Hospital Discharge Data

Vermont has been collecting and reporting hospital discharge data since the early 1980s. All 14 of Vermont's general acute care hospitals currently contribute records for Vermont residents and non-residents to the Vermont Uniform Hospital Discharge Data System.

Under the statutory authority to collect these data (18 V.S.A. § 9410, 9456 and 9457)­­­­­­, the Vermont Green Mountain Care Board (GMCB) administers the program and the Vermont Department of Health manages the data set under an agreement with the Green Mountain Care Board.

Under interstate agreements with agencies outside of Vermont, the Green Mountain Care Board also receives hospital discharge data for Vermont residents using hospitals in bordering states, including New Hampshire, New York, and Massachusetts. The final data set comprises the Vermont Uniform Hospital Discharge Data System that is used by the Health Department in analyses for the Vermont Hospitals Report on utilization.

The Vermont Hospital Utilization Reports (formerly known as the Monograph Series) present aggregated information about hospital services provided across three hospital settings: inpatient, outpatient and emergency department.

Data are presented in two basic ways – hospital-based analyses and hospital service area analyses:

• Hospital-based analyses compare data by Vermont hospital and include all patients who received services from each hospital, regardless of whether they reside in Vermont or in another state.
• Hospital service area population-based analyses are used to compare data for residents of 13 geographic regions of Vermont who were provided inpatient services in any Vermont, New Hampshire, New York or Massachusetts hospital.
• The Vermont Hospitals Report for 2010 through 2020 are based only on discharge data from Vermont hospitals. Because complete data for Vermont residents using hospitals in bordering states were not available at the time of production of these reports, it was not possible to provide accurate population-based rates for Vermont residents in these reports.
• Extensive analyses by hospital service area are provided in the 2004 and 2005 Vermont Hospital Monographs Series and the 2006 through 2009 Vermont Hospital Utilization Reports. The Highlights section in the 2006-2009 reports is an abbreviated version of what was known as the Monograph Companion through 2005.

The public use files are derived from the Vermont Uniform Hospital Discharge Data System. With the public use files, data users can generate their own reports about the use of the Vermont hospitals by residents and non-residents.

Public use files include:

• Vermont hospital records for inpatient, outpatient, emergency department, observation bed, and series patient discharges for both Vermont residents and non-residents.
• A set of fields common in discharge data files, such as codes for hospitals, diagnoses and procedures, age group, sex, hospital service area, and non-professional charges.

Public use files exclude:

• Information that could potentially identify a person to protect the privacy of individuals.
• Data from the Vermont psychiatric hospitals, including the Brattleboro Retreat and the Vermont State Hospital. The Department of Mental Health collects data from these psychiatric hospitals, and their reports can be found at the Department of Mental Health's website.
• Data for Vermont residents using hospitals outside of Vermont. 

Before downloading these files, read through the Frequently Asked Questions, where you will find important information about the contents of the files.

Note that significant changes have been made in the reporting of outpatient procedures and services in the 2014 data files, and in the reporting of all diagnoses and inpatient procedures in the 2015 data files. 

Vermont has been collecting and reporting hospital discharge data since the early 1980s. All 14 of Vermont's general acute care hospitals currently contribute records for Vermont residents and non-residents to the Vermont Uniform Hospital Discharge Data System (VUHDDS). Under the statutory authority to collect these data (18 V.S.A. § 9410, 9456 and 9457)­­­­­­, the Vermont Green Mountain Care Board administers the program and the Vermont Department of Health manages the data set under an agreement with the Board.

The Vermont Association of Hospitals and Health Systems-Network Services Organization contracts with the state of Vermont to collect the Vermont hospitals data that are then incorporated into the Vermont Uniform Hospital Discharge Data System following a series of quality assurance checks performed by the Health Department. The Vermont psychiatric hospitals, including the Brattleboro Retreat and the Vermont State Hospital, do not submit data to this data system.

In addition to the data collected from Vermont hospitals, the Green Mountain Care Board obtains records for Vermont residents using hospital services in the bordering states of New Hampshire, New York and Massachusetts under data use agreements with the New Hampshire Department of Health and Human Services, the New York Department of Health, and the Massachusetts Division of Health Care Finance and Policy. While records for Vermont residents using hospitals in New Hampshire, New York, and Massachusetts include inpatient discharges, not all states collect comparable data sets for outpatient and emergency department discharges. The Green Mountain Care Board is prohibited from releasing records obtained from these bordering states per provisions of the data use agreements with each state.

