Tessa Quinn
The Centers for Medicare & Medicaid Services (CMS) offers a wide range of data and statistics on healthcare facilities and providers. CMS data includes hospital-specific charges and clinical data from individual hospitals. This data is collected and published by CMS through initiatives such as the Acute Hospital Care at Home (AHCAH) program, which was introduced during the COVID-19 pandemic, as well as the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. CMS data is available for interactive analysis on Data.CMS.gov, and annual statistics booklets are published each June.
| Characteristics | Values |
|---|---|
| Data Availability | Data is available from 2003 to the most recent calendar year |
| Data Sources | Data.Medicare.gov, Data.CMS.gov, Physician and Other Supplier Look-up Tool |
| Data Type | Hospital-specific charges, Medicare payment amounts, beneficiary enrollment information, clinical data, cardiovascular disease risk reduction model data |
| Data Frequency | Weekly, monthly, annually |
| Data Format | Interactive datasets, statistics reference booklets, searchable database |
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What You'll Learn
CMS data on hospital charges
The data covers calendar years 2011 and 2012 and is based on the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Years (FY) 2011 and 2012. It includes estimated hospital-specific charges for 30 Ambulatory Payment Classification (APC) Groups paid under the Medicare Outpatient Prospective Payment System (OPPS). The Medicare payment amount comprises the APC payment amount, the Beneficiary Part B coinsurance amount, and the Beneficiary deductible amount.
In addition to the hospital charge data, CMS also provides a Statistics Reference Booklet published annually in June, containing the most current information available at the time of publication. These booklets have been published from 2003 onwards and are available on Data.Medicare.gov for download and exploration. The website also features a lookup tool that allows users to search for providers by name, location, or National Provider Identifier (NPI) and access information on services, procedures, and payment amounts.
Furthermore, CMS maintains cost report data in the Healthcare Provider Cost Reporting Information System (HCRIS). This system includes data for various cost reports, such as the Hospital Cost Report, Skilled Nursing Facility Cost Report, and Home Health Agency Cost Report. The cost reports contain provider information such as facility characteristics, utilisation data, cost and charges by cost centre, and financial statement data. Individual cost reports can be requested through the Freedom of Information Act (FOIA).
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Medicare payment amounts
CMS data for individual hospitals is available for download and exploration on Data.Medicare.gov. The data includes hospital-specific charges for over 3,000 US hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges. This information is from 2011 and 2012, and the amounts billed are based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG).
The Medicare Part A inpatient hospital deductible that beneficiaries pay when admitted to the hospital was $1,632 in 2024 and increased to $1,676 in 2025. This deductible covers the beneficiary's share of costs for the first 60 days of inpatient care. After that, beneficiaries must pay a coinsurance amount per day for each additional day of hospitalization.
For high-income beneficiaries, the monthly premium for Medicare Part B is higher. This additional amount is called the "income-related monthly adjustment amount" and is based on the beneficiary's income reported to the IRS. The specific premium amount is determined using a base premium specified by law.
Medicare Part B also has an annual deductible and coinsurance amount. The annual deductible for 2025 is $257, and the coinsurance amount is 20% of the Medicare-approved amount for most doctor services after the beneficiary has met the $233 yearly deductible.
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Hospital characteristics
The American Hospital Directory (AHD) is another source of hospital characteristics data. AHD offers a database of hospital information and analytics, including free hospital profiles with key characteristics such as bed size, discharges, patient days, and gross patient revenue. AHD also provides custom datasets and other information resources tailored to specific needs and interests, such as matching hospital characteristics with key personnel.
The NIH Library also provides access to hospital data through its Hospital Data subject guide. This includes the State Inpatient Databases (SID), which contain clinical and resource use information from participating states, as well as the State Ambulatory Surgery Databases (SASD) and State Emergency Department Databases (SEDD), which capture data on same-day surgeries and emergency department visits that do not result in admission, respectively.
