Types of Ambulatory Surgery and Other Outpatient Services Collected by the Partner

The Georgia Hospital Association (GHA) collects data on ambulatory surgery and other outpatient services such as observation services, imaging, and emergency department (ED) visits. GHA uses the following hierarchy to mark each type of outpatient record with a patient type.

• Ambulatory surgery (patient type A) based on any one of the following criteria
• Ambulatory surgery that originated in the ED (patient type AE)
• Emergency department (patient type E)
• Other outpatient records (patient type O)
• Swing beds (patient type SW)
• Ungrouped outpatient records (patient type U) that did not fit into any of the above definitions.

Because of the hierarchical assignment for the record type, an outpatient encounter that involved ambulatory surgery and observation services is only flagged as ambulatory surgery. However, ambulatory surgery records with evidence of observation services can be identified by HCUP data element HCUP_OS.

Outpatient Data File Provided to HCUP by the Partner

The content of the data file provided to HCUP varies by data year:

• Beginning in data year 2009, GHA has provided HCUP with a data file including all of their ambulatory surgery and other outpatient services (patient types A, AE, and O) and excluding swing beds and ungrouped outpatient records (patient types SW and U).
• Prior to data year 2009, GHA provided HCUP with their complete ambulatory surgery and other outpatient services file (patient types A, AE, O, SW, and U).

Beginning with 2003 ED data, GHA removes from the data any diagnosis codes indicating medical misadventures and adverse reactions.

Selection of Records for Inclusion in the SASD

All records identified by Georgia as ambulatory surgery are included in the SASD (HCUP data element STATE_AS =1 based on patient types A and AE). Any other nonemergent outpatient records (STATE_ED not equal to 1 based on patient types O, SW, and U) also are included in the SASD.

Additionally, any record in the SASD that also have evidence of ED services based on the HCUP criteria (HCUP data element HCUP_ED > 0), are also included in the HCUP State Emergency Department Databases (SEDD). These records will have the same value for the HCUP data element KEY.

SASD with evidence of other types of outpatient service, such as other outpatient services, can be identified by the data element OPService.

Types of Facilities Included in the Files Provided to HCUP by the Partner

GHA collects data on ambulatory surgery and other outpatient services performed in hospital-owned facilities. GHA does not collect data from ambulatory surgery facilities that are not owned by a hospital.

Identification of Hospital-Owned Ambulatory Surgery and Other Types of Outpatient Facilities in the SASD

The designation of a facility as hospital-owned is specific to its financial relationship with a hospital that provides inpatient care and not related to its physical location. Hospital-owned ambulatory surgery and other outpatient care facilities may be contained within the hospital, physically attached to the hospital, or located in a different geographic area. The designation as hospital-owned means that HCUP can identify that the hospital is billing for this service.

Starting in data year 2018, the HCUP data element HOSPITAL_OWNED can be used to identify hospital-owned facilities with ambulatory surgery and possibly other outpatient care data in the SASD. A facility is considered hospital-owned (HOSPITAL_OWNED = 1) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (HOSPITAL_OWNED = 0). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with HOSPITAL_OWNED=0 are hospital-owned.

From data year 1998-2018, the HCUP data element was called FREESTANDING. A facility is considered hospital-owned (FREESTANDING = 0) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (FREESTANDING = 1). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with FREESTANDING=1 are hospital-owned.

Exclusion of Records During HCUP Processing

Beginning with 2016 data, records with a discharge disposition of "still a patient" are retained in the HCUP SASD. Prior to 2016 data, these records were excluded.

Beginning in 2010, records with a designation of "admitted as an inpatient" are retained in the SASD, even though this rarely occurs. Prior to 2010, records with a designation of "admitted as an inpatient" were excluded from the files.