

claims account for inpatient stays of

Medicare Part A FFS beneficiaries.

About 98% of persons aged 65 and over

are Medicare beneficiaries and about

80% of them have Part A FFS coverage.

Those who were not Medicare

beneficiaries and who participated in

Medicare HMO and other than FFS

Medicare plans, were excluded from the

analysis.

Although all efforts were made to

select Medicare claims submitted by the

hospitals in agreement with the NHDS

sampling frame, some claims used in

this analysis may have been submitted

from hospitals outside of the NHDS

hospital selection.

References

1.	 Cullen KA, Hall MJ, Golosinskiy A.

Ambulatory surgery in the United

States, 2006. National health

statistics reports; no 11. Revised.

Hyattsville, MD: National Center for

Health Statistics. 2009. Available

from: http://www.cdc.gov/nchs/data/

nhsr/nhsr011.pdf.

2.	 Russo A, Elixhauser A, Steiner C,

Wier L. Hospital-based ambulatory

surgery, 2007. HCUP Statistical Brief

no 86. 2010. Agency for Healthcare

Research and Quality: Rockville,

MD. Available from: http://

www.hcup-us.ahrq.gov/reports/

statbriefs/sb86.pdf.

3.	 Centers for Medicare & Medicaid

Services. State Operations Manual.

Appendix L—Guidance for

Surveyors: Ambulatory Surgical

Centers. 2011. Available from:

https://www.cms.gov/Regulationsand-Guidance/Guidance/Manuals/

downloads/som107ap_l_

ambulatory.pdf.

4.	 Fleisher LA, Pasternak LR, Lyles A.

A novel index of elevated risk of

inpatient hospital admission

immediately following outpatient

surgery. Arch Surg 142(3):263–8.

2007.

5.	 Liu JT, Briner RP, Friedman JA.

Comparison of inpatient vs.

outpatient anterior cervical

discectomy and fusion: A

retrospective case series. BMC Surg

9:3. 2009.

6.	 Veterans Health Administration.

Criteria and standards for

performance of ambulatory (same

day) surgery performed in
Page 6	 National Health Statistics Reports n Number 57 n September 27, 2012

ambulatory or dedicated sites.

Appendix A. VHA Handbook 1102.5.

2003. Available from: http://

www.ct.gov/dph/lib/dph/ohca/

hc_facilities_advisory_body/

ascvolumearticle2_va_2003_

giudelines.pdf.

7.	 Centers for Disease Control and

Prevention. Trends in in-hospital

newborn male circumcision—United

States, 1999–2010. MMWR

60(34):1167–8. 2011. Available from:

http://www.cdc.gov/mmwr/preview/

mmwrhtml/mm6034a4.htm.

8.	 National Center for Health Statistics.

Health, United States, 2010: With

special feature on death and dying.

Hyattsville, MD. 2011. Available

from: http://www.cdc.gov/nchs/data/

hus/hus10.pdf.

9.	 Hall MJ, DeFrances CJ, Williams

SN, et al. National Hospital

Discharge Survey: 2007 summary.

National health statistics reports; no

29. Hyattsville, MD: National Center

for Health Statistics. 2010. Available

from: http://www.cdc.gov/nchs/data/

nhsr/nhsr029.pdf.

10. Cohen RA, Martinez ME. Health

insurance coverage: Early release of

estimates from the National Health

Interview Survey, January–March

2011. National Center for Health

Statistics. September 2011. Available

from: http://www.cdc.gov/nchs/nhis/

releases.htm.

11. Ehlenbach WJ, Barnato AE, Curtis

JR, Kreuter W, Koepsell TD, Deyo

RA, Stapleton RD. Epidemiologic

study of in-hospital cardiopulmonary

resuscitation in the elderly. N Engl J

Med 361(1):22–31. 2009.

12. Finks JF, Osborne NH, Birkmeyer

JD. Trends in hospital volume and

operative mortality for high-risk

surgery. N Engl J Med 364(22):

2128–37. 2011.

13. Goodney PP, Beck AW, Nagle J,

Welch HG, Zwolak RM. National

trends in lower extremity bypass

surgery, endovascular interventions,

and major amputations. J Vasc Surg

50(1):54–60. 2009.

