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

The North Carolina Department of Health and Human Services collects data on ambulatory surgery and other outpatient services. The types of services collected vary by data year:

• Starting in October 1, 2011, North Carolina collects outpatient data based on the following Uniform Billing Form (UB-04) bill types: ambulatory surgery center (bill type 83x), hospital outpatient (bill type 13x), clinic outpatient rehabilitation (bill type 74x), clinic outpatient comprehensive rehabilitation (bill type 75x), and critical access hospital (bill type 85x).
• Prior to October 1, 2011, North Carolina collected outpatient data only for two bill types: ambulatory surgery center (bill type 83x) and hospital outpatient (bill type 13x).

Outpatient Data File Provided to HCUP by the Partner

The North Carolina Department of Health and Human Services provides HCUP with their complete ambulatory surgery and other outpatient services file, which is provided separately from their emergency department (ED) file.

Selection of Records for Inclusion in the SASD

All records identified by North Carolina as ambulatory surgery (AS) (i.e., included in the separate AS data file provided to HCUP) are included in the SASD (HCUP data element STATE_AS=1 based on applicable bill type values).

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.

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

All licensed facilities in North Carolina are required to report their ambulatory surgery data to the State. To establish an ambulatory surgical facility in North Carolina, the applicant must obtain a certificate of need. The applicant must get approval for the construction of the facility and then apply for and obtain a license and certification to treat patients covered by Medicare or Medicaid. Licenses are renewed every year for both hospital-owned and nonhospital-owned ambulatory facilities.

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.