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

The New York State Department of Health Office of Quality and Patient Safety collects data on ambulatory surgery and other outpatient services as part of their Statewide Planning and Research Cooperative System (SPARCS). Legislation enacted in April 2006 provides for the expansion of the SPARCS outpatient data-reporting requirements. This Expanded Outpatient Data Collection (EODC) effort includes all hospital outpatient areas such as physical therapy, speech pathology, and dialysis. Data year 2011 was the first year that hospital outpatient departments began reporting all of their outpatient data.

Identification of the type of outpatient record varies across data years. In all years, SPARCS marked a record as ambulatory surgery based on specific revenue codes and nonmissing information on the procedure time, method of anesthesia, and operating room physician identifier. The difference across data years is the range of revenue codes used to define ambulatory surgery.

• Beginning in data year 2010
  • An ambulatory surgery record marked with the record type "A" included at least one of the following revenue center codes:
    • 0360, 0362, 0369 for operating room services
    • 0481 for cardiac catheterization
    • 0490 and 0499 for ambulatory surgery
    • 0750 for gastrointestinal services
    • 0790 for lithotripsy
  • All other outpatient records were marked with the record type of "O".
• Prior to data year 2010
  • An ambulatory surgery record marked with the record type "A" included at least one of the following expanded list of revenue center codes:
    • 0360, 0362, 0369 for operating room services
    • 0481 for cardiac catheterization
    • 0490 and 0499 for ambulatory surgery
    • 0750 for gastrointestinal services
    • 0790 for lithotripsy
    • 0321 for angiocardiography
    • 0322 for arthrography
    • 0323 for arteriography
    • 0361 for minor surgery
    • 0480 for general cardiology
    • 0489 for other cardiology
    • 0710 for recovery room
    • 0719 for other recovery room
    • 0760 for treatment/observation room
    • 0761 for treatment room
    • 0769 for other treatment/observation room.
  • All other outpatient records were marked with the record type of "O".

It should be noted that if the anesthesia service is reported on a separate record from the surgery, then the surgery record will not be flagged as ambulatory surgery (record type "A") because SPARCS requires both services to be indicated on the same record to qualify as ambulatory surgery.

Outpatient Data File Provided to HCUP by the Partner

SPARCS provides two outpatient data sets to HCUP. One includes emergency department visits. The types of outpatient data included in the other file vary by data year:

• Beginning in data year 2012, SPARCS has provided HCUP with their complete ambulatory surgery and other outpatient services file with the type of outpatient service identified by record type. The record type is stored in the HCUP data element OPservice. It should be noted that the other outpatient service records (OPservice=O) are missing some essential data elements such as primary expected payer (PAY1_X, PAY1) and discharge disposition (DISP_X, DISPUB04, DISPUNIFORM) because this information is not required to be reported by the hospitals for this record type.
• For data year 2011, SPARCS provided HCUP with ambulatory surgery records (patient type A) defined using a narrow selection of revenue center codes (listed above) but also included some records for other outpatient services such as laboratory and x-rays.
• For data year 2010, SPARCS provided HCUP with ambulatory surgery records (patient type A) defined using a narrow selection of revenue center codes (listed above).
• Prior to data year 2010, SPARCS provided HCUP with ambulatory surgery records (patient type A) defined using a wide selection of revenue center codes (listed above).

New York sets certain data elements to missing (blank) in the source file when the record contains an indication of an induced abortion or AIDS/HIV.

Selection of Records for Inclusion in the SASD

All records in the separate nonemergent outpatient data file are included in the SASD (STATE_AS=1 based on record types A and O).

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

New York requires a Certificate of Need (CON) to operate for licensure. Since 1984, every licensed facility that operates as an ambulatory surgery facility has been required to report to SPARCS. This includes hospital-owned and nonhospital-owned facilities.

Legislation enacted in April 2006 provides for the expansion of the SPARCS outpatient data-reporting requirements from facilities licensed to perform ambulatory surgery to all facilities licensed as diagnostic and treatment centers. The EODC effort was first implemented with hospital outpatient departments starting in data year 2011. SPARCS expects hospital-owned clinics to start reporting EODC in data year 2013 and other diagnostic and treatment centers to start reporting EODC sometime thereafter.

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.