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HCUP Fast Stats - State Trends in Inpatient Stays by Payer
HCUP Fast Stats provides easy access to the latest HCUP-based statistics for health care information topics. This section provides State-level trends in hospital inpatient stays by expected payer.

State Trends in Inpatient Stays by Payer

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*Medicaid expansion State

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*Medicaid expansion State

graphic depiction of State data which is available immediately following this image.
Michigan: All Adult Inpatient Stays by Expected Payer
State Year Qtr. Medicare, age 65+    Medicaid, age 19-64 Private, age 19-64 Uninsured, age 19-64
MI 2007 1 107,000 31,850 85,500 6,800
MI 2007 2 106,800 31,900 86,550 7,750
MI 2007 3 105,550 32,800 84,900 8,350
MI 2007 4 106,950 31,550 83,400 7,850
MI 2008 1 112,150 33,700 83,550 8,000
MI 2008 2 110,700 32,950 85,300 8,500
MI 2008 3 107,200 33,450 84,000 8,550
MI 2008 4 108,200 32,700 83,050 8,250
MI 2009 1 103,700 32,650 79,400 8,100
MI 2009 2 109,150 34,150 81,000 8,800
MI 2009 3 106,950 34,650 79,950 9,000
MI 2009 4 106,700 33,950 78,250 8,600
MI 2010 1 106,250 33,900 75,000 8,400
MI 2010 2 109,350 34,300 76,600 8,450
MI 2010 3 107,600 35,300 75,550 9,100
MI 2010 4 108,150 34,350 74,500 8,250
MI 2011 1 107,100 34,450 74,350 8,050
MI 2011 2 109,900 33,900 75,300 8,200
MI 2011 3 107,700 35,150 75,300 8,600
MI 2011 4 108,850 33,450 73,250 8,200
MI 2012 1 110,050 33,050 72,750 7,800
MI 2012 2 108,450 33,550 72,750 8,550
MI 2012 3 106,150 34,450 72,700 9,050
MI 2012 4 107,050 33,050 72,050 8,300
MI 2013 1 109,800 33,000 68,750 8,500
MI 2013 2 107,350 33,650 69,900 8,750
MI 2013 3 105,500 34,950 69,150 9,050
MI 2013 4 103,850 33,950 68,400 8,150
MI 2014 1 102,300 35,300 63,450 8,050
MI 2014 2 108,250 42,350 66,500 3,450
MI 2014 3 107,100 44,600 67,350 2,950
MI 2014 4 110,850 43,300 66,100 2,600
MI 2015 1 110,000 43,400 63,250 2,000
MI 2015 2 111,950 44,700 65,450 2,150
MI 2015 3 107,900 45,450 65,150 2,450
MI 2015 4 107,600 44,250 62,500 2,100
MI 2016 1 110,400 45,100 61,900 1,950
MI 2016 2 111,900 45,500 62,550 2,000
MI 2016 3 109,500 46,250 62,750 2,350
MI 2016 4 111,500 45,150 61,500 2,200
MI 2017 1 115,150 45,400 58,050 1,950
MI 2017 2 113,900 46,050 60,250 2,000
MI 2017 3 110,300 46,950 59,750 2,250
MI 2017 4 112,850 44,800 60,300 2,100
MI 2018 1 115,250 45,600 58,550 1,900
Values in data table have been rounded to the nearest 50 discharges          
  • Michigan uses a State-Federal partnership marketplace and is a Medicaid expansion State.
  • Michigan implemented a late Medicaid expansion effective April 1, 2014 (three months after the January 1, 2014 target date for Medicaid expansion under the Affordable Care Act).
