CMS Databases
Chris Haffer,, Ph.D.,, ORDI,, CMS
Edie Walsh, Ph.D., RTI
Kazi Ahmed,, Ph.D.,, NCQA
Q
June 2010
1
Session
S
i G
Goals:
l
Review the different types of data that
are available
 Focus on the utility
y of using
g these data
sets to answer timely and significant
questions in health services research

2
Sources of Medicare Data


Medicare Beneficiary Database
(Enrollment & Entitlement)
FFS
• Part A [Inpatient] – Claims, Quality
• Part
P t B [O
[Outpatient]
t ti t] – Claims,
Cl i
Quality
Q lit
Claims include: hospitals, HHAs, Hospices, hospital outpatient departments, rural health
clinics, renal dialysis facilities, outpatient rehabilitation facilities, comprehensive outpatient
rehabilitation facilities, community mental health centers, ambulatory surgical centers ,
SNFs physicians
SNFs,
physicians, physician assistants,
assistants clinical social workers
workers, nurse practitioners
practitioners,
independent clinical laboratories, ambulance providers, and standstand-alone ambulatory surgical
centers, DME

M di
Medicare
Managed
M
d Care
C
• Part C [Medicare Advantage] – HEDIS, HOS, CAHPS, Risk
• Part D [[Prescription
p
Drug
g Plans]] – Claims,, CAHPS
3

Provider Characteristics
U til a few
Until
f years ago…
Data, Data Everywhere
But Not a Byte is Linked
(with apologies to Coleridge)
4
Data
D t Li
Linking
ki Efforts
Eff t

FFS
• Chronic
Ch i Condition
C diti Warehouse
W h
(CCW)

MA
• Medicare Compare

Medicaid
• MAX
5
R l World
Real
W ld Research
R
h Experience
E
i

Chronic Condition Warehouse (FFS), Medicaid Claims
Extract (MAX), Nursing Home Minimum Data Set (MDS),
Online Survey,
Survey Certification,
Certification and Reporting System
(OSCAR)
• Edie Walsh–
Walsh– RTI,, International – Waltham,, MA

HOS and Medicare Prescription Drug (Part D)
• Kazi Ahmed
Ahmed–
– National Committee for Quality Assurance–
Assurance–
Washington, DC

Public Use Data and Access Pilot Program
• Chris Haffer – CMS Office of Research, Development, and
6
Information – Baltimore, MD
CMS CER Public Use Data &
Access Solution Pilot Project
Chris Haffer,, Ph.D.,, ORDI,, CMS
7
B k
Background:
d
CMS Data are a National Resource
 Transparency
 Open Government
 CER, Data Entrepreneurs, Information
I t
Intermediaries
di i