Additionally, specific states may have their own datasets on hospital characteristics. For example, the California Health and Human Services Open Data Portal provides a list of 15 characteristics for California hospitals for State Fiscal Year 2019-20. This dataset includes information such as the hospital's Department of Health Care Access and Information (HCAI) ID, designated neonatal intensive care unit status, cost-to-charge ratio, and wage index value.
Overall, there are a variety of sources of hospital characteristics data available, ranging from government agencies like CMS and the NIH Library to private companies like the American Hospital Directory. These sources provide data on hospital charges, clinical and resource use information, utilization statistics, and other characteristics that can be used for research, analysis, and decision-making in the healthcare industry.
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Raw clinical data
CMS data is specific to individual healthcare facilities that treat Medicare patients. It includes information on hospital-acquired infections (HAI), blood compatibility, and air embolisms. CMS has published this data in a raw spreadsheet format. The data covers calendar years 2011 and 2012 and contains hospital-specific charges for the Medicare Outpatient Prospective Payment System (OPPS) and the Medicare Inpatient Prospective Payment System (IPPS).
The raw data is available directly from the CMS Hospital Compare Archive, which includes information going back several years. The archive contains hospital-level information on healthcare-associated infections and patient responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey.
In addition to the above, the CMS Innovation Center has released raw clinical file data for the Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model. This model was a randomized controlled trial that provided incentives for healthcare practitioners to engage in beneficiary CVD risk calculation and population-level risk management. The Visit file within this dataset contains all data extracted to create a beneficiary visit, including manually entered data from the model data collection registry.
The Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020, collects data from individual hospitals on a weekly or monthly basis. The data includes beneficiary enrollment information for Medicare Advantage (Part C) and the Prescription Drug Program (Part D).
CMS also publishes Statistics Reference Booklets annually in June, representing the most current information available at the time of publication. The booklets are available from 2003 onwards, and the data can be downloaded and explored interactively on the Data.CMS.gov website.
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Cardiovascular disease risk reduction
The Million Hearts® Cardiovascular Disease (CVD) Risk Reduction Model is a randomized controlled trial that aims to prevent one million heart attacks and strokes by encouraging healthcare practitioners to engage in beneficiary CVD risk calculation and population-level risk management. The model incentivizes organizations to calculate the risk for eligible Medicare beneficiaries by using a modified version of the ACC/AHA ASCVD ten-year pooled cohort risk calculator. This calculator helps develop risk modification plans based on beneficiary risk profiles. The target population for this model is Medicare FFS beneficiaries aged 40-79 who have not experienced a heart attack, stroke, or transient ischemic attack.
The Million Hearts® CVD Risk Reduction Model proposes a novel approach to lowering CVD risks. Instead of screening for individual risk factors like blood pressure or cholesterol, the model utilizes data-driven predictive modeling to generate personalized risk scores and mitigation plans for eligible individuals. This method ensures that those at the highest risk for atherosclerotic cardiovascular disease (ASCVD) are identified and prioritized.
The Acute Hospital Care at Home (AHCAH) initiative, launched in November 2020 during the COVID-19 pandemic, enables Medicare-certified hospitals to provide inpatient-level care to patients in the comfort of their homes. The AHCAH dataset contains valuable information collected directly from individual hospitals on a weekly or monthly basis. This data is based on the hospitals' experience with delivering hospital-at-home services, ensuring that patients receive the necessary care while reducing the strain on healthcare facilities.
CMS publishes a Statistics reference booklet annually in June, containing the most current information available. Additionally, the Data.CMS.gov platform allows users to interactively analyze datasets in real-time, and the Physician and Other Supplier Lookup Tool enables users to search for providers by name, location, or National Provider Identifier (NPI). These resources provide transparent access to Medicare data, payment amounts, and utilization information, empowering users to make informed decisions and stay informed about healthcare facilities and services.
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Frequently asked questions
CMS data for individual hospitals is used to inform patients about hospital-specific charges and the services they provide. This data also helps patients understand the payment amounts for these services.
CMS data for individual hospitals is collected either weekly or monthly, depending on the hospital's participation tier.
CMS data for individual hospitals can be found on Data.CMS.gov, where users can interactively analyse datasets in real-time.