  • Statistics on the number of eligible individuals who enrolled in marketplace plans are available at the State level from the Office of The Assistant Secretary for Planning and Evaluation (ASPE) in periodic Enrollment Reports posted on their Web site under Affordable Care Act Research.
  • Information on Medicaid and CHIP enrollment is available at the State level from the Centers for Medicare & Medicaid Services (CMS) in monthly reports posted on the Medicaid Web site under Medicaid and CHIP Enrollment Data.
  • Information on the income-based eligibility levels required by the Affordable Care Act and effective as of April 1, 2016 is available at the State level from CMS on the Medicaid Web site under Medicaid and CHIP Eligibility Levels.
  • Yearly information on the percent of adults aged 19 to 64 years who were uninsured is available from the Kaiser Family Foundation (KFF) Web site under State Health Facts.
Michigan: All Adult Inpatient Stays by Expected Payer
State Year Qtr. Medicare, age 65+    Medicaid, age 19-64 Private, age 19-64 Uninsured, age 19-64
MI 2007 1 107,000 31,850 85,500 6,800
MI 2007 2 106,800 31,900 86,550 7,750
MI 2007 3 105,550 32,800 84,900 8,350
MI 2007 4 106,950 31,550 83,400 7,850
MI 2008 1 112,150 33,700 83,550 8,000
MI 2008 2 110,700 32,950 85,300 8,500
MI 2008 3 107,200 33,450 84,000 8,550
MI 2008 4 108,200 32,700 83,050 8,250
MI 2009 1 103,700 32,650 79,400 8,100
MI 2009 2 109,150 34,150 81,000 8,800
MI 2009 3 106,950 34,650 79,950 9,000
MI 2009 4 106,700 33,950 78,250 8,600
MI 2010 1 106,250 33,900 75,000 8,400
MI 2010 2 109,350 34,300 76,600 8,450
MI 2010 3 107,600 35,300 75,550 9,100
MI 2010 4 108,150 34,350 74,500 8,250
MI 2011 1 107,100 34,450 74,350 8,050
MI 2011 2 109,900 33,900 75,300 8,200
MI 2011 3 107,700 35,150 75,300 8,600
MI 2011 4 108,850 33,450 73,250 8,200
MI 2012 1 110,050 33,050 72,750 7,800
MI 2012 2 108,450 33,550 72,750 8,550
MI 2012 3 106,150 34,450 72,700 9,050
MI 2012 4 107,050 33,050 72,050 8,300
MI 2013 1 109,800 33,000 68,750 8,500
MI 2013 2 107,350 33,650 69,900 8,750
MI 2013 3 105,500 34,950 69,150 9,050
MI 2013 4 103,850 33,950 68,400 8,150
MI 2014 1 102,300 35,300 63,450 8,050
MI 2014 2 108,250 42,350 66,500 3,450
MI 2014 3 107,100 44,600 67,350 2,950
MI 2014 4 110,850 43,300 66,100 2,600
MI 2015 1 110,000 43,400 63,250 2,000
MI 2015 2 111,950 44,700 65,450 2,150
MI 2015 3 107,900 45,450 65,150 2,450
MI 2015 4 107,600 44,250 62,500 2,100
MI 2016 1 110,400 45,100 61,900 1,950
MI 2016 2 111,900 45,500 62,550 2,000
MI 2016 3 109,500 46,250 62,750 2,350
MI 2016 4 111,500 45,150 61,500 2,200
MI 2017 1 115,150 45,400 58,050 1,950
MI 2017 2 113,900 46,050 60,250 2,000
MI 2017 3 110,300 46,950 59,750 2,250
MI 2017 4 112,850 44,800 60,300 2,100
MI 2018 1 115,250 45,600 58,550 1,900
Values in data table have been rounded to the nearest 50 discharges.

