MEDICARE WAGE INDEX		
OCCUPATIONAL MIX SURVEY		
 		
		
Introduction		
		
      Section 304(c) of Public Law 106-554 amended section 1886(d)(3)(E) of the Act 		
to require CMS to collect data every 3 years on the occupational mix of employees for 		
"each short-term, acute care hospital participating in the Medicare program, in order to "		
construct an occupational mix adjustment to the wage index.  The law also requires the 		
"application of the occupational mix adjustment to the wage index beginning October 1, 2004"		
		
 		
      This survey provides for the collection of occupational mix data for a 12-		
"month period, that is, *from pay periods ending between January 1, 2010 and December 31, 2010,"		
to be applied to the FY 2013 wage index.  Complete the survey for any hospital 		
"that is subject to the inpatient prospective payment system (IPPS), or any hospital "		
that would be subject to IPPS if not granted a waiver .  [Note:  Do not complete this 		
survey if you are a no/low Medicare utilization provider.  Check with your Fiscal 		
intermediary (FI)/Medicare Administrative Contractor (MAC) to confirm your status.]  It is 		
important for hospitals to ensure that the data reported on the survey are accurate 		
and verifiable through supporting documentation.		
		
"      Completed occupational mix surveys must be submitted to fiscal intermediaries, "		
"on the Excel hospital reporting form, by July1, 2011, via email attachment or "		
overnight delivery.  The Excel version of the occupational mix survey may be obtained 		
from FIs/MACs or downloaded from CMSs website at:		
http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage.  		
		
      Instructions and definitions for the data elements and the occupational categories 		
are attached.		
		
"[1]  Note: Critical Access Hospitals (CAHs) are not paid under the IPPS, therefore CAHs are not "		
"required to complete the survey.  Also, hospitals that terminated participation in the Medicare "		
"program before January 1, 2010 are not required to complete the survey.  "		
		
"According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information "		
unless it displays a valid OMB control number.  The valid OMB control number for this information collection is 0938-		
"0907.  The time required to complete this information collection is estimated to average 480 hours per response, "		
"including the time to review instructions, search existing data resources, gather the data needed, and complete and "		
review the information collection.  If you have comments concerning the accuracy of the time estimate(s) or 		
"suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance "		
"Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.  "		
		
Instructions and definitions for the data elements and the occupational categories.		
MEDICARE WAGE INDEX		
OCCUPATIONAL MIX SURVEY		
		
Instructions		
		
"Complete this survey for employees who are full-time and part-time, directly hired, and "		
acquired under contract.  Do not include employees in areas excluded from IPPS via 		
"Worksheet S-3, Part II, Lines 8 and 8.01, such as skilled-nursing facilities, psychiatric, or "		
rehabilitation units or facilities.  This exclusion applies to directly-hired and contract 		
employees who provide either direct or indirect patient care services in IPPS excluded 		
"areas. Also, do not include employees whose services are excluded from the IPPS, such "		
"as physician Part B, and interns and residents. Include employees who are allocated from "		
the home office or related organizations to IPPS reimbursable cost centers and outpatient 		
"departments of the hospital that are included in the wage index (i.e., outpatient clinic, "		
emergency room).		
		
"Employees in the home office, related organizations, or general services costs centers "		
"(Worksheet S-3, Part II, Lines 21 through 35) typically provide services throughout the "		
"hospital, including the IPPS-excluded areas (Lines 8 and 8.01).  In completing the survey, "		
a hospital should apply the same methodology it uses for allocating home office and 		
"related organization costs on Worksheet S-3, Part II, and exclude from the survey such "		
costs associated with excluded areas.   If home office or related organization personnel 		
"provide only administrative services, report their wages and hours in the All Other "		
Occupations category.  To the extent that there are home office or related organization 		
"personnel that are engaged in nursing activities, they must be reported in the appropriate "		
nursing subcategory.		
		
"Additionally, hospitals should apply the methodology that is used in the wage index "		
calculation for allocating general service salaries and hours to excluded areas.  (See Step 		
"4 of the wage index calculation in 72 FR 47320, August 22, 2007, or in the Wage Index "		
Calculator at  		
http://www.cms.hhs.gov/AcuteInpatientPPS/WIFN/list.asp#TopOfPage		
"Note that, although wage-related costs are included in the general service allocation methodology"		
" for Worksheet S-3, wage-related costs should be excluded from the general service "		
allocation methodology for the occupational mix survey because the occupational mix survey		
 excludes wage-related costs. 		
		
