Dataset documentation and questions

CMS Open Payments

Elhadad

Chronic Conditions

Each cell is a record defined by all combinations of age category, gender, various chronic conditions, and dual-eligibility status (eligible for both Medicare and Medicaid) of the beneficiaries.

2010_Chronic_Conditions_PUF.csv 3.6 MB, 22003 rows, 55 columns - see data dictionary

COLUMNS

###Profile features:

• BENE_SEX_IDENT_CD: 1 or 2
• BENE_AGE_CAT_CD: 6 groups

###Conditions:

• CC_ALZHDMTA

• CC_CANCER

• CC_CHF

• CC_CHRNKIDN

• CC_COPD

• CC_DEPRESSN

• CC_DIABETES

• CC_ISCHMCHT

• CC_OSTEOPRS

• CC_RA_OA

• CC_STRKETIA

• CC_2_OR_MORE

• DUAL_STUS

###Claims variables (in the form of counts and averages): ####Part A: less than 12 months

• BENE_COUNT_PA_LT_12
• AVE_MO_EN_PA_LT_12
• AVE_PA_PAY_PA_LT_12
• AVE_IP_PAY_PA_LT_12
• AVE_SNF_PAY_PA_LT_12
• AVE_OTH_PAY_PA_LT_12
• AVE_IP_ADM_PA_LT_12
• AVE_SNF_DAYS_PA_LT_12

####Part A: equal to 12 months

• BENE_COUNT_PA_EQ_12
• AVE_PA_PAY_PA_EQ_12
• AVE_IP_PAY_PA_EQ_12
• AVE_SNF_PAY_PA_EQ_12
• AVE_OTH_PAY_PA_EQ_12
• AVE_IP_ADM_PA_EQ_12
• AVE_SNF_DAYS_PA_EQ_12 ####Part B: less than 12 months
• BENE_COUNT_PB_LT_12
• AVE_MO_EN_PB_LT_12
• AVE_PB_PAY_PB_LT_12
• AVE_CA_PAY_PB_LT_12
• AVE_OP_PAY_PB_LT_12
• AVE_OTH_PAY_PB_LT_12
• AVE_CA_VST_PB_LT_12
• AVE_OP_VST_PB_LT_12 ####Part B: equal to 12 months
• BENE_COUNT_PB_EQ_12
• AVE_PB_PAY_PB_EQ_12
• AVE_CA_PAY_PB_EQ_12
• AVE_OP_PAY_PB_EQ_12
• AVE_OTH_PAY_PB_EQ_12
• AVE_CA_VST_PB_EQ_12
• AVE_OP_VST_PB_EQ_12 ####Part C:
• BENE_COUNT_PC_LT_12
• AVE_MO_EN_PC_LT_12
• BENE_COUNT_PC_EQ_12 ####Part D:
• BENE_COUNT_PD_LT_12
• AVE_MO_EN_PD_LT_12
• AVE_PDE_CST_PD_LT_12
• AVE_PDE_PD_LT_12
• BENE_COUNT_PD_EQ_12
• AVE_PDE_CST_PD_EQ_12
• AVE_PDE_PD_EQ_12

Here is a useful read about how the data can be used.

####About Medicare Part A, B, C, D Different parts of Medicare cover different services. Original Medicare, made up of Parts A and B, is administered by the federal government:

1. Part A (Hospital Insurance) covers most medically necessary hospital, skilled nursing facility, home health and hospice care. No monthly premium if you’ve worked more than 10 years.
2. Part B (Medical Insurance) covers most medically necessary doctors’ services, preventive care, durable medical equipment, hospital outpatient services, laboratory tests, x-rays, mental health care, and some home health and ambulance services. You pay a monthly premium for this coverage.
3. Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits.
4. Part D provides prescription drug coverage and is provided only through private insurance.

###Questions for modeling:

1. What predicts average payment?
2. Which are the most costly chronic conditions, in terms of total dollar amount (avg payment * bene count) and aggregated by chronic condition?
3. Are there any conditions and age group combinations that are expensive to treat?
4. How do Part A and B differ?
5. How do Part A and B interact?
6. How much did payments increase from 2008 to 2010?

Notes: payments distribution is very skewed (90% of cost comes from 1% of patients). Consider taking logs.

NPDB Malpractice Claims

Medicare Provider Utilization and Payment Data

SPARCS