CMS Datasets
AcademyHealth
June 3, 2007
Agenda
• Overview of CMS data
• Updates
– Part D data
– MCBS
– HOS
– MAX
– The shiny new Chronic Conditions Data
Warehouse
At Times, CMS Data Can Be Daunting
Uninitiated Data
User
(played by Dante
Alighieri)
ResDAC
(played by Virgil)
Dante and Virgil at the Gates of Hell
William Blake (1826-27)
Research Data Assistance Center
(ResDAC)
• Consortium of faculty and staff from the University of
Minnesota, Boston University, Dartmouth Medical School,
and the Morehouse School of Medicine
• Free assistance to academic and non-profit researchers
interested in using Medicare, Medicaid, SCHIP, HOS, and
MCBS data for research.
• ResDAC offers a number of services for researchers with
all levels of experience using or planning to use CMS data
– technical data assistance
– information on available data resources
– training
• They have a booth here
• Or contact them at http://www.resdac.umn.edu/
Four Flavors of Data for Order
from CMS
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Cost Reports
Identifiable Data Files
Limited Data Sets
Non-Identifiable Data Files
Cost Reports
• Hospital Cost Report
(CMS−2552−96)
– Download or DVD
– FY1996-2000
– FY2001–2006
• Skilled Nursing Facility
(CMS−2540−96)
– CD only
– FY1996–2006
• Renal Facility (CMS−265−94)
– Download
– FY1994-2006
• Hospice (CMS−1984−99)
– Download
– FY1999-2006
• Home Health Agency
(CMS−1728−94)
– Download or CD
– FY1994-2006
Identifiable Data Files contain actual beneficiaryspecific / physician-specific information and require
a formal request to CMS for approval
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Standard Analytical Files (SAFs)
– Durable Medical Equipment
– Home Health Agency
– Hospice
– Inpatient
– Outpatient
– Physician/Supplier Part B
– Skilled Nursing Facility
Hospital Outpatient PPS
Hospital Outpatient PPS Partial Hospitalization Program
End Stage Renal Disease (ESRD) Composite Rate Payment System File
Medicare Provider Analysis and Review (MEDPAR)
Denominator File
Name and Address and Vital Status File
Renal Management Information System (REMIS)
Medicaid Analytic Extract (MAX)
Long Term Care Minimum Data Set (MDS)
Medicare Health Outcomes Survey (HOS)
Limited Data Set Files (LDS) contain beneficiary
level health information but exclude specified direct
identifiers as outlined in the HIPAA Privacy Rule
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National MEDPAR
Skilled Nursing Facility (SNF) MEDPAR
Long-Term Care Hospital (LTCH) PPS Expanded Modified MEDPAR
Hospital Outpatient PPS
Hospital Outpatient PPS Partial Hospitalization Program
Inpatient Psychiatric PPS
Denominator
Medicare Current Beneficiary Survey (MCBS)
Medicare Health Outcomes Survey (HOS)
Standard Analytical Files (SAFs)
– Durable Medical Equipment (5%)
– Home Health Agency (5% and 100%)
– Hospice (5% and 100%)
– Inpatient (5% and 100%)
– Outpatient (5% and 100%)
– Physician/Supplier Part B (5%)
– Skilled Nursing Facility (5% and 100%)
Non-Identifiable Data Files contain nonidentifiable person-specific information and are
within the public domain
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Health Care Information System (HCIS) Data File
Part B Extract Summary System (BESS) Carrier Data File
Part B Extract Summary System (BESS) Data File
Provider of Services File
Hospital Service Area File
Physician/Supplier Procedure Summary Master File
Unique Physician Identification Number (UPIN) Group File
Unique Physician Identification Number (UPIN) Directory
Medicaid Drug Claims Statistics
Medicare Health Outcomes Survey (HOS)
Prescription Drug Plan Formulary and Pharmacy Network Files
Implantable Cardioverter Defibrillator (ICD) Implantation Data
Cost Report Files
Laying Hands on CMS Data
• Requests for Identifiable Datasets and
LDS generally go through ResDAC
• Fees typically apply (~$100 per CD)
• Order forms and additional information are
available from ResDAC or at
http://www.cms.hhs.gov/home/rsds.asp
Update on Availability of Part D
Data
• Comments on preliminary regulation
regarding this data have been received and
digested
• Final reg will be published in August at the
earliest
• Following publication of the reg you can
expect
– ResDAC training sessions
– Availability of SAF-like files
Update on the Medicare Current
Beneficiary Survey (MCBS)
• Panel time-series survey of Medicare enrollees
• Survey participant (SP) information on
– health status
– socioeconomic and demographic characteristics
– health insurance
– program interactions
• Administrative data on
– Enrollment status, buy-in status, M+C
enrollment
– Claims
Current MCBS File Availability
• Access to Care 2005
– Fall interview from 2005 ... 16,000 SPs
– Summary Part A and Part B benefits
– Summer supplement on Part D activity
• Cost & Use 2004
– SPs alive during 2004
– Detailed use and expenditure
information
MCBS Summer 2006
Part D Supplement
• Overall, how easy or difficult is the drug benefit to
understand?
