What is included in Medicare claims data?
Claims data are clinically valid and include various key attributes related to care such as admission and discharge dates, diagnoses and procedure codes, source of care, date of death, and demographic data (e.g., age, race and ethnicity, place of residence).
What is a CMS data?
Overview. Data.CMS.gov has datasets about Medicare Fee-For-Service, special programs and initiatives, and the Health Insurance Marketplace. This includes information on providers who accept Medicare, services and procedures delivered by providers, and qualified health plans.
Which type of sampling does the health and Retirement employ?
2g. The HRS is based on a stratified multi-stage area probability sample of United States households. The HRS sample design is very similar in its basic structure to the multi-stage designs used for major federal survey programs such as the Health Interview Survey (HIS) or the Current Population Survey (CPS).
How many people participate in a Health and Retirement Study?
The University of Michigan Health and Retirement Study (HRS) is a longitudinal panel study that surveys a representative sample of approximately 20,000 people in America, supported by the National Institute on Aging (NIA U01AG009740) and the Social Security Administration.
Where does CMS data come from?
The Centers for Disease Control and Prevention (CDC) collects data from hospitals via the National Healthcare Safety Network (NHSN). For VHA hospitals, data is collected internally by the VHA from employee health records. Facility level data is validated centrally by VHA's program office.
What is the CMS Medicare tracking system?
The CMS Analysis, Reporting, Tracking (CMSART) system is the CMS system of record for tracking Contractor Business Proposals, Cost Reports, Deliverables, and Workload Information for various departments within the agency.
How is the Health and Retirement Study conducted?
The biennial HRS interviews are conducted by highly trained survey interviewers employed by the Survey Research Center at the Institute for Social Research at the University of Michigan. Baseline interviews are typically conducted face-to-face (FTF), most often in the respondent's home.
When did Health and Retirement Study Start?
In early 1988 the panel recommended the initiation of a new, long-term study to examine the ways in which older adults' changing health interacts with social, economic, and psychological factors and retirement decisions.
Is retirement good for your health?
Yet a different U.S. study of more than 6,000 people 50 and older found “strong evidence that retirement improves reported health, mental health, and life satisfaction.” Studies in the Netherlands and Japan also noted the positive effects of retirement on health.
What is the Wisconsin Longitudinal Study?
The Wisconsin Longitudinal Study (WLS) is a long-term study of a random sample of 10,317 men and women who graduated from Wisconsin high schools in 1957.
Abstract
Researchers investigating health outcomes for populations over age 65 can utilize Medicare claims data, but these data include no direct information about individuals’ health prior to age 65 and are not typically linkable to files containing data on exposures and behaviors during their worklives.
Background
Over the last decade, research has increasingly utilized administrative claims data to evaluate health outcomes [ 1 – 4 ], providing an insight into population health even without test results or clinician notes [ 3 – 6 ].
Methods
The primary goal of this paper is to demonstrate the integration of Medicare data and other administrative and health data from previous work-life. Because this is a proof-of-concept paper, the analyses are descriptive by design and methods designed for causal inference are unnecessary.
Ethics approval
The Stanford University Institutional Review Board approved this study protocol, invoking the epidemiologic exemption waiving the requirement for individual consent.
Results
Figure 1 presents the cross-sectional prevalence of diseases by age for Sample 1. Note that the rates of illness are higher than a comparable US population.
Conclusions
This paper provides a first look into how private insurance data can be merged with Medicare data to provide a glimpse at health trajectories across the life course and after joining Medicare as primary insurer.
Abbreviations
Consolidated omnibus budget reconciliation act—refers to temporary group insurance available for purchase to individuals whose insurance might otherwise be terminated
Why is it important to conduct research using CMS data?
Conducting research using the CMS data is a cost-effective way to conduct analysis of a large segment of the Medicare population , especially when considering the alternative of requesting individual patients’ medical charts. The data also allow access to claims information across multiple providers for a given beneficiary while providing a consistent reporting format.
Why is administrative data important in health care?
There are several reasons that make administrative data useful in health services research. Clinical validity. Medicare data contain information about covered services used by enrollees in the program. Examples include: Admission and discharge dates. Diagnoses.
What is utilization data?
Health Services utilization data, commonly referred to as claims data, are derived from reimbursement information or the payment of bills. As a general rule, those pieces of information that are required to determine payment/reimbursement will be of higher quality than other information reported on a claim. Also included in the available CMS data are enrollment data, which are the basis for determining whose bills are qualified to be paid by Medicare.
