ResDAC's Medicare Statistical FAQ
National Health Care Spending
- How much has the federal government spent on Medicare and Medicaid?
The Office of the Actuary statistical website contains information related to the projected national health spending. The downloadable file in the download section titled "National Health Expenditures by Type of Service and Source of Funds CY1960-2006" provides a break down of spending, such as personal out-of-pocket, private, Medicare, and Medicaid by state by year between 1960 and 2006.
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Medicare Enrollment
- I'm looking for the age, sex, race breakdown of the Medicare population by county.
A breakdown of the Medicare enrollment by age, sex, and race does not currently exist on the CMS website. However, researchers can calculate an approximation using the frequencies provided on the enrollment website and the Statistical Supplement, Table 6: Number of Medicare Enrollees, by Demographic Characteristics, Type of Coverage, Type of Entitlement, Type of Payment, Buy-in Status, and Residence.
Another potential source of this information is from the Medicare Current Beneficiary Survey. In the published report, The Characteristics and Perceptions of the Medicare Population, Section 1: The Medicare Population gives a frequency of the Medicare population based on the survey results that could be applied to the Medicare enrollment statistics.
Finally, the Medicare Advantage Rate website publishes Fee-For-Service Expenditure (and enrollment) Data by County from 1998-2005. Go to the links found on the left side of the website to find this information. These statistics are not broken out by demographic characteristics.
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- How many Medicare beneficiaries enrolled in the Medicare Part D drug plan?
Enrollment reports for the Medicare Part D drug plan can be found on the Medicare Part D Enrollment data page for beneficiaries enrolled in a fee-for-service Medicare plan. Medicare beneficiaries enrolled in a Medicare managed care plan that enrolled in Part D can be found on the Medicare Managed Care statistics website.
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- I'm looking for the enrollment in Medicare Part D by age, sex, race breakdown by county.
A breakdown of the Medicare Part D enrollment by age, sex, and race does not currently exist on the CMS website. However, CMS does publish Part D enrollment statistics by state, county, and plan and can be found on the Part D Enrollment website.
The Kaiser Family Foundation has a Medicare Health Plan Tracker information that includes information on the Prescription Drug Plans.
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- How many first-time Medicare enrollees are there each year?
This statistic does not exist on the CMS website. You need to purchase the Denominator file and calculate this statistic yourself by looking at the variables original reason for entitlement and number of months of coverage.
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- How many Medicare beneficiaries die each year? What is the death rate?
This information does not exist on the CMS website. Researchers would need to purchase the Denominator file to determine the number of deaths each year. Also, researchers can refer to the National Center for Health Statistics Deaths/Mortality website for death rates by age, sex, and race.
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Medicare Managed Care
- I'm interested in market trends for Medicare Advantage plans.
The main Medicare Managed Care website has several reports related to trends.
Another source for Medicare Managed Care information is the Kaiser Family Foundation, State Health Facts website.
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Medicare Utilization, Charges, and Payments
(Inpatient, Skilled Nursing Facilities, Outpatient, Home Health Care, Hospice, Physician, Durable Medical Equipment)- I need the estimated number of Medicare beneficiaries with a certain diagnosis code.
This information generally does not exist on the CMS website. This information exists only for some of the most common types of conditions. The Medicare and Medicaid Statistical Supplement contains information related to utilization by primary diagnosis, but not the number of individuals. Please refer to tables 27 (Hospitals), 41 (Skilled Nursing Facilities), 52 (Home Health Agencies), 63 (Physician services) for more information.
Another potential source of information is the Medicare Current Beneficiary Survey. The Characteristics and Perceptions of the Medicare Population, Section 2: Health Status gives the frequency of the self-reported health conditions from the MCBS survey respondents.
If the information is not contained within the Statistical Supplement or the MCBS, then the only other CMS data source would be the administrative data files. A link to the description for the Limited Data Set Files is found here. Researchers would have to use the administrative data file by type of service (inpatient, outpatient, skilled nursing facility, home health care, hospice, physician services).
Another source for this type of information is the National Center for Health Statistics, National Health Interview Survey or Healthcare Cost and Utilization Project.
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- I need the number, payments, and charges for all possible services provided to Medicare beneficiaries last year by state.
CMS publishes a limited number of these types of statistics. The majority of procedure statistics are found on the Fee-For-Service statistics website or in the Medicare and Medicaid Statistical Supplement. Generally, if the information is not found under these two sources, then files need to be purchased in order to calculate the statistic.