14. Centers for Medicare & Medicaid

Services. Medicare & Medicaid

Statistical Supplement. Table 2.1—

Medicare enrollment: Hospital

insurance and/or supplementary

medical insurance programs for total,

fee-for-service and managed care

enrollees as of July 1, 2010: Selected

calendar years 1966–2010. 2011.

Available from: http://www.cms.gov/

Research-Statistics-Data-andSystems/Statistics-Trends-andReports/MedicareMedicaidStatSupp/

2011.html.

15. Centers for Medicare & Medicaid

Services. Electronic billing & EDI

transactions. Institutional paper claim

form (CMS–1450). 2011. Available

from: https://www.cms.gov/Medicare/

Billing/ElectronicBillingEDITrans/

15_1450.html.

16. Dennison C, Pokras R. Design and

operation of the National Hospital

Discharge Survey: 1988 redesign.

Vital Health Stat 1(39). 2000.

Available from: http://www.cdc.gov/

nchs/data/series/sr_01/sr01_039.pdf.

17. Hansen MH, Hurwitz WN, Madow

WG. Sample Survey Methods and

Theory, Methods and Applications.

Wiley Classics Library Ed. New

York, NY: John Wiley & Sons. 1993.

18. Cochran WG. Sampling Techniques,

3rd Edition. New York, NY: John

Wiley & Sons. 1977.
National Health Statistics Reports n Number 57 n September 27, 2012 Page 7

Table 1. Denominators for rate calculation, by age and sex

U.S. civilian population Enrollment (July) in Medicare Part A FFS

1999 2007 1999 2007

Age in years, and sex

Number in

thousands Percent

Number in

thousands Percent

Number in

thousands Percent

Number in

thousands Percent

65 and over

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

34,239

14,238

20,001

100.0

41.6

58.4

37,888

15,976

21,912

100.0

42.2

57.8

26,406

10,777

15,629

100.0

40.8

59.2

28,167

12,125

16,042

100.0

43.0

57.0

65–74

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

75–84

18,044

8,148

9,896

52.7

23.8

28.9

19,352

8,887

10,465

51.1

23.5

27.6

13,068

5,945

7,123

49.5

22.5

27.0

14,174

6,730

7,444

50.3

23.9

26.4

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

12,047

4,853

7,194

35.2

14.2

21.0

13,024

5,313

7,711

34.4

14.0

20.4

9,646

3,793

5,853

36.5

14.4

22.2

9,732

4,052

5,680

34.6

14.4

20.2

85 and over

All . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

4,149

1,237

2,911

12.1

3.6

8.5

5,512

1,777

3,735

14.5

4.7

9.9

3,692

1,039

2,653

14.0

3.9

10.0

4,261

1,344

2,917

15.1

4.8

10.4

NOTE: FFS is fee-for-service.

SOURCES: U.S. Census Bureau; Centers for Medicare & Medicaid Services, Medicare 5% sample.
Page 8 National Health Statistics Reports n Number 57 n September 27, 2012

Table 2. Medicare inpatient claims characteristics for hospitals comparable with the hospital selection in the National Hospital Discharge

Survey

Inclusion criteria Code used Claim field name (CCW version) Comments

50 states and the District of Columbia ...............

Short-term hospital...........................

1–39, 41–47, and 49–53

0001–0879

Provider SSA state code

Provider number, positions

3–6 (any code listed)

OSCAR provider number1

Critical access hospital (former rural primary care hospital) . .

Rehabilitation hospital (excluded from PPS) ...........

Children’s hospital (excluded from PPS) .............

Psychiatric hospital (excluded from PPS) .............

Psychiatric unit of the hospital (excluded from PPS) ......

1300–1399

3025–3099

3300–3399

4000–4499

S Provider number, position

3 (any code listed)

Third character in the

OSCAR provider number

Rehabilitation unit of the hospital (excluded from PPS) .... T

1

Effective October 1, 2007, the OSCAR Provider Number has been renamed the CMS certification number.
 

NOTES: CCW is Chronic Condition Data Warehouse; SSA is Social Security Administration; PPS is Prospective Payment System; OSCAR is Online Survey Certification and Reporting.
 