The Vermont hospital subset of the Vermont Uniform Hospital Discharge Data System includes records for inpatient, outpatient, emergency department, observation bed, and series patient discharges for both Vermont residents and non-residents. The collection of emergency department records from Vermont hospitals began with reporting year 2003. From 1989 to 2000, outpatient data collection was limited to records that each hospital identified as surgical procedures performed in operating rooms. Starting in reporting year 2001, the outpatient definition was revised to include ICD-9-CM procedure codes 00.0-86.99 that occurred in all hospital-based outpatient settings. Starting in reporting year 2006, while all Vermont hospitals continued to report the core outpatient set specified by code range, most hospitals also started to submit all records considered outpatient procedures beyond the specified code range. This includes a wider range of diagnostic procedures and treatments. The Green Mountain Care Board is working with the Health Department, The Vermont Association of Hospitals and Health Systems-Network Services Organization, and Vermont hospitals to determine how to define, edit, and use the expanded outpatient data set.

Release of public use data is subject to the following conditions, which the requestor agrees to comply with upon accepting copies of the data:

Hospital Data Release Policy (Last updated November 2002) – The data may not be used in any manner that attempts to or does identify, directly or indirectly, any individual patient or health care practitioner (18 V.S.A. § 9457). The requestor agrees to incorporate the following, or a substantially similar, disclaimer in all reports or publications that include public use data:

“Hospital discharge data for use in this study were supplied by the Vermont Association of Hospitals and Health Systems-Network Services Organization (VAHHS-NSO) and the Vermont Green Mountain Care Board (GMCB). All analyses, interpretations or conclusions based on these data are solely that of [the requestor]. VAHHS-NSO and GMCB disclaim responsibility for any such analyses, interpretations or conclusions. In addition, as the data have been edited and processed by VAHHS-NSO, GMCB assumes no responsibility for errors in the data due to coding or processing by hospitals, VAHHS-NSO or any other organization, including [the requestor].”

Public use file data elements

• Patient type (Inpatient, Outpatient, Emergency Department, Observation Bed, Series Patient, Expanded Outpatient)
• Hospital of discharge
• Admission type
• Admission source
• Age groups: Under 1, 1-17, 18-24, 25-29, 30-34, 35-39, 40-44, 45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75+
• Sex
• Discharge status
• Principal payment source
• Total charges
• Special Care Unit (SCU) days (Inpatient only)
• Diagnosis related group (DRG) (Inpatient only)
• Major diagnostic category (MDC) (Inpatient only)
• Grouper used to assign DRG and MDC (Inpatient only)
• Principal diagnosis and up to 19 secondary diagnoses (ICD-9-CM coding system prior to October 1, 2015; ICD-10-CM coding system from October 1, 2015 forward)
• Principal procedure and up to 19 secondary procedures (ICD-9-CM coding system for all inpatients and outpatients prior to July 1, 2014; HCPCS/CPT coding system for outpatient procedures as of July 1, 2014; ICD-10-CM coding system for all inpatients from October 1, 2015 forward)
• E-codes (up to three; ICD-9-CM coding system prior to October 1, 2015; ICD-10-CM coding system for all inpatients from October 1, 2015 forward)
• Clinical Classifications Software (CCS) single and high level diagnosis groups
• Clinical Classifications Software (CCS) single and high level procedure groups
• Hospital service area
• Patient days (length of stay)
• Same day flag – flags those admitted and discharged on the same day
• Year of discharge
• Emergency department flag (flags those records with an associated emergency department revenue record)
• Observation bed flag (flags those records with an associated observation bed revenue record)
• UNIQ: a field used to link discharges with revenue records

NOTE:  Significant changes in 2014 for reporting outpatient procedures.

As of July 1, 2014, changes were made in the requirements for Vermont hospitals’ reporting of all outpatient procedures and services. Prior to that date, outpatient procedures were reported using the ICD-9-CM coding system; these codes were included as appropriate on each individual discharge record with a primary procedure code determined by the reporting hospital. As of July 1, 2014, outpatient procedures are reported using the HCPCS/CPT coding system; these codes are included on each of one-to-many revenue records, and there is no determination by the reporting hospital of which CPT code is considered to be primary. Therefore, a primary CPT code has been calculated and flagged for each outpatient discharge using an algorithm that includes relative value units, charges, and whether the CPT code is for an ambulatory surgical procedure. Any CPT codes reported prior to July 1, 2014 are considered incomplete, as are any ICD-9-CM procedure codes reported on or after that date.

