Data Sources: Centers for Medicare & Medicaid Services

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Medicare Claims Data

Sponsor

Centers for Medicare and Medicaid Services (CMS).

Mode of Administration

Medicare claims data contain substantial utilization data for Medicare beneficiaries for a variety of providers and services. The files used here are the institutional and non-institutional Standard Analytic Files (SAFs). The institutional SAFs include inpatient, outpatient, skilled nursing facility (SNF), home health, and hospice files. The non-institutional SAFs include physician/supplier files. The SAFs include only claims in their final action form (CMS, 2000).

Survey Sample Design

The 5% sample for the Standard Analytic File is selected based on the two terminal digits of the beneficiary's HIC number. For the analyses presented in this report, these data were subset to the sample of beneficiaries who died between 1996 and 1999.

Primary Survey Content

Medical expenditure data as well as detailed data on procedures, diagnoses, co-morbidities, enrollment status, and basic demographics.

Population Targeted

All Medicare beneficiaries.

Demographic Data

Age, race, state and county of residence.

Years Collected

1991 to present.

Schedule

NA.

Geographic Estimates

Both national and sub-national analyses can be estimated with these data (including Census region, CMS region, state, and urban/rural locations).

Contact Information

Agency homepage: http://www.cms.gov.

References

Centers for Medicare and Medicaid Services (CMS) (2000). Claims and Utilization Data. http://www.cms.hhs.gov/home/rsds.asp

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Medicare Current Beneficiary Survey (MCBS)

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Office of Strategic Planning

Mode of Administration

MCBS is a computer assisted personal survey of Medicare beneficiaries residing in the United States and Puerto Rico. The data in this report are from repeat interviews of Medicare beneficiaries who resided in community settings. Community residents receive a baseline questionnaire and community core questionnaires. The baseline questionnaire collects information on health insurance, household composition, health status, access to and satisfaction with medical care, and demographic and socioeconomic characteristics. The core questionnaires collect information on health insurance, medical care use, charges and payments for medical care, and specific topics such as income and assets. These data are supplemented with administrative data on Medicare and Medicaid eligibility, enrollment in Medicare managed care, and claims for Medicare-covered services.

Survey Sample Design

The MCBS sample consists of aged and disabled beneficiaries enrolled in Medicare Part A (hospital insurance) or Part B (medical insurance) or both. Beneficiaries are selected for the survey by using a stratified, multistage area probability design. A key feature of the survey is that sample persons are followed over time as part of a four-year rotating panel design. Each person is interviewed 3 times per year over 4 years, regardless of whether he or she resides in the community or a long-term care facility.

The data are used to produce calendar year public use files on Access to Care and Cost and Use. All four panels are included in the Access to Care File. Only three panels are included in the Cost and Use File since the panel that is being retired during a calendar year is not asked about medical utilization for that year.

Primary Survey Content

Medical expenditure data as well as detailed data on health conditions, health status, use of medical care services, charges and payments, access to care, satisfaction with care, health insurance coverage, income, and employment.

Population Targeted

The MCBS is a nationally representative survey of all Medicare beneficiaries, regardless of age or place of residence.

Demographic Data

Age, race, ethnicity, region, occupation, employment status, and household composition.

Years Collected

1991 to present.

Schedule

Annual releases of Access to Care and Cost and Use files. The Access to Care File for a calendar year is released about one year after the end of data collection. The Cost and Use File for a calendar year is released about two years after the end of data collection.

Geographic Estimates

National. The data also can be shown for the four Census regions (Northeast, Midwest, South, and West).

Notes

The MCBS contains four overlapping panels of Medicare beneficiaries. Each year one panel is dropped from the survey and a new one is added. This design produces three calendar years of medical utilization data for each sample person. The data are collected over a four-year period in which sample persons are interviewed 12 times. The first interview collects baseline information on the beneficiary. The next 11 interview are used to collect three complete years of utilization data.

Contact Information

Data system homepage: http://www.cms.hhs.gov/mcbs/01_overview.asp?

References

G. S. Adler, Summer 1994, A Profile of the Medicare Current Beneficiary Survey, Health Care Financing Review, 15(4): 153-163.

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Medicare Quality Improvement Organizations (QIO) Program

Sponsor

U.S. Department of Health and Human Services,

Centers For Medicare & Medicaid Services (CMS)

Description

Under the direction of CMS, the QIO program consists of a national network of fifty-three QIOs responsible for each U.S. state, territory, and the District of Columbia. QIOs work with consumers, physicians, hospitals, and other caregivers to refine care delivery systems to make sure patients get the right care at the right time, particularly among underserved populations. The program also safeguards the integrity of the Medicare trust fund by ensuring payment is made only for medically necessary services, and investigates beneficiary complaints about quality of care.

Data collection

Data are collected by the national network of fifty-three QIOs responsible for each U.S. state, territory, and the District of Columbia according to data collection tools developed by QIOs or related organizations.

Primary Content

QIO measures included in the NHQR include those related to: acute myocardial infarction; heart failure; and pneumonia.

Population Targeted

Medicare beneficiaries as required for the relevant measure.

Demographic Data

Age, race, gender.

Years Collected

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Schedule

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Geographic Estimates

Need info on this

Contact Information

Agency homepage: http://www.cms.hhs.gov.

Data system homepage: http://www.cms.hhs.gov/QualityImprovementOrgs/.

References

Go to the QIO Statement of Work at http://www.cms.hhs.gov/QualityImprovementOrgs/04_9thsow.asp#TopOfPage

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Minimum Data Set (MDS)

Sponsor

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services (CMS), Survey and Certification Group.

Mode of Administration

Survey of all residents of Medicare and Medicaid certified facilities; completed by facility personnel, attestation of accuracy required. The MDS is a component of the Resident Assessment Instrument (RAI).

Primary Content

Standardized, primary screening and assessment tool of health status; measures physical, medical, psychological and social functioning of long-term care residents. Includes a set of 24 quality indicators (QIs) developed by researchers to identify potential problems with care in nursing facilities.

Population Targeted

Residents in Medicare or Medicaid certified nursing and long-term care facilities.

Demographic Data

Gender, age, marital status, location, facility, ethnicity and health status.

Years Collected

Since June 1998.

Schedule

Administered on admission, quarterly, annually, whenever the resident experiences a significant change in status and whenever the facility identifies a significant error in a prior assessment.

Geographic Estimates

National, State, facility.

Contact information

Agency homepage: http://cms.hhs.gov.

Oversight homepage: http://www.cms.hhs.gov/MDSPubQIandResRep/.

Data system homepage: http://www.cms.hhs.gov/minimumdatasets20/01_overview.asp?.

Comments

An extract of MDS data, the Nursing Home Resident Profile Table, was used to make estimates of Long Term Care measures. This extract includes information about active residents of nursing homes. An active resident is a resident whose most recent MDS assessment transaction is not a discharge and whose most recent transaction has a target date less than 180 days old. If a resident has not had a transaction for 180 days, then that resident is assumed to have been discharged.

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