National Health Statistics Reports n Number 57 n September 27, 2012 Page 9

Table 3. International Classification of Diseases, 9th Revision, Clinical Modification code for selected procedures, 1999 and 2007

ICD–9–CM code

Procedure name 1999 2007

All procedures ......................................... 00–99 00–99

Operations on the nose, mouth, and pharynx ...................... 21–29 21–29

Thoracentesis .......................................... 34.91 34.91

Coronary artery bypass graft (CABG) ........................... 36.1 36.1

Angioplasty with or without stent insertion ........................ 36.01,36.02,36.05–36.07 36.06,36.07,00.66

Endarterectomy of vessels of head, neck, except intracranial............. 38.12 38.12

Cardiac catheterization .................................... 37.21–37.23 37.21–37.23

Insertion, replacement, removal and revision of pacemaker leads or devices. . . 37.7,37.8 37.7,37.8,00.50,00.52,00.53

Shunt or vascular bypass................................... 39.0–39.2 39.0–39.2

Hemodialysis .......................................... 39.95 39.95

Gastrostomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43.1 43.1

Endoscopy of small intestine, with or without biopsy .................. 45.11–45.14,45.16 45.11–45.14,45.16

Endoscopy of large intestine, with or without biopsy .................. 45.21–45.25 45.21–45.25

Gall bladder removal ..................................... 51.2 51.2

Prostatectomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60.2–60.6 60.2–60.6

Oophorectomy ......................................... 65.3–65.6 65.3–65.6

Hysterectomy .......................................... 68.3–68.7,68.9 68.3–68.7,68.9

Reduction of fracture ..................................... 76.7,79.0–79.3 76.7,79.0–79.3

Excision or destruction of intervertebral disc and spinal fusion ............ 80.5,81.0 80.5,81.0

Total hip replacement ..................................... 81.51 81.51

Total knee replacement .................................... 81.54 81.54

Amputation of lower limb ................................... 84.1 84.1

Mastectomy (includes lumpectomy, resection of breast, and mammectomy).... 85.21–85.23,85.33–85.36,85.4 85.21–85.23,85.33–85.36,85.4

Continuous mechanical ventilation ............................. 96.7 96.7

NOTE: ICD–9–CM is International Classification of Diseases, 9th Revision, Clinical Modification.
Page 10 National Health Statistics Reports n Number 57 n September 27, 2012

Table 4. Hospital discharges and all-listed procedures among persons aged 65 and over, by age and sex

1999 2007

NHDS Medicare FFS NHDS Medicare FFS

Percent change

between 2007

and 1999

Number in

thousands

SE in

thousands

Number in

thousands

SE in

thousands

Number in

thousands

SE in

thousands

Number in

thousands

SE in

thousands NHDS Medicare

Discharges

All ................................ 12,683 469 9,726 1.1 12,863 573 10,009 1.5 1.4 †2.9

Sex

Men ...............................

Women .............................

5,245

7,438

201

275

4,019

5,707

0.7

0.9

5,453

7,411

264

317

4,242

5,767

1.0

1.1

4.0

–0.4

†5.6

†1.1

Age in years

65–74 ..............................

75–84 ..............................

85 and over ..........................

4,883

5,227

2,572

181

200

113

3,506

4,075

2,145

0.6

0.7

0.5

4,722

5,188

2,954

218

246

132

3,503

4,041

2,466

0.9

1.0

0.7

–3.3

–0.7

†14.9

†–0.1

†–0.8

†15.0

Procedures

All ................................ 15,467 697 13,364 31.5 16,029 714 15,095 34.3 3.6 †12.9

Sex

Men ...............................

Women .............................

7,012

8,455

334

376

6,127

7,237

21.2

23.2

7,337

8,691

345

383

7,121

7,974

23.7

24.7

4.6

2.8

†16.2

†10.2

Age in years

65–74 ..............................

75–84 ..............................

85 and over ..........................

6,771

6,295

2,401

304

303

130

5,598

5,623

2,144

20.4

20.3

12.3

6,958

6,386

2,684

350

279

130

6,257

6,151

2,687

22.1

21.7

14.0

2.8

1.4

11.8

†11.8

†9.4

†25.4

Discharges with procedure(s) listed

All ................................ 7,057 301 5,341 0.0 7,197 305 5,722 0.0 2.0 †7.1

Sex

Men ...............................

Women .............................

3,098

3,959

138

168

2,339

3,002

0.0

0.0

3,180

4,017

141

170

2,562

3,160

0.0

0.0

2.6

1.5

†9.5

†5.2

Age in years

65–74 ..............................

75–84 ..............................

85 and over ..........................