How many people are enrolled in Medicare?
Furthermore, over 99 percent of deaths in the US among persons age 65 and older are accounted for by the Medicare program. There are over 45 million beneficiaries enrolled in the Medicare program today, allowing for detailed sub-group analysis with reduced concerns about loss of statistical power.
When are CMS data files available?
CMS data files are complete and available relatively quickly after the close of a given calendar or fiscal year. For example, Medicare enrollment information for each calendar year contained in the Master Beneficiary Summary File is generally available the following Fall. Similarly, calendar year utilization files are more than 98 percent complete by the Summer of the following year and available for release soon after.
What conditions must be diagnosed in order to appear in utilization files?
Conditions must be diagnosed in order to appear in the utilization files; however, some diseases such as hypertension, depression and diabetes are often under-diagnosed. In addition, while the files provide a reliable record of the care received by the beneficiary, they do not provide information on the care needed.
What is data dictionaries?
The data dictionaries (record layouts) contain information about some assumptions, data combinations, limitations, etc. These are an important tool to use when designing your study and analyzing your data, and they can be found on our website under the CMS Data section.
Abstract
Hospitalizations and emergency department (ED) visits for people with Alzheimer’s disease and related disorders are of particular concern because many of these patients are physically and mentally frail, and the care delivered in these settings is costly.
Study Data And Methods
Below we briefly describe our study data and population, variables, and statistical methods. A fuller description with additional details is provided in the online Appendix. 15
Study Results
The prevalence of dementia varied by setting and subsample ( Exhibit 1 ). For example, the prevalence was seven times higher among nursing home residents (84 percent) than among community residents (12 percent). Forty-four percent of decedents had dementia in the last year of life.
Discussion
Our results suggest several key findings that have policy implications.
Conclusion
The aging of the population makes it likely that the number of people with Alzheimer’s disease and other dementias will increase dramatically in the coming years. The high rates of hospitalizations and ED visits—especially those that are potentially avoidable—have clear implications for the patients’ quality of life.
ACKNOWLEDGMENTS
Results from an earlier version of this article were presented at the annual scientific meeting of the Gerontological Society of America, New Orleans, Louisiana, November 24, 2013. This research was funded in part by the Office of the Assistant Secretary for Planning and Evaluation (ASPE) in the Department of Health and Human Services (Contract No.
What are some examples of services not covered by Medicare?
Examples of services not covered include routine physical exams, long-term care, and some cancer screening procedures. These gaps in coverage mean that there are no claims records for these services or for certain time periods. You may find more information on what is not currently covered by Medicare in the Medicare and You Handbook at www.medicare.gov (accessed December 3, 2012).
What is the hospice file?
The Hospice File contains final action claims data submitted by Hospice providers. The data contained in this file include the type of hospice care received (e.g., routine home care, inpatient respite care). The Hospice File contains data fields for 10 ICD-9-CM diagnosis and 6 procedure codes, dates of service, reimbursement amount, and some demographic information (such as date of birth, race, and sex).
What is a MedPAR file?
The MedPAR File contains inpatient hospitalization and skilled nursing facility (SNF) final action claim records. All Medicare Part A short and long stay hospitalization claims and SNF claims for each calendar year are included on the MedPAR File. Each MedPAR claim record includes up to 10 ICD-9-CM diagnoses and 6 ICD-9-CM procedures associated with each hospital or SNF stay. The MedPAR File will include all hospitalizations that had a discharge date during the calendar year and all SNF stays with an admission date during the calendar year.
Is NCHS survey data on the denominator file?
There may be instances where an NCHS survey respondent is on the Denominator file but there is no claims data. It is possible to be enrolled in Medicare but not utilizing Medicare services during the coverage period. In addition, there may be some record keeping inconsistencies because CMS data are collected for administrative, not research purposes.
Does CMS receive Medicare claims?
CMS generally does not receive claims data for Medicare beneficiaries who enroll in Medicare Part C plans (including private fee-for-service plans paid on a capitation basis). Please note that exceptions to this do exist. For example, all Hospice claims are processed as Medicare claims regardless of whether the beneficiary is in a Fee for Service (FFS) or a Medicare Part C plan. During the time covered by the linked database, enrollment in Medicare Part C plans increased from approximately 6% of beneficiaries in 1991 to 20% in 2007.
Is death information reported to CMS?