To ensure that analyses of outpatient procedures include complete data that are as consistent across time as possible, the 2014 files include two new fields (CCSPROC and CCSPROCGRP) that have been created using Clinical Classifications Software (CCS). This software groups both ICD-9-CM procedure codes and HCPCS/CPT codes into the same single and high level categories based on body systems. For the first half of 2014, groupings are based on the first procedure in ICD-9-CM range 00.00-86.99, and for the second half of 2014 groupings are based on the primary CPT. In analyses that include prior years of data, these new fields are comparable to the earlier CCSPPX and CCSPPXGRP fields. Some discontinuities may exist due to differences between the two coding systems.

No changes were made to the reporting of inpatient procedures, and ICD-9-CM codes were used throughout 2014. CCSPPX and CCSPPXGRP have been renamed to CCSPROC and CCSPROCGRP in the inpatient data file for consistency across hospital settings in 2014 and forward.

NOTE:  Significant changes in 2015 for reporting all diagnosis codes, and inpatient procedure codes.

As of October 1, 2015, federal regulations require that all diagnosis codes be reported using the ICD-10-CM coding system, and that all inpatient procedure and service codes be reported using the ICD-10-PCS system.

Click on the link below, or here to complete the Webform request.

https://gmcboard.vermont.gov/form/vuhdds-puf

Brief Descriptions of Data Files

• The Inpatient Data and Outpatient Data files combine to make the complete data set for each calendar year (based on discharge date). These files are separated for easier downloading and because they are frequently used individually.
• The third data file for each year includes only records relating to the Emergency Department (ED), and is extracted from both the Inpatient and Outpatient data files; it duplicates ED records contained in the inpatient and outpatient files.
• The fourth data file, starting in 2006, is the Expanded Outpatient file. The submission of "expanded" outpatient records by Vermont hospitals for calendar years 2006, 2007, and 2008 with principal procedures outside the ICD-9-CM range of 00.00-86.99 was incomplete and inconsistent across the hospitals. The Green Mountain Care Board is working with the Vermont hospitals to ensure a complete and consistent filing of the expanded outpatient data set in more recent reporting years.
• The fifth data file is the Revenue Code file, which includes one record per revenue code for each discharge in the Inpatient, Outpatient, Emergency Department and Expanded Outpatient files. Each discharge may have from one to many records in the revenue code file.
• Text files are .zip formatted for greater downloading ease. Zipped file sizes are provided.
• Two Excel files containing documentation are provided, one for use with the Inpatient, Outpatient, Emergency Department, and Expanded Outpatient data files and the other for use with the Revenue Code data files. These files include the file layouts, field properties and code tables. These Excel files can be used to set up tables prior to downloading or to reduce the size of tables after downloading the data files. Please download these Excel files along with any public use files that you download: the information included will help you to understand and analyze the public use files correctly.
• Note that the Inpatient data files include a number of fields that do not appear in the Outpatient, Emergency Department and Expanded Outpatient data files (SCU, SAME DAY FLAG, DRG, MDC, and DRG_GROUPER_VERSION). These fields are not valid across all hospital settings and should only be used with the Inpatient data.
• The DRG field in the Inpatient data file changed to the use of MS-DRG codes as of October 1st, 2008 as a result of federal regulation. The field name is still referred to as DRG, but MS-DRG codes populate the data field. The values in this field prior to October 1st, 2008 are not comparable to those after this date.
• Note that for each year from 2006 forward, the UNIQ field can be used to link each discharge record with its associated revenue records. For the years prior to 2006, an ID field is not included:  you may want to add a unique ID to the data sets if multiple text files are being combined into a master file.

Contact the Green Mountain Care Board to request research files with non-public data elements.

Analytical Team
Green Mountain Care Board
144 State Street
Montpelier, VT  05620-1701
GMCB.DATA@vermont.gov

This section has been prepared to assist you with loading and using the Vermont Uniform Hospital Discharge Data System public use files. This section covers Installation Minimum Requirements, Concepts & Purpose of this Relational Data Set, Data Issues, and Getting Started Instructions. If you have questions about or run into issues with the loading of these data sets, please send an email requesting assistance to the Health Department, as listed in the Contacts section.

Installation Minimum Requirements

• The Expanded Outpatient and Revenue Code public use files are very large and contain millions of records. These larger data files are too large to load into software packages such as Microsoft Excel or Microsoft Access.
• To load the large files and take advantage of their features, a relational database application is required, such as MYSql, Oracle, DB2, SAS, SPSS or SQLServer.
• It is also recommended that sufficient hard drive storage space be available to efficiently manage the processing of the data tables.
• Your Database Administrator (DBA) should be able to determine minimum storage requirements based on the size of the files that are extracted to your computer.

Concepts & Purpose of this Relational Data System

The primary purpose of this relational data set is to give research entities access to de-identified hospital discharge data that can be used to produce public research analyses.