2,981

2,876

1,200

128

129

59

2,140

2,234

968

0.0

0.0

0.0

2,988

2,866

1,343

140

118

66

2,242

2,318

1,162

0.0

0.0

0.0

0.2

–0.3

11.9

†4.8

†3.8

†20.0

† The change between 2007 and 1999 is statistically significant (p < 0.05, z test).
 

0.0 Quantity more than zero but less than 0.05.
 

NOTES: NHDS is National Hospital Discharge Survey; FFS is fee-for-service; SE is standard error.
 

SOURCES: CDC/NCHS, National Hospital Discharge Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
 
National Health Statistics Reports

n Number 57n September 27, 2012 Page 11

sex, 1999 and 2007

1999 2007

Percent change

between 2007

NHDS1 Medicare2 NHDS1 Medicare2 and 1999

Rate SE Rate SE Ratio Rate SE Rate SE Rate NHDS Medicare

3,704.1 136.9 3,683.1 0.42 0.99 3,395.1 151.3 3,553.6 0.54 1.05 –8.3 †–3.5

3,683.6 141.1 3,729.1 0.67 1.01 3,412.9 165.3 3,498.7 0.83 1.03 –7.3 †–6.23,718.7 137.3 3,651.4 0.54 0.98 3,382.1 144.6 3,595.2 0.70 1.06 –9.1 †–1.5

2,706.4 100.2 2,683.1 0.49 0.99 2,439.9 112.4 2,471.4 0.63 1.01 –9.8 †–7.9

2,835.3 110.1 2,778.9 0.76 0.98 2,559.3 116.5 2,513.8 0.96 0.98 –9.7 †–9.5

2,600.2 99.3 2,603.2 0.64 1.00 2,338.4 114.6 2,433.0 0.84 1.04 –10.1 †–6.5

4,338.9 165.7 4,223.9 0.76 0.97 3,983.3 188.9 4,152.0 1.01 1.04 –8.2 †–1.7

4,476.3 185.2 4,492.1 1.26 1.00 4,162.6 237.1 4,285.5 1.60 1.03 –7.0 †–4.64,246.1 161.0 4,050.1 0.96 0.95 3,859.8 165.6 4,056.8 1.30 1.05 –9.1 †0.2

6,200.2 271.4 5,809.4 1.46 0.94 5,358.9 239.2 5,787.1 1.66 1.08 †–13.6 †–0.4

6,160.2 308.5 6,379.5 2.90 1.04 5,440.6 287.6 6,059.1 3.15 ††1.11 –11.7 †–5.0

6,217.2 274.7 5,586.0 1.69 ††0.90 5,320.0 237.6 5,661.9 1.94 1.06 †–14.4 †1.4

significant (p < 0.05, z test).

the statistically significant level (p < 0.05, z test).

A fee-for-service beneficiaries.

y; SE is standard error.

Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
Page 12 National Health Statistics Reports n Number 57 n September 27, 2012 

rates, 1999 and 2007 1999 2007 Percent change between 2007 NHDS1 Medicare2 NHDS1 Medicare2 and 1999 

Rate SE Rate SE Ratio Rate SE Rate SE Rate NHDS Medicare 

.............. 4,517.2 203.6 5,061.0 11.9 †1.12 4,230.5 188.5 5,359.1 12.2 †1.27 –6.3 ††5.9 

............. 16.3 1.8 20.3 0.6 †1.25 13.8 1.4 18.3 0.5 †1.33 –15.3 ††–9.9 

.............. 30.5 2.1 37.4 0.6 †1.23 40.6 3.8 43.4 0.7 1.07 ††33.1 ††16.0 

.............. 94.1 7.5 106.6 1.2 1.13 60.9 5.2 70.3 1.0 1.15 ††–35.3 ††–34.1 

.............. 145.8 11.4 166.9 1.7 1.14 161.0 15.6 200.2 1.8 †1.24 10.4 ††20.0 

ept intracranial .... 28.8 2.3 35.3 0.6 †1.23 17.5 1.6 23.4 0.4 †1.34 ††–39.2 ††–33.7 