Transition from ICD-9-CM to ICD-10-CM/PCS Coding

On October 1, 2015, the United States transitioned from ICD-9-CM1 to ICD-10-CM/PCS2. The 2015 data in HCUP Fast Stats include three quarters of information based on ICD-9-CM coding, whereas the fourth quarter is based on ICD-10-CM/PCS coding. Users may observe discontinuity in trends analyses that span the October 1, 2015 transition date. More information on the impact of ICD-10-CM/PCS is available on the HCUP User Support (HCUP-US) Web page for ICD-10-CM/PCS Resources.

1 International Classification of Diseases, Ninth Revision, Clinical Modification
2 International Classification of Diseases, Tenth Revision, Clinical Modification/Procedure Coding System

Inpatient Stays

State-level statistics on inpatient stays are from the HCUP State Inpatient Databases (SID) and quarterly data if available. The unit of analysis is the hospital discharge (i.e., the hospital stay), not a person or patient. This means that a person who is admitted to the hospital multiple times in one year will be counted each time as a separate "discharge" from the hospital.

Counts are summarized by discharge quarter. Information based on quarterly data should be considered preliminary. Quarterly data will be replaced by the State's complete annual SID for the year when it is available.

This analysis is limited to patients treated in community, nonrehabilitation hospitals in the State. Discharge counts for inpatient stays exclude transfers out to another acute care hospital.

We adjust the discharge counts for community, nonrehabilitation hospitals that are not included in the SID or quarterly data. Across all States, the SID are missing about 7 percent of community hospitals and about 1.5 percent of discharges. Weighting for missing hospitals uses the following information from the American Hospital Association (AHA) Annual Survey of Hospitals to define strata within the State:

  • Ownership: government, private nonprofit, and private investor-owned
  • Size of the hospital based on the number of beds: small, medium, and large categories defined within region
  • Location combined with teaching status: rural, urban nonteaching, urban teaching

If a stratum is missing one or more hospitals in the State data, then we set the discharge weight to the total number of discharges reported in the AHA divided by the total number of discharges in the State data. If all hospitals in a stratum are represented in the State data, then we set the discharge weight to 1. We also adjust the discharge weights for hospitals that have missing discharge quarters of data, provided there is no indication in the AHA Annual Survey that the facility had closed.

Discharge weights are specific to the data year for SID through 2012 (e.g., discharge weights for the 2012 SID use 2012 AHA data). Weighting for HCUP data starting in 2013 is based on AHA data from the prior year because current information is often unavailable (e.g., discharge weights for the 2014 SID use 2013 AHA data).

Counts are rounded to the nearest 50 discharges with any counts less than 26 suppressed for confidentiality. This will cause a discontinuity in the trend lines displayed in the figures.

Expected Payer

The "expected payer" data element in HCUP databases provides information on the type of payer that the hospital expects to be the source of payment for the hospital bill. Trends in discharge counts are provided by the following expected primary payers and limited to specific age ranges as indicated:

  • Medicare patients aged 65 years and older
  • Medicaid patients aged 19 to 64 years with the exception that information on maternal discharges is limited to those aged 19 to 45 years
  • Privately insured patients aged 19 to 64 years with the exception that information on maternal discharges is limited to those aged 19 to 45 years
  • Uninsured patients aged 19 to 64 years with the exception that information on maternal discharges is limited to those aged 19 to 45 years

Patients identified as uninsured have an expected primary payer of self-pay, charity, and no charge. Uninsured patients may also include those with an expected payer of Indian Health Services, county indigent, migrant health programs, Ryan White Act, Hill-Burton Free Care, or other State or local programs for the indigent when those programs are identifiable in the Partner-provided coding of expected payer. This reclassification of patients is only possible for some States. More information on identifying programs reported in HCUP data that may cover the uninsured is available in HCUP Methods Series Reports by Topic "User Guide - An Examination of Expected Payer Coding in HCUP Databases" (multiple documents; updated annually).

Discharges with other, missing, or invalid expected primary payer are not reported in Fast Stats reporting by payer. These excluded discharges typically represent approximately 3 to 6 percent of all discharges.

It should be noted that in certain data years and for certain States, data anomalies are identified that may impact the observed trends in inpatients stays by expected primary payer:

  • In the Nebraska SID prior to 2016, some Medicaid managed care patients may have been categorized in the data under private insurance instead of Medicaid because the Medicaid program was managed by a commercial insurance company. Beginning with data year 2016, there are large increases in the number of Medicaid records and proportionate decreases in records categorized as private insurance because the Nebraska Partner organization improved the process for the identification of patients covered by Medicaid managed care programs managed by commercial insurance companies.
  • In the Texas 2004-2011 SID data, some Medicare records were incorrectly mapped to private insurance. Thus, the counts for Medicare are slightly underreported and the counts for private insurance are slightly overreported. This impacts roughly 1.5-3.5 percent of SID records between 2004-2011.
  • In the Vermont 2015 SID, increases in Medicaid should be considered an anomaly. Vermont briefly modified their billing process in late 2014, which led to increases in records with a primary expected payer value of Medicaid. In 2016 data, the coding of Medicaid returns to a normal level that is consistent with historical data.

