Medicare

Medicare is a health insurance program, administered by the United States government, for people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other special criteria like the End Stage Renal Disease program (ESRD).

Medicare Shared Savings Program Accountable Care Organizations (ACO) Beneficiary-level RIF

CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:

  • The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)
  • The Shared Savings Program Provider-Level RIF

What does this file include? (variable highlights)

  • ACO ID
  • Assigned in Preliminary/Prospective Assignment Period
  • Assigned in Quarter 1
  • Assigned in Quarter 2
  • Assigned in Quarter 3
  • Assigned in Quarter 4
  • Assigned in Final Reconciliation
  • Part D Eligible Months
  • HICN (populated in PY2013-PY2019/2019-A)
  • Date of birth
  • Date of death
  • Gender
  • Race
  • Medicare Beneficiary Identifier (MBI)

Special considerations

  • This file can be linked to any other CMS file that includes the Bene ID.
  • These files differ from the monthly Claim and Claim Line Feed (CCLF) files active Shared Savings Program ACOs receive from CMS. CCLF files include claims for the ACO’s assigned or assignable beneficiary population. The purpose of the CCLFs is to assist active Shared Savings Program ACOs with coordination of care. In contrast, Shared Savings Program Beneficiary-Level RIFs are statistics on beneficiaries and services included in each ACOs annual reconciliation. CCLF files cannot be linked to the Shared Savings Program Provider or Beneficiary RIFs.
  • Shared Savings Program RIFs do not include data for models such as ACO Realizing Equity, Access and Communication Health (ACO REACH) or Kidney Care Choices (KCC) models.
  • All technical questions related to the Shared Savings Program should be directed to the ACO Information Center at SharedSavingsProgram@cms.hhs.gov.

Medicare Shared Savings Program Accountable Care Organizations (ACO) Provider-level RIF

CMS has created a set of analytical files that contain data from the Medicare Shared Saving Program. There are two separate files in this data set:

  • The Shared Savings Program Beneficiary-Level Research Identifiable File (RIF)
  • The Shared Savings Program Provider-Level RIF

What does this file include? (variable highlights)

  • ACO ID
  • ACO Name
  • Start Date
  • Tax Identification Number (TIN) of ACO Participant
  • TIN Legal Business Name
  • National Provider Identifier (NPI) for practitioner
  • Name of Provider Associated with the NPI
  • CMS Certification Number (CCN; formerly OSCAR number)
  • CCN Facility Type
  • CCN Facility Type Description
  • Provider Specialty Code
  • ACO Location (county primarily served)
  • Year of ACO Source Record

Special considerations

  • Shared Savings Program RIFs do not include data for models such as ACO Realizing Equity, Access and Communication Health (ACO REACH) or Kidney Care Choices (KCC) models.
  • All technical questions related to the Shared Savings Program should be directed to the ACO Information Center at SharedSavingsProgram@cms.hhs.gov.

Pioneer Accountable Care Organization (ACO)

The Centers for Medicare and Medicaid Services (CMS) has created a set of files that contain Pioneer Accountable Care Organizations information. There are three separate files in the set:

  • Provider-includes one record for each facility or professional participating provider
  • Beneficiary-each record represents an individual beneficiary who was associated with a Pioneer ACO
  • Settlement-one record for each Pioneer ACO provides information on the post-performance year financial settlement

What does this file include? (variable highlights)

  • Provider file
    • Pioneer ACO ID
    • Tax identification number
    • Provider specialty code
  • Beneficiary file
    • Bene ID
    • Pioneer ACO ID
    • Aggregated expenditures and claim counts
  • Settlement file
    • Pioneer ACO ID
    • Beneficiary counts
    • Performance year expenditures and savings

Special considerations

  • Each file needs to be specified separately on a data request.
  • Only the Pioneer ACO Beneficiary file can be linked to other CMS data via the Bene ID.

Medicare Data on Provider Practice and Specialty (MD-PPAS)

The MD-PPAS file assigns Medicare providers to medical practices based on the tax identification numbers and elaborates on the Centers for Medicare & Medicaid Services (CMS) provider specialty classification. This provider-level dataset is built around two identifiers: the national provider identifier (NPI) and the tax identification number (TIN).

What does this file include? (variable highlights)

  • The MD-PPAS contain data on specialty, TIN practice assignment, place of service information, provider demographics, geographic location, and summary Medicare utilization measures for over 1.2 million providers.
  • The MD-PPAS has been updated to version 2.4 from version 2.3 to reflect the following changes: 
    • The MD-PPAS data include a modified broad specialty variable that provides a more detailed breakdown of non-physician specialties.
    • The data also include two additional variables related to the percent of providers' line items that are performed in a given place of service (POS). Specifically, MD-PPAS data now include variables that report the percent of line items performed in urgent care centers and retail clinics.

