CMS Datasets

1. CMS Datasets AcademyHealth June 3, 2007

2. Agenda • Overview of CMS data • Updates • Part D data • MCBS • HOS • MAX • The shiny new Chronic Conditions Data Warehouse

3. 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)

4. 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/

5. Four Flavors of Data for Order from CMS • Cost Reports • Identifiable Data Files • Limited Data Sets • Non-Identifiable Data Files

6. 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 Cost Reports

7. Identifiable Data Files contain actual beneficiary-specific / physician-specific information and require a formal request to CMS for approval • 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)

8. Limited Data Set Files (LDS) contain beneficiary level health information but exclude specified direct identifiers as outlined in the HIPAA Privacy Rule • 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%) 

9. Non-Identifiable Data Files contain non-identifiable person-specific information and are within the public domain • 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

10. 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

11. 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

12. 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

13. 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

14. MCBS Summer 2006Part 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.

15. 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.

16. 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-the-science in functional health outcomes measurement, and quality improvement interventions and strategies.

17. 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

18. 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

19. 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)

20. 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

21. 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) • Inpatient hospital • Long term care • Prescription drug • Other Services

22. 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_MedicaidPharmacy.asp#TopOfPage

23. 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/MedicaidDataSourcesGenInfo/07_MAXGeneralInformation.asp#TopOfPage

24. http://www.cms.hhs.gov/home/rsds.asp

25. 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

26. 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