Nursing personnel working in the following cost centers as used for Medicare cost 		
reporting purposes must be included in the appropriate nursing subcategory. These cost 		
centers reflect where the majority of nursing employees are assigned in hospitals and are 		
selected to ensure consistent reporting among hospitals. The wages and hours for nursing 		
personnel working in other areas of the hospital that are reimbursable under the IPPS or 		
"OPPS, or nurses who are performing solely administrative functions, would be included "		
in the All Other Occupations category.		
		
COST CENTER DESCRIPTIONS	Lines for 2552-96	Lines for 2552-10
Nursing Administration	14	13
Adults and Pediatrics (General Routine Care)	25	30
Intensive Care Unit	26	31
Coronary Care Unit	27	32
Burn Intensive Care Unit	28	33
Surgical Intensive Care Unit	29	34
Other Special Care (specify)	30	35
Nursery	33	43
Operating Room	37	50
Recovery Room	38	51
Delivery Room and Labor Room	39	52
Electrocardiology	53	66
Renal Dialysis 	57	71
Ambulatory Surgical Center (Non-Distinct Part)	58	72
Other Ancillary	59	73
Clinics	60	90
Emergency	61	91
Observation Beds	62	92
Note: Subscripted cost centers that would normally fall into one of 		
these cost centers should be included on the survey.		
		
		
Definitions		
		
Paid Salaries and Paid Hours:		
		
Paid Salaries  Include the total of paid wages and salaries for the specified 		
"category of hospital employees including overtime, vacation, holiday, sick, lunch, "		
"and other paid-time-off, severance, and bonuses.  Do not include fringe benefits "		
"or wage-related costs as defined in Provider Reimbursement Manual, Part II, "		
Section 3605.2.   		
		
Paid Hours  Include the total paid hours for the specified category of hospital 		
"employees.  Paid hours include regular hours, overtime hours, paid holiday, "		
"vacation, sick, and other paid-time-off hours, and hours associated with severance "		
pay.  Do not include non-paid lunch periods and on-call hours in the total paid 		
hours.  (Note: On-call hours for the occupational mix survey must be treated the 		
same as on-call hours for Worksheet S-3 wage data; see Provider Reimbursement 		
"Manual, Part II, section 3605.2, column 4 instructions).  Overtime hours must be "		
calculated as one hour when an employee is paid time and a half.  No hours are 		
required for bonus pay.  The hours reported for salaried employees who are paid a 		
fixed rate must be recorded based on 40 hours per week or the number of hours in 		
the hospitals standard workweek.  		
		
Occupational Categories:		
		
[The occupational categories and definitions included in this survey derive directly from the U. S. 		
"Bureau of Labor Statistics (BLS), 2001 Occupational Employment Statistics survey.   The numbers "		
"in parentheses are the BLS standard occupational categories (SOCs).  As with the BLS survey, "		
workers should be classified in the occupation that requires their highest level of skill.  If no 		
"measurable difference in skills, workers are to be included in the occupation that they spend the most "		
time.] 		
		
"Registered Nurses (RNs, SOC 29-1111) - Assess patient health problems and "		
"needs, develop and implement nursing care plans, and maintain medical records.  "		
"Administer nursing care to ill, injured, convalescent, or disabled patients.  May "		
advise patients on health maintenance and disease prevention or provide case 		
management.  Licensing or registration required.  RNs who have specialized 		
"formal, post-basic education and who function in highly autonomous and "		
"specialized roles, may be assigned a variety of roles such as staff nurse, advanced "		
"practice nurse, case manager, nursing educator, infection control nurse, "		
"performance improvement nurse, and community health nurse.  Advanced "		
"practice nurses (APNs) (that is, nurse practitioners, clinical nurse specialists, "		
"certified nurse midwives, and certified registered nurse anesthetists) are usually "		
paid by Medicare under a Part B fee schedule and not the IPPS.  APNs must be 		
"excluded from the survey if they are excluded from Worksheet S-3, but should be "		
included on the survey if they are included in one of the cost centers for the 		
survey and are included on Worksheet S-3.   		
		
"Licensed Practical Nurses (LPNs, SOC 29-2061) and Surgical "		
"Technologists** (SOC 29-2055)  LPNs: Care for ill, injured, convalescent, or "		
"disabled persons in hospitals, nursing homes, clinics, private homes, group "		
"homes, and similar institutions.  Most LPNs provide basic bedside care, such as "		
"vital signs as temperature, blood pressure, pulse, and respiration.  May work "		
under the supervision of a registered nurse.  Some more experienced LPNs 		
supervise nursing assistants and aides.  Licensing is required after the completion 		
of a state-approved practical nursing program.  Surgical Technologists: Assist in 		
"operations, under the supervision of surgeons, registered nurses, or other surgical "		
"personnel. May help set up operating room, prepare and transport patients for "		
"surgery, adjust lights and equipment, pass instruments and other supplies to "		
"surgeons and surgeon's assistants, hold retractors, cut sutures, and help count "		
"sponges, needles, supplies, and instruments."		
		
