Hospitals are now able to obtain their SSI Ratio detail files from CMS in less than an hour. This is accomplished through the self-service DSH application available in the CMS Enterprise Portal at:
https://portal.cms.gov/wps/portal/unauthportal/home/
This is the same portal used to control access to Medicare PS&R reports, so most hospitals should have at least one person that can gain access to the DSH application. SSI data from 1988 onward can be exported to Excel for review and analysis. There is a limit of five years per request, but multiple requests are allowed. It is possible for a hospital to download 30+ years of SSI data in under an hour. This is a huge improvement from the days of Data Use Agreements. Kudos to CMS!
One of the primary reasons for a hospital to obtain their SSI data is to determine if an "SSI Realignment" would be beneficial. The SSI Ratios published by CMS are calculated based on the federal fiscal year ("FFY"), which ends September 30. Many hospitals operate on a different fiscal year ("FY"), possibly ending June 30 or December 31. Hospitals can submit a letter to their MAC asking CMS to recalculate their SSI Ratio based on the hospital-specific FY instead of the FFY. A higher SSI Ratio will usually increase Medicare DSH payments. However, SSI Realignment requests cannot be withdrawn, even if the ratio goes down. It is important for a hospital to verify which ratio is higher prior to requesting realignment. The SSI data must be evaluated for each FY to determine whether realignment would be beneficial for that year.
The SSI data obtained through the DSH application must be summarized by FY and FFY to determine which ratio is higher. A basic Excel template to help with this process is available for download:
https://drive.google.com/file/d/19H2egliVvFrkon8CjGjSNfJwiBdzHvD5/view?usp=sharing
Populate the Data tab, refresh the pivot tables, and compare the results. If the SSI Ratio based on FY data (e.g. 07/01/2017 to 06/30/2018) is higher than the SSI Ratio based on FFY data (e.g. 10/01/2016 to 09/30/2017), it is generally beneficial to request an SSI Realignment.
REMINDER: SSI data obtained through the DSH application is ePHI that must be protected in accordance with the HIPAA Security Rule.
For additional information on Medicare DSH, refer to the MLN Fact Sheet from CMS:
The information and files on this web site, individually and collectively, are provided for educational and informational purposes only.