The concept used in the creation of this data set was to create primary data tables that hold specific information and then provide code tables that define the values listed within primary data tables. A conceptual layout of the field properties and code tables is included on this web site.

Each line of information is a unique discharge where all information relating to a given discharge record has already been combined. Since there are a large number of variables in these files, the unique discharge is separated from the revenue code file, but can be linked together using the unique id for each record. There may be many revenue records that link to a single discharge record.

This method provides a useable dataset where all adjustments to the data have been applied to the extent possible within the given time period. The annual data sets provided on the website are based on the discharge date by calendar year. A given year’s data set will be posted as soon as the data are cleaned and become available for public use.

Data Issues

Discharge records may contain values that are blank or negative dollar charge values. Although the data are edited and cleaned, there may still be missing information or unresolved code issues in some cases. Timely availability of data requires the acceptance of a reasonable degree of errors or missing data.

Getting Started

The Vermont Public Use files are in a comma-delimited text file format and can be read by any software package/database loading process that can use this format. In each of the data files the first row contains the appropriate Data Dictionary field/column name.

The hospital service area (HSA) definitions used in the Vermont Uniform Hospital Discharge Data Set have been modified three times to reflect changing discharge patterns. Starting with the 2002 Monograph, HSAs are based on inpatient discharges where the diagnosis indicated the need for immediate care, for the cumulative reporting years spanning 1997 through 2001.

Prior definitions of HSAs had been based on all inpatient stays (except for newborns and transfers) and had used a strict decision rule for inclusion of ZipTowns in a hospital’s service area (towns or groups of towns: see definition below for ZipTowns). Use of a strict inclusion rule meant that there were always towns that were not assigned to any HSA and were labeled “contested.”

In preparing for the fourth version of HSAs, rules used to define the third version of HSAs were applied to 1997-2001 data. The number of contested towns rose from 54 to 80, nearly a third of all Vermont towns. This resulted in the loss of one hospital service area and a serious erosion of others. As a result of this increase in contested towns, two major changes were made to the process of defining HSAs.

The first major change was that selection of records was limited to those discharges with diagnoses considered to require immediate hospitalization as described by Newton and Goldacre in their 1994 article, “How many patients are admitted in districts other than their own, and why?” (Journal of Public Health Medicine, 1994, Vol. 16, No. 2, pp. 159-164). Newton and Goldacre used records of patients with acute conditions that require immediate hospitalization, because patients with these conditions tend to go to the hospital nearest to them when they become ill. The authors excluded newborns and patients transferred from another hospital. The authors included records with the following acute conditions as their primary diagnoses: appendicitis, abscess of anal and rectal regions, peritonitis, acute myocardial infarction, pneumococcal pneumonia, and asthma.

The second major change was the shift to a plurality rule in assigning ZipTowns to HSAs, so that all towns are assigned to an HSA with none remaining contested. ZipTowns are towns or groups of towns with over 1,000 residents and relatively contained ZIP code boundaries. ZipTowns were assigned to hospital service areas as follows:

• If the plurality of a ZipTown’s discharges were from a Vermont hospital or Dartmouth Hitchcock Medical Center (DHMC) in Lebanon, New Hampshire, the ZipTown was assigned to that hospital’s service area.
• If the plurality of a ZipTown’s discharges were from a non-Vermont hospital other than DHMC, the ZipTown was assigned to the HSA of the Vermont hospital (or DHMC) with the next highest number of discharges.
• The HSAs continue to include two multi-hospital areas: the White River Junction HSA (Dartmouth Hitchcock Medical Center and Mt. Ascutney Hospital) and the Brattleboro HSA (Brattleboro Memorial Hospital and Grace Cottage Hospital). These HSAs include multiple hospitals because resident hospitalizations are split among the hospitals with no clear majority of inpatient discharges concentrated at any one hospital.
• In addition to these definitional changes, HSA names were changed. To distinguish these new HSAs from previous ones, HSAs were given the name of the most populous town in their area.

• Centers for Medicare and Medicaid
• Clinical Classification Software for ICD-9-CM
• Clinical Classification Software for ICD-10-CM/PCS
• Clinical Classification Software for Services and Procedures (CPT/HCPCS)
• Healthy Vermonters 2020 Indicators
• ICD-9 Codes in Downloadable Formats
• Massachusetts Division of Health Care Finance and Policy
• National Center for Health Statistics
• National Health Care Cost and Utilization Project
• New Hampshire Department of Health and Human Services
• New York Department of Health
• Vermont Association of Hospitals and Health Systems
• Vermont Data Maps and Trends
• Vermont Department of Financial Regulation
• Vermont Green Mountain Care Board
• Vermont Hospital Report Cards