The Medicare Advantage Rates & Statistics website publishes Fee-For-Service Expenditure (and enrollment) Data by County from 1998-2004. Go to the right side of the website to find this information (FFS Data). This utilization data is aggregated at the level of Part A or Part B enrollment and utilization, not individual procedure code nor is it by service type (eg: inpatient vs outpatient.)
For statistics on inpatient services, the Fee-For-Service MedPAR statistics page would provide information on total charges, Medicare reimbursement, and days by state or DRG. Similar information can be found in the Statistical Supplement under the Medicare Short-Stay Hospitals category. Utilization for other types of institutional services, such as Hospital Outpatient, Skilled Nursing Facility, Home Health Agencies, and Hospice can also be found in the Statistical Supplement under their respective category. Another source with more detailed information can be found on the Health Care Consumer Initiatives website. Reports for inpatient services include the Top 30 DRGs, which includes the number of discharges by DRG by hospital and average payment.
For statistics on physician services, the Fee-For-Service statistics page under the section Medicare Utilization for Part B provides information on allowed charges and allowed services for the Top 200 HCPCS codes. Further, CMS breaks out the HCPCS codes and provides the Top 200: Level I-CPT-4 codes, Level II-HCPCS codes, Lab codes, and E&M codes. Although not as detailed, some statistics on physicians' services can be found in the Statistical Supplement under the Medicare Short-Stay Hospitals category. Utilization for other types of institutional services, such as Hospital Outpatient, Skilled Nursing Facility, Home Health Agencies, and Hospice can also be found in the Statistical Supplement under their respective category. Another source with more detailed information can be found on the Health Care Consumer Initiatives website. Reports for physician services include the Top 72 most common procedures, which includes the volume, charges, and average payments by Medicare locality by specialty.
Frequency reports from the MDS assessment information for nursing home residents can be found on the MDS Quality Indicator and Resident Reports website. Frequency reports from the Home Health Care OASIS assessments can be obtained from the OASIS-Based Home Health Agency Patient Outcome and Case Mix Reports website.
Other possible data sources include the downloadable Payment System data files. These files were intended to provide information that would allow researchers to calculate payment impact changes. The data files do provide the number of services and some provide the average Medicare payment amounts. The link to the main Payment Systems website is found here. Some specific data files of interest include:
- Hospital Outpatient - Median Costs for Hospital Outpatient Services, by HCPCS code (This is found by selecting the Federal Regulation of interest and then looking in the download section for the specific file.)
- Hospice Expenditures and Units of Care
- "Specialty Utilization File [ZIP, 7MB]" used for determining the 2005 Physician Fee Schedule
Lastly, if the particular statistic is not found in the resources above, then a public use file or a Limited Data Set (LDS) file may be purchased to generate the statistic.
- Public Use Files: For institutional services (hospitals, hospital outpatient, skilled nursing facilities, home health agencies, hospices) consider the Health Care Information Systems (HCIS) file. For physician services, the two public use files that can be purchased include the Part B Extract Summary System (BESS) or the Physician Supplier Procedure Summary File .
- Limited Data Sets (LDS): LDS files contain beneficiary level claim information, with some of the data elements encrypted, blanked, or range to protect the identity of the beneficiary and/or physician. A link to the description for the Limited Data Set Files is found at here. Researchers would have to use the administrative data file by type of service (inpatient, outpatient, skilled nursing facility, home health care, hospice, physician services).
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- I need the number and payments for Part D services provided to Medicare beneficiaries last year by state.
Currently, the only information available for Part D services includes enrollment and dispensing rates, which is part of the Part D performance standards.
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- What is the average Medicare payment by type of service?
Each type of service is reimbursed differently, for an overview of how each Medicare provider is paid, please see the MedPAC Payment Basics found under the "Other Documents" section of their website. Another MedPAC report that describes an overview is Report to the Congress: Medicare Payment Policy, March 2003, Appendix A: How Medicare Pays for Services: an overview. .
In order to generate this statistic, one option is to go to the Fee-For-Service statistics page or to the Medicare and Medicaid Statistical Supplement and calculate an average payment for the particular type of service you are interested in, such as by average Medicare payment by DRG, by HCPCS, or by day.
Lastly, if the particular statistic is not found in the resources above, then a public use file or a Limited Data Set (LDS) file may be purchased to generate the statistic.
- Public Use Files: For physician services, the two public use files that can be purchased include the Part B Extract Summary System (BESS) or the Physician Supplier Procedure Summary File.