Maternal

Adult discharges are categorized into five hospitalization types in the following hierarchical order: maternal, mental health/substance use, injury, surgical, and medical. Maternal hospitalizations are identified using the Clinical Classifications Software (CCS) for ICD-9-CM and for ICD-10-CM tools, and specifically defined as a principal diagnosis CCS code in any one of the following:
176: Contraceptive and procreative management
177: Spontaneous abortion
178: Induced abortion
179: Postabortion complications
180: Ectopic pregnancy
181: Other complications of pregnancy
182: Hemorrhage during pregnancy; abruptio placenta; placenta previa
183: Hypertension complicating pregnancy; childbirth and the puerperium
184: Early or threatened labor
185: Prolonged pregnancy
186: Diabetes or abnormal glucose tolerance complicating pregnancy; childbirth; or the puerperium
187: Malposition; malpresentation
188: Fetopelvic disproportion; obstruction
189: Previous C-section
190: Fetal distress and abnormal forces of labor
191: Polyhydramnios and other problems of amniotic cavity
192: Umbilical cord complication
193: OB-related trauma to perineum and vulva
194: Forceps delivery
195: Other complications of birth; puerperium affecting management of mother
196: Normal pregnancy and/or deliver

This definition of maternal, which relies on the CCS categories, may result in slightly different counts of discharges when compared with other ways of classifying diagnosis codes. For example, compared with using Major Diagnostic Categories (MDCs), the CCS approach assigns 0.9 percent fewer cases to "maternal" because a maternal discharge is classified into a mental health CCS or a substance use CCS when the diagnosis code includes a mental health or substance abuse condition along with a maternal condition (e.g., drug dependence in pregnancy).

Mental Health/Substance Use

Adult discharges are categorized into five hospitalization types in the following hierarchical order: maternal, mental health/substance use, injury, surgical, and medical. Mental health/substance use hospitalizations are identified using the Clinical Classifications Software (CCS) for ICD-9-CM and for ICD-10-CM tools, and specifically defined as a principal diagnosis CCS code in any one of the following:
Starting in 2007
650: Adjustment disorders
651: Anxiety disorders
652: Attention-deficit, conduct, and disruptive behavior disorders
653: Delirium, dementia, and amnestic and other cognitive disorders
654: Developmental disorders
655: Disorders usually diagnoses in infancy, childhood, or adolescence
656: Impulse control disorders, NEC
657: Mood disorders
658: Personality disorders
659: Schizophrenia and other psychotic disorders
660: Alcohol-related disorders
661: Substance-related disorders
662: Suicide and intentional self-inflicted injury
663: Screening and history of mental health and substance abuse codes
670: Miscellaneous disorders
From 2003 through 2006
65: Mental retardation
66: Alcohol-related mental disorders
67: Substance-related mental disorders
68: Senility and organic mental disorders
69: Affective disorders
70: Schizophrenia and related disorders
71: Other psychoses
72: Anxiety; somatoform; dissociative; and personality disorders
73: Preadult disorders
74: Other mental conditions
75: Personal history of mental disorder; mental and behavioral problems; observation and screening for mental condition

Beginning with the 2017 data year, the Iowa SID includes records for behavioral health patients treated in chemical dependency or psychiatric care units. Prior to 2017 data, these records were prohibited from release, and therefore not reported within this section of Fast Stats.

Injury

Adult discharges are categorized into five hospitalization types in the following hierarchical order: maternal, mental health/substance use, injury, surgical, and medical. Injury discharges are identified by a principal diagnosis in the following ranges of ICD-10-CM and ICD-9-CM codes:

ICD-10-CM Codes Starting October 1, 2015
  • S00-T34 series: Injuries to the head, neck, thorax, abdomen, lower back, lumbar spine, pelvis, external genitals, shoulder and upper arm, elbow and forearm, wrist, hand, fingers, hip and thigh, knee and lower leg, ankle and foot; injuries involving multiple body regions; injury of unspecified body region; effects of foreign body entering through natural orifice; burns and corrosions of external body surface, specified by site; burns and corrosions confined to eye and internal organs; burns and corrosions of multiple and unspecified body regions; frost bite; including initial encounters, subsequent encounters, and sequela
  • T36-T50 series: Poisoning by, adverse effect of and underdosing of drugs, medicaments, and biological substances; including initial encounters, subsequent encounters, and sequela; excluding adverse effects and underdosing of drugs, medicaments and biological substances (codes with the 6th character of 5 or 6 or with the 5th-6th characters of 5X or 6X)
  • T51-T75 series: Toxic effects of substances chiefly nonmedicinal as to source; other and unspecified effects of external causes; including initial encounters, subsequent encounters, and sequela
  • T76 series: Adult and child abuse, neglect and other maltreatment, suspected; including initial encounters, subsequent encounters, and sequela
  • T79 series: Certain early complications of trauma, not elsewhere classified; including initial encounters, subsequent encounters, and sequela