.............. 180.4 12.6 208.9 1.3 †1.16 136.5 9.3 184.0 1.2 †1.35 ††–24.3 ††–11.9 

of pacemaker leads 

.............. 83.3 6.2 104.6 1.3 †1.26 75.9 5.0 107.1 1.3 †1.41 –8.9 2.4 

.............. 28.8 2.2 33.6 0.6 †1.17 17.5 1.8 18.6 0.4 1.06 ††–39.2 ††–44.6 

.............. 65.9 5.8 82.7 1.5 †1.25 76.8 6.8 100.3 1.6 †1.31 16.5 ††21.3 

.............. 40.4 2.7 48.7 0.6 †1.21 26.1 2.0 34.3 0.5 †1.31 ††–35.4 ††–29.6 

biopsy .......... 161.2 8.1 179.9 1.2 †1.12 143.8 7.7 166.3 1.2 †1.16 –10.8 ††–7.6 

biopsy . . . . . . . . . . 104.4 5.3 110.2 1.0 1.06 75.2 4.0 89.0 0.8 †1.18 ††–28.0 ††–19.2 

.............. 46.0 3.0 46.2 0.6 1.00 35.4 2.3 38.1 0.5 1.08 ††–23.0 ††–17.5 

.............. 41.0 3.5 40.1 0.6 0.98 21.2 2.1 25.8 0.4 †1.22 ††–48.3 ††–35.7 .............. 16.1 1.4 19.5 0.4 †1.21 12.4 1.3 14.9 0.3 1.20 –23.0 ††–23.6 

. . . . . . . . . . . . . . 17.1 1.3 19.1 0.4 1.12 13.3 1.4 14.4 0.3 1.08 –22.2 ††–24.6 

.............. 77.9 5.5 77.9 0.8 1.00 69.4 4.5 73.3 0.8 1.06 –10.9 –5.9 

nd spinal fusion. . . . 28.4 3.7 29.1 0.6 1.02 40.9 4.0 46.4 0.8 1.13 ††44.0 ††59.5 

.............. 29.7 2.4 30.0 0.5 1.01 33.0 2.7 36.3 0.5 1.10 11.1 ††21.0 

.............. 53.3 4.4 55.4 0.7 1.04 83.4 7.1 91.5 0.9 1.10 ††56.5 ††65.2 

. . . . . . . . . . . . . . 23.3 2.2 27.4 0.6 1.18 16.4 1.4 18.1 0.5 1.10 ††–29.6 ††–33.9 

of breast, and 

.............. 16.6 1.6 17.4 0.4 1.05 9.1 1.2 9.8 0.3 1.08 ††–45.2 ††–43.7 

.............. 86.5 3.8 109.4 1.0 †1.26 85.6 5.8 102.9 1.0 †1.20 –1.0 ††–5.9

the statistically significant level (p < 0.05, z test).

significant (p < 0.05, z test). 

A fee-for-service beneficiaries.

y; SE is standard error.

Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
National Health Statistics Reports

n Number 57n September 27, 2012 Page 13

age, 2007

Ages 65–74 Ages 75–84 Ages 85 and over

NHDS1 Medicare2 NHDS1 Medicare2 NHDS1 Medicare2

Rate SE Rate SE Ratio Rate SE Rate SE Ratio Rate SE Rate SE Ratio

...... 3,595.7 180.7 4,414.5 15.6 †1.23 4,903.5 214.3 6,320.1 22.3 †1.29 4,869.2 236.3 6,306.4 33.0 †1.30

...... 10.5 1.5 15.5 0.7 †1.48 17.3 2.8 20.1 0.9 1.16 17.0 3.0 23.3 1.4 1.37

...... 24.5 3.8 28.0 0.8 1.14 47.5 4.8 49.0 1.2 1.03 80.8 13.5 81.8 2.4 1.01

...... 67.3 6.7 75.4 1.4 1.12 70.0 7.5 84.4 1.8 1.21 16.5 2.9 21.1 1.3 1.28

...... 168.6 16.0 200.8 2.6 †1.19 187.1 22.0 233.2 3.3 †1.25 72.4 9.8 122.9 3.6 †1.70

ept

...... 17.0 1.8 20.6 0.6 1.21 21.5 2.7 30.7 0.8 †1.43 9.9 2.5 16.1 0.9 †1.63

...... 138.9 10.6 179.3 1.6 †1.29 164.3 12.0 220.9 2.2 †1.34 62.2 6.8 115.3 2.4 †1.85

of

...... 39.2 3.7 51.2 1.2 †1.31 100.5 7.9 140.0 2.4 †1.39 149.7 12.9 218.0 4.6 †1.46

