2005-06 INPATIENT Cost Data Edits

* DHS PRELIMINARY INPATIENT COST DATA EDITS;



* CODE 1 - NEGATIVE COSTS OF LESS THAN $1.00 CONTAINED IN COST CATEGORIES;
if allied   < (-1) then eflag1 = 'E';
if ccu      < (-1) then eflag1 = 'E';
if emerg    < (-1) then eflag1 = 'E';
if icu      < (-1) then eflag1 = 'E';
if imaging  < (-1) then eflag1 = 'E';
if medsurg  < (-1) then eflag1 = 'E';
if mednon   < (-1) then eflag1 = 'E';
if nursing  < (-1) then eflag1 = 'E';
if path     < (-1) then eflag1 = 'E';
if pharm    < (-1) then eflag1 = 'E';
if theator  < (-1) then eflag1 = 'E';
if theatnor < (-1) then eflag1 = 'E';
if other    < (-1) then eflag1 = 'E';
if prosth   < (-1) then eflag1 = 'E';
if s100     < (-1) then eflag1 = 'E';
if hithcost < (-1) then eflag1 = 'E';



* CODE 2 - RECORD CONTAINS INVALID OR NULL DRG;
if w13vicdrg in ('') then eflag2 = 'E';



* CODE 3 - NEGATIVE TOTAL COST;
if totcost < 0 then eflag3 = 'E';



* CODE 4 - ZERO TOTAL COST;
if totcost eq 0 then eflag4 = 'E';



* CODE 5 - SAME DAY EPISODE WITH TOTAL COST LESS THAN $50;
if sameday in ('Y') and (0 < totcost < 50) then do;

 if sepmode not in ('D','T') then eflag5 = 'E'; 
   * ie, if patient did not die or was not transferred, then flag as error;

 if sepmode in ('D','T') and totcost lt 40 then eflag5 = 'E';
   * ie, if patient died or was transferred, then flag if cost is less than $40;

end;



* CODE 6 - NON SAMEDAY EPISODES WITH TOTAL COST LESS THAN $300;

mds_cpd = totcost / los;
 * ie, calculate cost per day for non-sameday episodes with total cost < $300;

if sameday in ('N') and (0 < totcost < 300) then do;

     if sepmode not in ('D','T') and w13vicdrg not in ('P66D','P67D') then do;
        if mds_cpd lt 100 then eflag6 = 'E'; end;
          * ie, flag non-died, non-transferred, non normal birth episodes with < $100 per day;

     if sepmode not in ('D','T') and w13vicdrg in ('P66D','P67D') then do;
        if mds_cpd lt 50 then eflag6 = 'E'; end;
          * ie, flag non-died, non-transferred normal birth episodes with < $50 per day;

     if sepmode in ('D','T') and w13vicdrg not in ('P66D','P67D') then do; 
        if mds_cpd lt 70 then eflag6 = 'E'; end;
          * ie, flag died or transferred, non normal birth episodes with < $70 per day;

     if sepmode in ('D','T') and w13vicdrg in ('P66D','P67D') then do; 
        if mds_cpd lt 50 then eflag6 = 'E'; end;
          * ie, flag died or transferred normal birth episodes with < $50 per day;
     
end;



* CODE 7 - TOTAL COST > $200,000;
if totcost > 200000 then eflag7 = 'E';



* CODE 8 - DAILY AVERAGE COST > (5 x DRG DAILY AVERAGE);
if (avetot not in ('','.')) and (avetot > 0) then do;
if ((totcost/los) > (5*avetot)) then eflag8 = 'E';
end;



* CODE 9 - TOTAL COST PER DAY FOR REHABILITATION EPISODES > $3,000 per day;
if care in ('2','6','7') then do;
avetotcost = totcost / los;
if avetotcost > 3000 then eflag9 = 'E';
end;



* CODE 10 - TOTAL COST BALANCES WITH SUM OF COST CATEGORIES (+/- $30);
diff = totcost - totbuckets;
if ((diff > 30) or (diff < -30)) then eflag10 = 'E';



* CODE 11 - ICU Costs: Flag if ICU hours > 0 & ICU costs = $0;
if icuhrs gt 0 and icu eq 0 then eflag11 = 'E';

* CODE 12 - ICU Costs: Flag if ICU hours = 0 & ICU costs > $0;
if icuhrs eq 0 and icu gt 0 then eflag12 = 'E';

* CODE 13 - CCU Costs: Flag if CCU hours > 0 & CCU costs = $0;
if ccuhrs gt 0 and ccu eq 0 then eflag13 = 'E';

* CODE 14 - CCU Costs: Flag if CCU hours = 0 & CCU costs > $0;
if ccuhrs eq 0 and ccu gt 0 then eflag14 = 'E';