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Dataset documentation and questions
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
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
Useful read about how the data can be used: https://www.cms.gov/mmrr/Downloads/MMRR2013_003_02_b02.pdf
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: 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. 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.
Part C is the part of Medicare policy that allows private health insurance companies to provide Medicare benefits. Part D provides prescription drug coverage and is provided only through private insurance.
Questions for modeling: What predicts average payment? Which are the most costly chronic conditions, in terms of total dollar amount (avg payment * bene count) and aggregated by chronic condition? Are there any conditions and age group combinations that are expensive to treat? How do Part A and B differ? How do Part A and B interact? 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.