Definitions (see Formulas, bottom of page)

Acute care:
The provision of care to a person who is in the acute phase of an illness or injury and who will probably have a hospital stay of less than 30 days.

Adjusted Admissions and Adjusted Patient Days: These figures are calculated and used as a way to standardize the per unit measure between hospitals allowing for more valid comparisons. The adjustment factor is calculated by dividing Total Charges by Inpatient Charges, thereby standardizing the inpatient/outpatient mix. When this factor is multiplied by the inpatient days and admissions it creates a denominator of units of service in terms of inpatient activity.

Available beds: the number of beds that can be made available for use within 24 hours. Available beds include pediatric bassinets, but do not include newborn bassinets, labor rooms, postoperative recovery room beds, psychiatric holding beds, or beds that are used only as holding facilities for patients prior to their transfer to another hospital.

Average Daily Census (ADC): A measure of the average inpatient load in terms of number of patients on a given day.

Average Length of Stay (ALOS): A measure of the average period of time in terms of days that a patient spends in the hospital on an inpatient basis. One must take into account varying acuity levels and service types when comparing one hospital to another.

Centers for Medicare and Medicaid Services (CMS): formerly the Health Care Financing Administration, or HCFA, this organization administers the Medicaid, Medicare and State Children's Health Insurance Program.

Critical access hospital (CAH): A hospital that meets very specific CMS criteria and thus gets special payments for Medicare patients. Hospital can only provide short-term, limited care and must have a referral agreement.

Diagnosis related groups (DRGs): Methodology developed by the CMS to group Medicare patients based on their clinical condition, age, other existing conditions, etc. into one of almost 500 DRGs. Providers are then paid a set fee based on the DRG assigned.

FTE: A full-time equivalent is a measurement that standardizes the mix of part-time and full-time employees within a fiscal year. The measurement reflects the number of people necessary in terms of full-time status by dividing the total number of paid hours in a year by a factor of 2,080 hours. 2,080 is the standard number of hours a full-time person would be paid in a year.

FTEs per Adjusted Admission and Adjusted Patient Day: This measures the relative labor utilized on a standardized service unit basis. Since an FTE reflects the relative number of employees employed by the hospital on a given day, it needs to be multiplied by 260, the number of 8-hour shifts in a year in which an FTE is available.

General Assistance Medical Care (GAMC): an entitlement program for low-income Minnesotans.

Health maintenance organization (HMO): A prepaid health plan that acts as both an insurer and provider of comprehensive health services.

Licensed Beds: The number of beds a hospital has a license to operate.

Managed care: A system of providing health care through which access, cost and quality are controlled.

Medicaid: The joint federal and state program that provides health care coverage to low-income and disabled persons under 65 years of age. Minnesota's program is called Medical Assistance (MA).

Medicare: The federal program that provides health care services to all persons 65 years of age and older, regardless of income.

MinnesotaCare: funded by enrollee premiums, the State of Minnesota, a tax on health care providers and some federal matching dollars, MinnesotaCare was created in 1992 by the Minnesota Legislature to subsidize a health care program for Minnesotans who do not have access to health insurance.

Patient days: Each calendar day of health care provided to a hospital inpatient under the terms of his insurance, usually beginning at midnight.

Percentage Occupancy of Licensed Beds: A measure of the average inpatient volume, excluding newborns, compared on a percentage basis to the licensed bed capacity for the reporting period.

Prepaid Medical Assistance Program (PMAP): A managed care program for Medical Assistance enrollees.

Psychiatric hospital: a facility licensed as a psychiatric hospital under Minnesota Statutes, sections 144.50 to 144.58, to provide psychiatric services to inpatients for the diagnosis and treatment of mental illness.

Uniform Billing Code (UB-92): A federal code that outlines the specific billing procedures hospitals must follow and list on each patient invoice.

Formulas

Adjusted Admissions = (Total Charges/Inpatient Charges) x Acute Admissions

Adjusted Patient Days = (Total Charges/Inpatient Charges) x Acute Patient Days

FTE = Total paid hospital employee hours in a year / 2080

FTEs per Adj. Admission = (# of FTEs x 260) / Adjusted Admissions

FTEs per Adj. Patient Day = (# of FTEs x 260) / Adjusted Patient Days

Average Length of Stay = Total Acute Patient Days / Total Acute Admissions

Average Daily Census = Total Acute Patient Days / 365 days

Percent Occupancy of Licensed Beds = Total Acute Patient Days / (# Licensed Beds x 365)


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