...... 19.3 2.1 18.5 0.6 0.96 19.1 3.5 21.3 0.7 1.12 7.5 1.8 13.1 0.8 †1.75

...... 82.3 11.2 97.2 2.3 1.18 82.1 6.6 114.9 2.9 †1.4 44.9 5.8 77.0 3.4 †1.71

. . . . . . 11.4 1.6 18.0 0.5 †1.58 31.5 3.2 40.8 0.9 †1.3 65.0 8.2 73.9 1.9 1.14

biopsy . . 93.5 5.4 110.0 1.3 †1.18 181.4 11.5 204.3 2.2 1.13 231.7 18.9 266.6 3.7 1.15

biopsy . . 47.6 3.1 57.2 0.9 †1.20 97.9 6.1 114.0 1.6 †1.16 118.8 10.9 137.6 2.7 1.16

...... 27.9 3.0 32.9 0.7 1.18 44.7 3.6 44.2 1.0 0.99 40.2 4.8 41.4 1.4 1.03

. . . . . . 25.2 2.6 27.2 0.6 1.08 18.8 3.0 26.7 0.8 †1.42 12.7 2.3 19.0 1.0 †1.50

...... 15.1 2.0 17.5 0.5 1.16 12.0 1.7 14.3 0.5 1.19 4.3 1.2 7.5 0.6 1.74

...... 15.1 1.9 17.6 0.5 1.17 14.3 2.6 13.6 0.5 0.95 †† †† 5.4 †0.5 ††

...... 34.4 2.8 35.3 0.8 1.03 71.8 5.6 82.6 1.4 1.15 186.5 18.5 178.6 3.1 0.96

nd

...... 54.1 5.9 59.4 1.2 1.10 33.2 4.6 42.0 1.2 1.27 12.6 3.3 12.9 1.0 1.02

...... 33.6 3.8 34.1 0.7 1.01 37.7 3.2 44.0 1.0 1.17 19.7 3.7 26.1 1.1 1.32

...... 95.8 8.8 99.5 1.3 1.04 89.4 7.9 104.9 1.5 1.17 25.7 4.5 34.5 1.3 1.34

...... 15.8 2.1 15.5 0.6 0.98 17.0 2.2 19.0 0.8 1.12 17.5 3.9 24.6 1.3 1.41

of

...... 9.9 1.8 9.3 0.4 0.94 9.4 1.6 10.6 0.5 1.13 5.6 1.5 9.7 0.7 1.73

...... 72.8 6.8 79.4 1.2 1.09 97.3 8.5 123.8 1.8 †1.27 103.2 8.3 133.5 2.8 †1.29

the statistically significant level (p < 0.05, z test).

A fee-for-service beneficiaries.

y; SE is standard error.

Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
Page 14 National Health Statistics Reports n Number 57 n September 27, 2012

Table 8. All-listed procedure rates, by sex, 2007

Men Women

NHDS1 Medicare2 NHDS1 Medicare2

Procedure name Rate SE Rate SE Ratio Rate SE Rate SE Ratio

All procedures ............................... 4,592.5 216.1 5,872.9 19.5 †1.28 3,966.6 174.6 4,970.8 15.4 †1.25

Operations on the nose, mouth, and pharynx ............ 17.1 2.2 20.9 0.8 1.22 11.3 1.7 16.3 0.6 †1.44

Thoracentesis................................ 36.0 4.8 46.4 1.1 †1.29 44.0 4.5 41.1 0.9 0.93

Coronary artery bypass graft ...................... 98.9 8.4 110.8 1.8 1.12 33.1 3.9 39.6 0.9 1.20

Angioplasty with or without stent insertion .............. 234.0 24.1 279.9 3.3 1.20 107.7 10.5 140.0 2.0 †1.30

Endarterectomy of vessels of head, neck, except intracranial . . 23.5 2.7 31.1 0.8 †1.32 13.2 1.5 17.6 0.5 †1.33

Cardiac catheterization .......................... 181.2 13.3 236.1 2.0 †1.30 103.9 7.8 144.6 1.4 †1.39

Insertion, replacement, removal and revision of pacemaker

leads or devices ............................. 88.8 6.8 122.8 2.1 †1.38 67.3 6.0 95.2 1.6 †1.41

Shunt or vascular bypass ........................ 22.9 2.4 24.9 0.7 1.09 13.6 2.3 13.9 0.5 1.02