The above definition of injury includes ICD-10-CM diagnosis codes that also are included under two CCS diagnosis categories used for the definition of the mental health/substance use hospitalization type:

  • CCS = 661 (Substance-related disorders): ICD-10-CM diagnoses with the first three digits of T40 indicating poisoning by, adverse effect of, and underdosing of narcotics and psychodysleptics [hallucinogens]; excluding adverse effects and underdosing (codes with the 6th character of 5 or 6)
  • CCS = 662 (Suicide and intentional self-inflicted injury): ICD-10-CM diagnosis of T14.91 indicating suicide attempt or diagnoses with the first three digits of T36-T65 or T71 indicating poisoning by, adverse effect of, and underdosing of drugs, medicaments, and biological substances; toxic effects of substances chiefly nonmedicinal as to source; asphyxiation

Because of the hierarchical ordering used to assign discharges to hospitalization type, discharges with these principal ICD-10-CM diagnosis codes are assigned to the mental health/substance use hospitalization type and not the injury hospitalization type.

A full list of the ICD-10-CM codes used in the definition of injury is available in the exported data file, which can be downloaded by expanding "Show Data Export Options."

ICD-9-CM Codes Prior to October 1, 2015
  • 800-909.2, 909.4, 909.9: Fracture of skull, spine, trunk, upper limb, and lower limb; dislocation; sprains and strains of joints and adjacent muscles; intracranial injury, excluding those with skull fracture; internal injury of chest, abdomen, and pelvis; open wound of the head, neck, trunk, upper limb, and lower limb; injury to blood vessels; late effects of injury, poisoning, toxic effects, and other external causes, excluding those of complications of surgical and medical care and drugs, medicinal or biological substance
  • 910-994.9: Superficial injury; contusion with intact skin surface; crushing injury; effects of foreign body entering through orifice; burns; injury to nerves and spinal cord; certain traumatic complications and unspecified injuries; poisoning by drugs, medicinals, and biological substance; toxic effects of substances chiefly nonmedicinal as to source; other and unspecified effects of external causes
  • 995.50-995.59: Child maltreatment syndrome
  • 995.80-995.85: Adult maltreatment, unspecified; adult physical abuse; adult emotional/ psychological abuse; adult sexual abuse; adult neglect (nutritional); other adult abuse and neglect

The above definition of injury includes five ICD-9-CM diagnosis codes that are also included under two CCS diagnosis categories used for the definition of the mental health/substance use hospitalization type:

  • CCS = 660 (Alcohol-related disorders): ICD-9-CM diagnosis 980.0 (toxic effect of ethyl alcohol)
  • CCS = 661 (Substance-related disorders): ICD-9-CM diagnoses 965.00 (poisoning by opium (alkaloids), unspecified), 965.01 (poisoning by heroin), 965.02 (poisoning by methadone), 965.09 (poisoning by other opiates and related narcotics)

Because of the hierarchical ordering used to assign discharges to hospitalization type, discharges with one of these five principal ICD-9-CM diagnosis codes are assigned to the mental health/substance use hospitalization type and not the injury hospitalization type.

Excluded Codes

It should be noted that ICD-9-CM and ICD-10-CM diagnosis codes related to complications of surgical or medical care, or adverse events or anaphylactic shock resulting from medication, anesthesia, or food are not used in the definition of the injury hospitalization type.