Special considerations

  • The data use a new methodology to assign providers to CBSAs based on the zip code reported on their submitted claims. This change resulted in a small percentage of providers with different values for their CBSA code and type variable.

Healthcare Effectiveness Data and Information Set (HEDIS)

The Healthcare Effectiveness Data and Information Set (HEDIS) Patient-Level Detail (PLD) files are a set of standardized healthcare quality measures designed to provide information for reliable comparison of health plan performance. The HEDIS PLD data are submitted annually by Medicare Advantage (MA) Organizations, Cost Plans, and Demonstration Plans and contribute to the assignment of CMS Star Ratings for MA plans.

HEDIS data are released as a set of two files per year:

HEDIS data are released based on the measurement year of the plan data submission, which reflect health care delivered in that calendar year. Other HEDIS reports may distinguish between measurement year and submission year. Care should be taken to confirm that the correct years are being requested.

HEDIS record layouts vary depending on measurement year and data source. ResDAC will work with the researcher to identify the appropriate data source depending on the measurement years requested.

Long Term Care Minimum Data Set (MDS) - Swing-Bed 2.0

The Long Term Care Minimum Data Set (MDS)-Swing Bed is a health status screening and assessment tool. It is required for Medicare payment of hospital-based skilled nursing care. Swing-bed providers are hospitals that can use beds, as needed, to provide either acute or post-acute skilled nursing care.  The swing-bed assessment includes a subset of the skilled nursing facility (SNF) MDS items. MDS Swing Bed 2.0 was replaced by version 3.0 in October, 2010.

What does this file include? (variable highlights)

  • Resource Utilization Group (RUG) code
  • Clinical status measures
  • Physical functioning assessment
  • Psychological status measures
  • Psycho-social functioning measure

Consumer Assessment of Healthcare Providers & Systems RIF

CMS administers several surveys to assess beneficiary experience with different types of health care. Some of these are CMS-only surveys. Others, those designated as CAHPS, have been approved by the AHRQ-overseen CAHPS consortium.

Healthcare providers/populations addressed by specific, individual surveys include:

  • Hospital
  • Home Health
  • Home and Community Based Services
  • Fee-for-Service
  • Medicare Advantage & Part D Plan (PDP)
  • In-Center Hemodialysis
  • Nationwide Adult Medicaid
  • Hospice
  • Accountable Care Organizations
  • Outpatient and Ambulatory Surgery
  • Merit-based Incentive Payment System quality payment program

Measures of beneficiary experience focus on the patient experience or perception rather than patient satisfaction. Focus areas include:

  • Communication with providers
  • Understanding medication instructions
  • Coordination of healthcare needs

The number of participating patients and institutions varies by survey. For example, over 4,000 hospitals participates in HCAHPS, and over 7,000 home health agencies participate in HHCAHPS.

Special considerations:

National Health and Aging Trends Study (NHATS) - Medicare Linked Data

The National Health and Aging Trends Study (NHATS) collects interview data on functioning in late life among the elderly population. NHATS began collecting data in 2011, with over 8,000 Medicare beneficiaries responding to the first round.

CMS is no longer distributing this file. See the NIA Data LINKAGE Program website to request this data.

The NHATS interview data include:

  • Residence
  • Health conditions
  • Housing/household
  • Functional status
  • Insurance
  • Labor force participation

The NHATS interview data are linked to CMS Medicare claims data for information on healthcare use.

Special considerations

Health and Retirement Survey - Medicare Linked Data

The Health and Retirement Study (HRS)-Medicare linked dataset includes HRS survey information linked to CMS claims and assessment data for the HRS study population. The HRS has been fielded since 1992 and surveys more than 30,000 people age 50 and older.

The Health and Retirement Study (HRS) is designed to:

  • facilitate understanding of the relationship between medical history and financial status
  • examine how use of health care may change as people age.

The longitudinal survey data is linked to CMS data to provide information on health care utilization and beneficiary assessment.

CMS is no longer distributing this file. See the NIA Data LINKAGE Program website to request this data.

What does this file include? (variable highlights)

  • HRS data include:
    • Demographic and background information, including household
    • Physical and mental health
    • Cognition
    • Functional limitations
    • Employment
    • Disability
    • Health insurance
    • Assets and Income
    • Wills, including advanced directives
  • Linked files include:

Special considerations

Health Outcomes Survey RIF

The Medicare Health Outcomes Survey (HOS) collects patient-reported outcomes measures from beneficiaries enrolled in Medicare Advantage plans. The Medicare HOS program collects health status data for use in quality improvement activities, plan accountability documentation, and health improvement activities in a base survey and two year follow-up survey. The baseline sample size is 1,200.

HOS variables contain the following information in a baseline survey and two-year follow-up survey:

  • Demographic information including primary language
  • Disability status
  • Physical and mental health status
  • HEDIS Effectiveness of Care measures
  • Health-related quality of life (HRQOL)

Special considerations