Prospective Payment System (PPS) Data

Source CMS

PPS is a system of Medicare reimbursement for Part A benefits which bases most hospital payments on the patient's diagnosis at the time of hospital admission. PPS data was created by the Centers for Medicare & Medicaid Services' (CMS).

"The Inpatient Minimum Datasets contain cost, statistical, financial, and other information from the Medicare Hospital Cost Report. The datasets include only the most current cost report (as submitted, final settled, or reopened) submitted for a Medicare-certified hospital by the Medicare fiscal intermediary to HCFA. These datasets are updated at the end of each calendar quarter and are available on the last day of the following month."

"The Capital Datasets contain selected data for capital-related costs, interest expense and related information, and complete balance sheet data from the Medicare Hospital Cost Report."

"The Outpatient Datasets contain Part B Medicare cost and charges by cost center from the Medicare Hospital Cost Report."

Quotes are from "Data Users Reference Guide". U.S. Department of Health and Human Services, Health Care Financing Administration, Bureau of Data Management and Strategy. September 1995.

Updates and changes

Prospective Payment System (PPS)

File	Fiscal Year	Manual	Begin Date	End Date	Layout and Tables	Ebcdic Data	Stata Data	SAS Data	SAS Prog
TEFRA	1983	2552-83	1982-10-01	1983-09-30	tefra.pdf	--	tefra	tefra	--
PPS I Minimum	1984	possibly 2552-84	1983-10-01	1984-09-30	--
PPS II Minimum	1985	probably 2552-85	1984-10-01	1985-09-30	min2.pdf	min2	min2	min2	2_5.sas
PPS III Minimum	1986	2552-85	1985-10-01	1986-09-30	min3	min3	min3
PPS IV Minimum	1987	1986-10-01	1987-09-30	min4.pdf	min4	min4	min4
PPS V Minimum	1988	1987-10-01	1988-09-30	min5.pdf	min5	min5	min5
PPS VI Minimum	1989	2552-85 and 2552-89	1988-10-01	1989-09-30	min6.pdf	min6	min6	min6	6_8.sas
PPS VII Minimum	1990	2552-89	1989-10-01	1990-09-30	min7.pdf	min7	min7	min7
PPS VIII Minimum	1991	1990-10-01	1991-09-30	min8	min8	min8
PPS XIX Minimum	1992	2552-92	1991-10-01	1992-09-30	min9-10.pdf	covr9-12.pdf tbl9-12.pdf	min9	min9	min9	9_10.sas
PPS X Minimum	1993	1992-10-01	1993-09-30	min10	min10	min10
PPS XI Minimum	1994	1993-10-01	1994-09-30	min9-12.pdf	min11	min11	min11	11_12.sas
PPS XII Minimum	1995	1994-10-01	1995-09-30	min12	min12	min12

PPS XIII Minimum	1996	2552-96	1995-10-01	1996-09-30	min13-15.pdf	covr13-15.wpd tbl13-15.wpd	min13	min13a min13b	min13	13_15.sas
PPS XIV Minimum	1997	1996-10-01	1997-09-30	min14	min14a min14b	min14
PPS XV Minimum	1998	1997-10-01	1998-09-30	min15	min15a min15b	min15	15_16.sas
PPS XVI Minimum	1999	1998-10-01	1999-09-30	min16.xls	covr16.wpd tbl16.doc	min16	min16a min16b	min16

PPS II Part B	1985	possibly 2552-85	1984-10-01	1985-09-30	--	2b	--
PPS III Part B	1986	1985-10-01	1986-09-30	3b
PPS IV Part B	1987	1986-10-01	1987-09-30	4b
PPS V Part B	1988	1987-10-01	1988-09-30	5b
PPS VI Part B	1989	2552-85 and 2552-89	1988-10-01	1989-09-30	6b	6b
PPS VII Part B	1990	2552-89	1989-10-01	1990-09-30	7_8b	7b
PPS VIII Part B	1991	1990-10-01	1991-09-30	8b

PPS IV Capital	1987	DK	1986-10-01	1987-09-30	cap1_8.pdf	4cap	sample program
PPS V Capital	1988	1987-10-01	1988-09-30	5cap
PPS VI Capital	1989	1988-10-01	1989-09-30	6cap
PPS VII Capital	1990	1989-10-01	1990-09-30	7cap
PPS VIII Capital	1991	1990-10-01	1991-09-30	8cap

* -- TEFRA stands for Tax Equity and Fiscal Responsibility Act.
This 1982 act defines the primary and secondary coverage responsibilities of the Medicare program and also the provisions to be used by health plans in their contracts with the HCFA (Health Care Financing Administration).

The most up-to-date hospital data for fiscal year 1996 on is the Healthcare Cost Report Information System (HCRIS) data.
PPS 16 / fiscal year 1999 is the last year hospital data was released in PPS format.
Means and Frequencies of these files are available.
The Stata files were created via Stat/Transfer. Stat/Transfer imposed a limit of 2,047 variables. So, the files were split into two pieces. The medicare provider number, f1, is in both datasets.

Send questions to data@nber.org

Last Update: February 22, 2010