Surgical

Adult discharges are categorized into five hospitalization types in the following hierarchical order: maternal, mental health/substance use, injury, surgical, and medical. Surgical discharges are identified by a surgical diagnosis-related group (DRG). The DRG grouper first assigns the discharge to a major diagnostic category (MDC) based on the principal diagnosis. For each MDC, there is a list of procedure codes that qualify as operating room procedures. If the discharge involves an operating room procedure, it is assigned to one of the surgical DRGs within the MDC category; otherwise it is assigned to a medical DRG. If the DRG indicates the information on the record is ungroupable (i.e., not identifiable as medical or surgical), then the discharge is assumed to be medical. This rarely occurs (less than 0.1 percent of total discharges).

Medical

Adult discharges are categorized into five hospitalization types in the following hierarchical order: maternal, mental health/substance use, injury, surgical, and medical. Medical discharges are identified by a medical DRG. The DRG grouper first assigns the discharge to an MDC based on the principal diagnosis. For each MDC there is a list of procedure codes that qualify as operating room procedures. If the discharge involves an operating room procedure, it is assigned to one of the surgical DRGs within the MDC category; otherwise it is assigned to a medical DRG. If the DRG indicates the information on the record is ungroupable (i.e., not identifiable as medical or surgical), then the discharge is assumed to be medical. This rarely occurs (less than 0.1 percent of total discharges).

Asthma

Asthma discharges are identified by a principal diagnosis CCS code of 128 (asthma) as defined in the Clinical Classifications Software (CCS) for ICD-9-CM and for ICD-10-CM tools.

It should be noted that beginning with the transition to the ICD-10-CM/PCS coding system on October 1, 2015, a noticeable decrease in the number of asthma-related inpatient stays was observed for adults aged 65 years and older in most States. Additional information regarding this pattern is available on the HCUP-US Web page for ICD-10-CM/PCS Resources under "ICD-10-CM/PCS Coding in HCUP Data: Comparisons with ICD-9-CM and Precautions for Trend Analyses" in the report ICD-10-CM Diagnosis Coding Trends.

Congestive Heart Failure

The reporting of Congestive Heart Failure (CHF) in HCUP Fast Stats has been discontinued as of November 2017 because a change in the ICD-10-CM coding guidelines effective October 1, 2016 has caused a discontinuity in the trend. Congestive heart failure discharges had been identified by a principal diagnosis CCS code of 108 (congestive heart failure; nonhypertensive) as defined in the Clinical Classifications Software (CCS) for ICD-9-CM and for ICD-10-CM tools. There is a sharp decline in the number of CHF discharges identified by CCS 108 because the revised coding criteria specify that whenever codes for CHF and hypertension co-occur on the record, the discharge must be coded to the ICD-10-CM code for hypertension complicated by CHF. The CHF option has been removed from the active query tool, but historical data previously reported in HCUP Fast Stats for CHF (with data reported through 2016 Q3 for some States) is offered in the Excel download file, which can be downloaded by expanding "Show Data Export Options."

Diabetes

Diabetes discharges are identified by a principal diagnosis CCS code of 49 (diabetes mellitus without complication) or 50 (diabetes mellitus with complications), as defined in the Clinical Classifications Software (CCS) for ICD-9-CM and for ICD-10-CM tools.

State-Specific Medicaid Expansion Information Sources

The State-specific Medicaid expansion information quoted on this site is compiled from the Kaiser Family Foundation (kff.org):3

When these sources indicate a definitive implementation date for expansion, and HCUP data are available for the time period covered by the expansion, the graphs in this section of Fast Stats show a vertical dotted line marking the initial Medicaid expansion date.

3 The U.S. Department of Health and Human Services (HHS) is offering this link for informational purposes only, and this fact should not be construed as an endorsement of the host organization's programs or activities.

Use this export feature to download all of the underlying data (quarterly counts by hospitalization type and payer) for all available States in Microsoft Excel (.xls) format. Values have been rounded to the nearest 50 discharges.

  1. Click this Excel Export link to request the download.
  2. Follow the prompts to save a copy of the Excel file to your computer. Prompting will vary by browser.
  3. If you decide to use these data for publishing purposes please refer to Requirements for Publishing with HCUP Data.


Internet Citation: HCUP Fast Stats. Healthcare Cost and Utilization Project (HCUP). November 2018. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/faststats/statepayer/statepayer.jsp?state1=MI.
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Last modified 11/27/2018