- Limited Data Sets (LDS): LDS files contain beneficiary level claim information, with some of the data elements encrypted, blanked, or range to protect the identity of the beneficiary and/or physician. A link to the description for the Limited Data Set Files is found here. Researchers would have to use the administrative data file by type of service (inpatient, outpatient, skilled nursing facility, home health care, hospice, physician services).
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- What is the number of prescription drugs reimbursed by Medicare over the past five years?
This information is not currently available on the CMS website. For those drugs that Medicare does cover under Part B, files that would contain that information would be found on the Non-Identifiable Data Files website, Part B Extract Summary System (BESS) or the Physician Supplier Procedure Summary File. Only dispensing rates are available for drugs covered under Part D.
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Medicare Providers, Physicians, and Suppliers
- I'm interested in the number of institutional facilities by geographic area.
Several statistical publications contain general information on characteristics of institutional facilities. The CMS Statistics contains statistics on institutional providers and physicians, however, it has limited information by geographic location. Please refer to the Provider/Supplier section starting on page 15 of the publication.
The Data Compendium does provide general statistics on providers and suppliers, but it does not provide the information by geographic location.
The Medicare and Medicaid Statistical Supplement contains limited information by provider. Please refer to Tables 32 and 34 (Hospitals), 43 (Skilled Nursing Facilities), 50 (Home Health Agencies), 54 (Hospices), 61 (Physician services) for more information.
The Medicare Cost Reports contain information for Hospitals, Skilled Nursing Facilities, Home Health Care Agencies, Hospices, and End Stage Renal Disease programs. Even though the cost reports contain characteristics of these types of facilities, the exact variables needed are often difficult to extract from the database. In order to understand the structure of the data found in the cost reports, please refer to the ResDAC technical publication "Cost Report Database Format". In order to view the variables contained within each type of cost report, please refer to the "6. Forms" section on the ResDAC cost report data documentation webpage.
For hospitals covered under the Inpatient Prospective Payment System, the free downloadable Impact Files contain limited descriptive characteristics. The current year Impact File is located on the Acute Inpatient Prospective Payment webpage and the Historical Impact Files go back to 1994.
Several free databases can be downloaded from the www.medicare.gov website. The download website includes the Dialysis Facility Compare, Home Health Compare, Nursing Home Compare, Hospital Quality Alliance, and Supplier Directory databases and each database contains information for each individual facility.
As of May 2007, all providers are using the National Provider Identifier or NPI. The downloadable NPI file contains information about each provider that receives payment from Medicare. CMS offers a searchable NPI database as well as downloadable file. Descriptive information about the downloadable NPI file is found on the CMS NPI Data Dissemination website.
The former searchable UPIN Registry has been discontinued as of May 2007, but researchers can look up individual UPINs at the eCare.com website. This site does allow users to search by geographic location in order to find the number of physicians for a given geographic area. Another web source for physician information is the American Medical Association's Doc Finder.
If these physician sources did not have the information needed, then the UPIN Directory may be purchased in order to calculate statistics on Medicare enrolled physicians.
The Area Resource File can be purchased and contains information about facilities and physicians at a county level. The American Hospital Association is another good source for hospital characteristics.
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- I need financial information for institutional providers, such as the total margin by facility type.
This information is not provided in a table format on the CMS website. MedPAC's A Data Book published annually, contains information on financial margin's by institutional facility.
If researchers wanted to calculate the margin by facility type, the Medicare Cost Reports would contain the information needed to calculate financial ratios. For Hospitals, Skilled Nursing Facilities, and Hospices, the financial information is contained on Worksheet G. Even though the cost reports contain financial information, the exact variables needed are often difficult to extract from the database. In order to understand the structure of the data found in the cost reports, please refer to the ResDAC technical publication "Cost Report Database Format". In order to view the variables contained within each type of cost report, please refer to the "6. Forms" section on the ResDAC cost report data documentation webpage.
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Nursing Homes
- I'm interested in finding the most frequent nursing home deficiencies
The Nursing Home Compare database that can be downloaded from the Medicare.gov website includes four separate files. One of which, Nursing Home Inspection Results, contains deficiency information. The database on the Medicare.gov website is for the current period only. If historical years are needed, please submit a request for contact information through the ResDAC Request and Response Transmission System (RRTS).
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- How many Nursing Homes have Alzheimer's treatment units?
This information can be found in the MDS Quality Indicators & Resident Report. Nursing Homes that provide services to Alzheimer's patients can be found using the Active Resident Information Report.
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Last Modified September 29, 2008