• How much the SP thinks they know about the benefit
• How much they actually know about details of the benefit
• Did they consider enrolling in a Medicare Prescription Drug
plan?
• Contact with employer-sponsored plan regarding benefits;
autoenrollment through Medicaid or HMO
• Sources of information regarding coverage options
• Things thought about when considering options for coverage
• Reasons for not enrolling
• Ease of getting needed medicines through the SP’s plan
• Overall satisfaction with prescription drug coverage
• Etc.
Update on the Medicare Health
Outcomes Survey (HOS)
• Developed and implemented in 1998 as a Medicare
HEDIS® Effectiveness of Care Measure.
• In addition to health outcome and functional
status measures, the HOS is used to collect
Urinary Incontinence in Older Adults, Physical
Activity in Older Adults, Osteoporosis Testing in
Older Women, and Fall Risk Management HEDIS®
measures.
• CMS uses HOS data to meet the MMA 2003
Section 722(a)(3)(A)(i) mandate requiring the
collection, analysis, and reporting of data that
permits the measurement of health outcomes and
other indices of quality.
The goal of the HOS program: To
gather valid, reliable, and clinically
meaningful data that are used by:
• MCOs, providers, and quality improvement
organizations to monitor and improve health care
quality.
• CMS to assess the performance of MCOs and
reward high performers.
• Medicare beneficiaries, their families, and
advocates when making health care purchasing
decisions.
• Health researchers to advance the state-of-thescience in functional health outcomes
measurement, and quality improvement
interventions and strategies.
HOS Version 2 (HOS 2.0)
HOS 2.0 Implemented in 2006:
• Reduction in Core Outcome Items
– Veterans RAND 12 Item Health Survey replaced MOS 36
Item Health Survey 1.0
• Reduction in Other Items
– Q22: Do you have difficulty controlling urination? has
been superseded by Q44, the HEDIS Management of
Urinary Incontinence Measure, which was added in 2003
– Stroke symptom severity questions 19 A and B eliminated
• Addition of Items
– Self-reported height and weight categories to construct
BMI
– Osteoporosis Testing in Older Women HEDIS Measure
– Fall Risk Management HEDIS Measure
HOS Data Availability
• Currently available
– 2003-2005 Cohort 6
– 2005 Cohort 8 Baseline
• Coming in late summer 2007
– 2004-2006 Cohort 7
– 2006 Cohort 9 Baseline
Update on the Medicaid Analytic
Extract Data (MAX)
• Person-level data files on Medicaid
eligibility, service utilization, and payments
• Annual calendar year files derived from
Medicaid Statistical Information System
(MSIS)
Developments in MAX
• Major changes for 2005 to include data elements
that are being captured by MSIS in FY2005 and
later.
– Multiple choices for race and ethnicity
– Monthly dual (Medicaid/Medicare eligibility) –
currently MSIS captures dual states once per
quarter
– National Provider Identifier (NPI) – as
implemented by states
– Medicaid waiver type and waiver identifiers
– Additional characters (bytes) to accommodate
ICD-10 when implemented
MAX Files Currently Available
• Person Summary File
– Eligibility (annual and monthly)
– Managed care enrollment
– Utilization and Medicaid payment by
type of service
• Claims Files (premium payments only
for prepaid managed care)
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Inpatient hospital
Long term care
Prescription drug
Other Services
MAX Files Currently Available
• Years
– 1999-2002: All States and DC
– 2003: 38 states and DC (the remainder later in
Jun 2007)
– 2004: Projected completion during Nov-Dec 2007
• Extensive statistics on Medicaid prescription drug
data, by state and nationally for three Medicaid
populations (all Medicaid, duals, and full-year nursing
facility resident) at:
http://www.cms.hhs.gov/MedicaidDataSourcesGenInfo/08_Med
icaidPharmacy.asp#TopOfPage
Links for More Information on
Research Datasets
• MCBS:
http://www.cms.hhs.gov/MCBS/
• HOS:
http://www.cms.hhs.gov/HOS/
• MAX:
http://www.cms.hhs.gov/MedicaidDataSourc
esGenInfo/07_MAXGeneralInformation.as
p#TopOfPage
http://www.cms.hhs.gov/home/rsds.asp
Chronic Conditions Warehouse
• Created in response to the Medicare
Modernization Act legislation requiring a
plan to “improve the quality of care and
reduce the cost of care for chronically ill
Medicare beneficiaries”
• Central feature of the plan is a research
database assembling information at the
beneficiary level from a variety of
administrative, clinical, and survey data
sources
Chronic Conditions Warehouse
• First step is a database built from
Medicare data
– Linked by beneficiary
– Fee-for-service Medicare claims data
and assessments across the continuum of
care
– Medicare eligibility/enrollment data
• Contract awarded to Iowa Foundation for
Medical Care to help develop specifications
and to build the database