"Nursing Aides, Orderlies, & Attendants (SOC 31-1012) - Provide basic patient "		
"care under direction of nursing staff.  Perform duties, such as feed, bathe, dress, "		
"groom, or move patients, or change linens.  "		
Examples: Certified Nursing Assistant; Hospital Aide; Infirmary Attendant.		
		
Medical Assistants** (SOC 31-9092) - Performs administrative and certain 		
clinical duties under the direction of physician.  Administrative duties may 		
"include scheduling appointments, maintaining medical records, billing, and "		
coding for insurance purposes.  Clinical duties may include taking and recording 		
"vital signs and medical histories, preparing patients for examination, drawing "		
"blood, and administering medications as directed by physician.  Exclude "		
Physician Assistants (29-1071).  Include only those employees who perform 		
administrative and certain clinical functions under the direction of a physician in 		
the IPPS cost centers and outpatient areas of the hospital that are listed above.  Do 		
"not include phlebotomists, information technology personnel, health information "		
"management personnel, medical secretaries, ward clerks, and general business "		
office personnel.		
Examples: Morgue Attendant; Ophthalmic Aide; Physicians Aide		
		
**Note: Medical Assistants and Surgical Technologists are nursing employees for 		
"purposes of the occupational mix survey.  Whenever the terms nursing staff, nursing "		
"personnel, nursing occupations, nursing employees, or nursing categories are used "		
"with regards to the occupational mix survey, they are deemed to include medical assistants "		
and surgical technologists.		
		
"Note: Only nurses, surgical technologists, nursing aides/orderlies/attendants, and medical "		
"assistants, as defined on the survey, can be included in the respective RNs, LPNs, Surgical "		
"Technologists, Aides/Orderlies/Attendants, and MAs categories.  Do not include other "		
"occupations that may provide similar services as nursing personnel.  Instead, those "		
occupations (if assigned to IPPS/OPPS areas of the hospital) must be included in the All 		
"Other Occupations category.  For example, hospital-based paramedics may provide services "		
"that are similar to those provided by nursing personnel; however, on the occupational mix "		
"survey, these non-nursing occupations must be included in All Other Occupations.  This is to "		
ensure consistent reporting among hospitals.		
		
All Other Occupations  Non-nursing employees (directly hired and under 		
contract) in IPPS reimbursable cost centers and outpatient departments that are 		
"included in the wage index (i.e., outpatient clinic, emergency room) must be "		
"included in the All Other Occupations category.  In addition, this category "		
would include the wages and hours of nurses (including APNs) that function 		
"solely in administrative or leadership roles, that do not directly supervise staff "		
"nurses who provide patient care, and do not provide any direct patient care "		
themselves. This category must not include occupations that are excluded from 		
"the wage index (such as physician Part B services, interns, residents, and the "		
"services of APNs - nurse practitioners, clinical nurse specialists, certified nurse "		
"midwives, and certified registered nurse anesthetists  that are excluded from the "		
wage index because their services are billable under a Part B fee schedule).  		
"Also, the All Other Occupations category must not include employees in areas "		
"of the hospital that are excluded from the wage index via Worksheet S-3, Part II, "		
"Lines 8 and 8.01, such as skilled nursing, psychiatric, and rehabilitation units and "		
"facilities.  Therapists and therapy assistants, equipment technologists and "		
"technicians, medical and clinical laboratory staff, pharmacists and pharmacy "		
"technicians, administrators (other than nursing), computer specialists, dietary, and "		
housekeeping staff are examples of employees who should be reported in the All 		
Other Occupations category.  Also include the wages and hours of personnel 		
from the home office or related organizations if they perform solely 		
administrative functions and work in IPPS cost centers and outpatient departments 		
that are included in the wage index.		
		
"Note: Do not include salaries and hours for APNs (nurse practitioners, clinical nurse "		
"specialists, nurse midwives, or certified registered nurse anesthetists) in any of the Nursing "		
or All Other Occupations categories if their services are billable under Medicare Part B.  		
The services of these nurses are generally billable under a Part B fee schedule and excluded 		
from the wage index because they are not paid under the hospital inpatient prospective 		
payment system (IPPS).  		