Death information is occasionally mis-reported to CMS but included on the yearly Denominator File. This erroneous information is not corrected by CMS; however, these cases can be identified as they continue to be eligible for Medicare benefits in later years or they have new death information recorded in a later Denominator File. Analysts should use extra caution in analyzing Medicare death information to insure that deaths are not over-counted. In addition, the actual date of death information is occasionally mis-reported to CMS. Cases can be identified by examining the variable, “Valid Date of Death Switch”, where a value of “V” indicates that CMS has validated the actual date the beneficiary died, whereas a “blank” indicates that it was not validated. In the event, that the date of death is not validated, CMS assigns the date of death as the last day of the month.
Why is Medicare data important?
Medicare data provide an opportunity to identify treatment variations over time and across providers and geographic locations, and the data can be used to help benchmark the quality of healthcare delivery for stroke-related therapies and interventional procedures.
What is Medicare data used for?
Many domains of care are included, and depending on specific research questions, data can be used to examine a broad range of outcomes, including in-hospital outcomes, discharge destinations, short- and long-term mortality, readmissions, and the use of outpatient Medicare resources across a variety of care settings (hospital outpatient, home health agency, hospice, and skilled nursing facility). Research files for CMS data include a unique, encrypted beneficiary identifier that is consistent across the different Medicare file types, permitting researchers to link and analyze information across the continuum of care. Because the data are continuously collected as part of the Medicare billing system, they include every patient encounter associated with a billing record. The data are also available from a single source and are provided in standard formats.
How does Medicare data help with stroke?
Medicare data can provide a complete national sample with ample power to conduct subgroup analyses, such as by patient demographic characteristics or geographic region. This is particularly valuable because of the lack of a dedicated national stroke surveillance system in the United States to track national trends in stroke hospitalizations and outcomes, as well as provide insights into patterns of stroke care. 11 The data allow for stroke surveillance at the patient, hospital, community, state, and national levels. For example, the Centers for Disease Control and Prevention, in collaboration with CMS, published an atlas showing geographic patterns in age-adjusted stroke hospitalization rates by county that demonstrated variations across regions, with higher rates in the southeastern Atlantic region, often referred to as the stroke belt. 12 Medicare data have also been used to track poststroke events, such as recurrent stroke hospitalizations. A study using patient-linked data including >2.5 million beneficiaries found heterogeneity in the occurrence of recurrent ischemic stroke by geographic region from 1994 to 2002. 13 Overall, recurrent stroke rates declined by ≈5% over the time period, but temporal patterns of patient-level outcomes varied markedly by region; recurrence rates decreased within sections of the Southeast stroke belt and increased in counties in the Midwestern and Western regions of the United States. A more recent study using 2006 Medicare fee-for-service data assessed national rates and variations in potentially preventable readmissions after stroke across hospitals and regions ( Figure 4 ). 14 Among 307 887 ischemic stroke discharges, 14.4% of patients were readmitted within 30 days, and 11.9% of these readmissions were the result of a preventable cause (eg, pneumonia). There was regional variation in preventable readmissions, with the highest rates observed in the Southeast, Mid-Atlantic, and United States territories and the lowest in the Mountain and Pacific regions, as well as considerable hospital-level variation both within and between regions ( Figure 4 ).
What is a research file for CMS?
Research files for CMS data include a unique, encrypted beneficiary identifier that is consistent across the different Medicare file types, permitting researchers to link and analyze information across the continuum of care.
What is the gold standard for assessing treatment effects on patient outcomes?
Randomized clinical trials, considered the gold standard for assessing treatment effects on patient outcomes, generally use strict inclusion/exclusion criteria that may limit their generalizability to the population as a whole. Moreover, clinical trials may not be ethical or feasible for the study of certain exposures on outcomes (eg, the study of air pollution on cardiovascular events). Community-based studies and registries that use primary data collection provide invaluable information on disease cause, care, and outcomes, but they can be costly, time consuming, and potentially challenging to conduct in diverse populations and regions. Medicare claims data are nationally representative, collected on an ongoing basis, and readily available in a timely matter.
Why is understanding patterns of care and outcomes important?
Understanding patterns of care and outcomes are increasingly important because there is a national focus on quality of care, performance measures, costs, and efficiency. The purpose of this topical review is to provide an overview on the use of Medicare data for stroke research.
What are the challenges of using administrative data?
Finally, it is important to recognize that there can be analytic challenges in using administrative data, including data management and selection of analytic approaches for multilevel data (eg, statistical techniques that account for clustering of cases within hospitals). Given the potentially large number of observations involved in these types of analyses, care is also needed when interpreting study results and distinguishing meaningful differences from merely statistically significant ones.