8
Pil t Project
Pilot
P j t Goals:
G l
While strictly
y protecting
p
g
beneficiary confidentiality….
Increase access to CMS claims data
through the creation of dede-identified
d t sets
data
t and
d a public
bli access solution…
l ti
While
e strictly
st ct y protecting
p otect g
beneficiary confidentiality!!!!
9
Statistical Disclosure Control &
HIPAA Privacy Rule Protections (45 CFR § 164.514)
Statistical Standard
A covered entity may determine that health information is
nott individually
i di id ll id
identifiable
tifi bl h
health
lth iinformation
f
ti only
l ifif: (1) A
person with appropriate knowledge of and experience with
generally accepted statistical and scientific principles and
methods for rendering information not individually
identifiable: (i) Applying such principles and methods,
determines that the risk is very small that the information
could be used, alone or in combination with other
reasonably
bl available
il bl iinformation,
f
ti
b
by an anticipated
ti i t d
recipient to identify an individual who is a subject of the
information; and (ii) Documents the methods and results of
the analysis that justify such determination; OR
10
Statistical Disclosure Control &
HIPAA Privacy Rule Protections (45 CFR § 164.514)
Safe Harbor Standard
(2)(i) The following identifiers of the individual or of relatives, employers, or household members of
the individual,
individual are removed: (A) Names; (B) All geographic subdivisions smaller than a State
State,
including street address, city, county, precinct, zip code, and their equivalent geocodes, except for the
initial three digits of a zip code if, according to the current publicly available data from the Bureau of
the Census: (1) The geographic unit formed by combining all zip codes with the same three initial
digits contains more than 20
20,000
000 people; and (2) The initial three digits of a zip code for all such
geographic units containing 20,000 or fewer people is changed to 000. (C)
All elements of
dates (except year) for dates directly related to an individual, including
birth date
date, admission date
date, discharge date
date, date of death; and all ages over
11
89 and all elements of dates (including year) indicative of such age, except that such ages and
elements may be aggregated into a single category of age 90 or older; (D) Telephone numbers; (E)
Fax numbers; (F) Electronic mail addresses; (G) Social security numbers; (H) Medical record
numbers; (I) Health plan beneficiary numbers; (J) Account numbers; (K) Certificate/license numbers;
(L) Vehicle identifiers and serial numbers, including license plate numbers; (M) Device identifiers and
serial numbers; (N) Web Universal Resource Locators (URLs); (O) Internet Protocol (IP) address
numbers; (P) Biometric identifiers, including finger and voice prints; (Q) Full face photographic images
and any comparable images; and (R) Any other unique identifying number
number, characteristic
characteristic, or code;
and (ii) The covered entity does not have actual knowledge that the information could be used alone
or in combination with other information to identify an individual who is a subject of the information.
Team:
Team:
12

IMPAQ International

National Opinion Research Center

B
Buccaneer
C
Computer
t S
Systems
t
&S
Service,
i
IInc.

New Wave Telecom & Technologies
Technologies, Inc.
Inc

George Washington University Medical Center

Drinker, Biddle & Reath, LLP

Expert Consultants: Beth Virnig, Marshall McBean
Phase
Ph
O
One: BASIC Fil
Files
Create a set of BASIC or slim/thin files
 Comply with the HIPAA “safe harbor”
standard
 Test the utility of the files for CER

13
P d t
Products:

Release 1 – September 2010
• 2008 Inpatient 5%
• 2008 PDE Utilization 5%
• 2008 Beneficiaryy Summaryy File 5%

Release 2 – December 2010
•
•
•
•
•
•
14
2008 SNF Claims 5%
2008 Outpatient Hospital Claims 5%
2008 DME Claims 5%
2008 Physician/Supplier Claims 5%
2008 Hospice Claims 5%
2008 Home Health
l h Claims
Cl
5%
%
Phase 2: ENHANCED &/or LINKED Files
Proof of Concept:
Are we able to create p
public use data and
an access solution available at no/low cost
and robust enough to permit advanced
analysis??
analysis
15
Comparative Effectiveness Research (CER) Public Use Data Pilot Project
TEP/ Data Users Group
Phase 1 CREATE, DISSEMINATE & SUPPORT
BASIC FILES
Environmental Scan
Stakeholder Interviews
De-ID
De
ID Experts
Privacy Advocates
Gov Data Provider Reps
Case Studies
Lit Review/Legal Analysis
Develop &Test
ENHANCED
Stand Alone Files
GENERATE
ALTERNATIVES
Needs Assessment
Public, Academic, Private, NFP CER
Pretest LINKED SAFs
16
Phase 2
Develop
Implementation Plan
Create Data &
Access Solution
(3 Years Data)
Dissemination
User Support
P d t &D
Products
Dates
t

Fall 2011 – Winter 2012
• Enhanced Stand Alone Files ((3 y
years))
• Linked by person across claim types
(single year for each of 3 years)
• Linked by person across claim types
and across years (3 years)
17
You
Y C
Can H
Help!!
l !!
Are you a “privacy expert”?
 Are
A you a “comparative
“
i effectiveness
ff i
researcher”?
 Do you have time to be an active
participant in a Data Users Group?
Group?“

18
See me afterward OR
email: CER_PUF@impaqint.com
CER PUF@impaqint com OR
call: 866866-677677-4283