Hemodialysis ................................ 83.8 8.2 114.6 2.6 †1.37 71.7 8.3 89.4 2.1 †1.25

Gastrostomy ................................ 26.5 2.7 36.9 0.8 †1.39 25.9 2.5 32.4 0.6 †1.25

Endoscopy of small intestine, with or without biopsy ........ 137.4 7.9 164.1 1.8 †1.19 148.5 8.6 168.0 1.5 †1.13

Endoscopy of large intestine, with or without biopsy ........ 69.8 4.8 82.1 1.2 †1.18 79.2 4.7 94.2 1.1 †1.19

Gall bladder removal ........................... 34.5 3.3 41.3 0.8 †1.20 36.1 3.4 35.7 0.7 0.99

Prostatectomy ............................... 50.2 5.1 59.8 1.0 1.19 . . . . . . . . . . . . . . .

Oophorectomy ............................... . . . . . . . . . . . . . . . 21.5 2.2 26.1 0.6 †1.21

Hysterectomy ................................ . . . . . . . . . . . . . . . 23.1 2.4 25.3 0.6 1.10

Reduction of fracture ........................... 37.2 3.4 40.8 0.9 1.10 92.8 6.7 97.9 1.2 1.05

Excision or destruction of intervertebral disc and spinal fusion . . 45.8 5.0 48.2 1.2 1.05 37.3 4.5 44.9 1.0 1.20

Total hip replacement ........................... 32.3 3.9 31.2 0.7 0.97 33.5 3.0 40.1 0.7 †1.20

Total knee replacement.......................... 71.6 7.1 75.4 1.2 1.05 92.0 7.8 103.7 1.2 1.13

Amputation of lower limb ......................... 20.1 2.1 24.0 0.8 1.19 13.8 1.7 13.6 0.5 0.99

Mastectomy (includes lumpectomy, resection of breast, and

mammectomy) .............................. . . . . . . . . . . . . . . . 15.5 2.1 16.9 0.5 1.09

Continuous mechanical ventilation ................... 97.1 7.8 117.2 1.6 †1.21 77.3 5.6 92.1 1.2 †1.19

† Medicare rate differs from NHDS procedure rate at the statistically significant level (p < 0.05, z test).
 

. . . Category not applicable.
 1

NHDS procedure rate per 10,000 civilian population.
 2

Medicare procedure rate per 10,000 Medicare Part A fee-for-service beneficiaries.
 

NOTES: NHDS is National Hospital Discharge Survey; SE is standard error.
 

SOURCES: CDC/NCHS, National Hospital Discharge Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
 
National Health Statistics Reports n Number 57 n September 27, 2012 Page 15

Table 9. Percentage of hospital inpatient discharges, by number of procedures mentioned, 1999 and 2007

1999 2007
 

NHDS Medicare NHDS Medicare
 

All discharges....................... 100.0 100.0 100.0 100.0
 

No procedure ....................... 44.4 45.4 44.0 43.5 
 

1–3 procedures...................... 43.3 42.0 42.7 41.5 
 

4 procedures ....................... 12.4 4.3 13.2 4.6 
 

4 or more procedures .................. 12.4 12.6 13.2 15.0 
 

5 or more procedures .................. ... 8.3 ... 10.4 
 

. . . Category not applicable.
 

NOTE: NHDS is National Hospital Discharge Survey.
 

SOURCES: CDC/NCHS, National Hospital Discharge Survey and Health Data Interactive; Centers for Medicare & Medicaid Services, Medicare 5% sample.
 
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National Health Statistics Reports n Number 57 n September 27, 2012

Acknowledgments

The authors gratefully acknowledge Donna Pickett, National Center for Health Statistics (NCHS); Gerald S. Adler, Centers for Medicare &

Medicaid Services (CMS); Gerald F. Riley, CMS; Yuri A. Deychak (Maryland Heart, P.C.); and Richard W. Niska, NCHS, for their contributions

to this report.

Suggested citation

Gorina Y, Owings M, Elgaddal N, Weeks J.

Comparability between the rates for all-listed

inpatient procedures using National Hospital

Discharge Survey and Medicare claims, 1999

and 2007. National health statistics reports; no

57. Hyattsville, MD: National Center for Health

Statistics. 2012.

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DHHS Publication No. (PHS) 2012–1250 • CS234496