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NCHS Linked Medicare Data for Health Research

NCHS Linked Medicare Data for Health Research. Special Projects Branch Office of Analysis and Epidemiology NCHS Data Users Conference August 13, 2008 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention

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NCHS Linked Medicare Data for Health Research

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  1. NCHS Linked Medicare Data for Health Research Special Projects Branch Office of Analysis and Epidemiology NCHS Data Users Conference August 13, 2008 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics

  2. NCHS Record Linkage Program • Links survey data with data collected from administrative records • Designed to maximize the scientific value of the NCHS population-based surveys • Examine factors that influence chronic disease, disability,health care utilization, morbidity, and mortality

  3. What is Record Linkage? NCHS Records NCHS Records AdministrativeRecords Administrative Records SSN SSN SSN SSN Name Name Name Name DoB DoB DoB DoB Sex Sex Sex Sex State of Birth State of Birth State of Birth State of Birth Race Race Race Race State of Residence State of Residence State of Residence State of Residence Marital Status Marital Status Marital Status Marital Status Scoring system, Scoring system, Potential matches Potential matches Non matches Non matches clerical review clerical review True matches True matches Non matches Non matches Linked Data File LinkedData File

  4. Record Linkage Activities • Mortality • National Death Index • Social Security Retirement and Disability • Data from the Retirement, Survivors, Disability Insurance (RSDI) and Supplemental Security Income (SSI) programs • Medicare enrollment and payments • Enrollment and claims data

  5. Medicare 101 • Medicare eligibility groups: • 65 years and older • Disabled • End Stage Renal Disease • Medicare components during this time period: • Part A (Hospital insurance) • Part B (Medical insurance) • Medicare data: • Claims based records for covered health services

  6. Medicare Linkage • Medicare enrollment and claims data for the years 1991-2000 • Denominator file • MEDPAR Inpatient hospitalization • MEDPAR Skilled nursing facility (SNF) • Hospital outpatient • Home Health Agency (HHA) • Hospice • Carrier (physician/supplier Part B file) • Durable Medical Equipment (DMERC) • Next data release (1999-2006) • All of the above files • Chronic Conditions Warehouse • Medicare Part D (Prescription Drugs)

  7. Medicare Linkage • Summary Medicare Enrollment and Claims Files (SMEC) for 1991-2000 • Enrollment information from the Denominator file plus summary variables of claims and payments • Variables modeled after MCBS cost and use files • Total reimbursements per year • Total number of claims by Medicare record type • Summary of charges by Medicare record type • Termination status & reason for termination • Monthly HMO enrollment • Medicare status code (i.e. Part A, B or both)

  8. NCHS Health Surveys Completed Linkage CMS data 1991-2000 Future Linkage CMS data 1999-2007 NHIS 1994-1998 X X NHIS 1999-2005 X LSOA II (1994-2000) X X NHEFS (1971-1992) X X NHANES II (1976-1980) X X NHANES III (1988-1994) X X NHANES 1999-2004 X NNHS 1997, 2004 X NCHS Linked Medicare Data Files

  9. Research Potential of Linked Medicare Data • Examine risk factors for health conditions • Examine reliability of survey data • Compare survey reported Medicare enrollment to Medicare claims records • Examine survey report of disability with program participation eligibility criteria • Examine disparities in Medicare service utilization

  10. Medicare: Analytic Issues • Eligibility status • Eligible but not matched • Death • Linked but no Medicare data • Managed care enrollment • Non covered services • Issues with Medicare data files • See the NCHS-CMS linkage web page under “Analytic/Programming Support”

  11. Linkage Ineligibility • Cannot attempt to link survey records to other data sources if respondent • Refused to provide SSN; or • Lacks sufficient key identifying information • These cases are INELIGIBLE for linkage and MUST BE DROPPED from all analysis • They are not a random sample of respondents • More of a problem for NHIS than for NHANES

  12. NCHS Health Survey % Ineligible % Linked among eligible NHIS 1994 17.9 92.8 NHIS 1995 19.3 92.8 NHIS 1996 22.2 92.1 NHIS 1997 30.7 93.7 NHIS 1998 40.3 92.4 LSOA II 20.4 96.2 NHEFS 7.1 84.9 NHANES II 0.0 81.0 NHANES III 1.9 95.9 Medicare Ineligible Population and Linkage Rates (65+ years)

  13. Ineligibles and Non-Matches • Must be excluded from your sample • Identify using the variable (CMS_MATCH) on the Feasibility Study Data

  14. Identifying Deaths • Survey participants interviewed before the availability of linked Medicare files could have died before 1991 • E.g. NHEFS, NHANES II or NHANES III • Persons may die during study period and cease to have Medicare records • Enrolled in Medicare in 1991 but died before 2000

  15. Identifying Deaths • Survey respondents who died before 1991 (e.g. from NHANES) can be identified by merging mortality information from the Linked Mortality files • Needed to create analytic sample • Persons who died during 1991-2000 should no longer have Medicare records after date of death • Look for a CMS date of death (DOD) on each of the Denominator or SMEC files (1991 to 2000)

  16. No Denominator Record • Deceased prior to 1991 • check CMS date of death • Loss of entitlement during 1991-2000 • check termination codes on Denominator or SMEC files (PART_A_TERM_CD and PART_B_TERM_CD) • Deceased during 1991-2000 • Non payment of premium • Voluntary withdrawal • Other termination • CMS record keeping inconsistencies

  17. No Denominator Record • Lack of denominator record can affect your analytic sample – why? • Can’t determine managed care enrollment • In general, managed care enrollees are excluded from sample (more on this to come)

  18. Denominator recordbut no claims data • Entitled to Medicare but not utilizing Medicare services during 1991-2000 • Entitled to Medicare but Medicare services being used are not reimbursable claims • Note: • Small fraction of linked participants may have claims data but no associated Denominator record • Some Medicare beneficiaries only enrolled in Part A • CMS record keeping inconsistencies

  19. Managed Care Enrollment • Medicare does not receive claims for beneficiaries enrolled in managed care plans (HMO) • Do not have complete information on payments or services received • Could miss health events that are being counted based upon submitted claims • Complex issue. See ResDAC Technical brief at http://www.resdac.umn.edu/Tools/TBs/TN-009_MedicareManagedCareEnrolleesandUtilFiles_508.pdf

  20. Managed Care Enrollment • Studies on reimbursements/charges • Option may be to exclude those with any managed care enrollment because you don’t have complete information on payments or services received • Studies on health outcomes/events • Option may be to exclude those with any managed care enrollment because you could miss events • Option may be to censor observations at time of first HMO enrollment • Other methods for addressing HMO enrollment possible depending upon research question

  21. Services not covered in Medicare 1991-2000 files • Out-patient prescription drugs • Routine physical and dental exams • Dentures • Eye glasses • Out-of-pocket expenses for Medicare beneficiaries (e.g. deductibles, coinsurance)

  22. Final Tips • Read relevant documentation !!! • Survey file layouts & detailed notes • Linkage methodology reports • Analytic guidelines • Consult basic program information • CMS – http://www.cms.gov • ResDAC – http://www.resdac.umn.edu

  23. Final Tips • Determine NCHS public-use files needed • Determine RDC linked files needed • Determine feasibility of research question based upon successfully linked respondents

  24. What is Feasibility Study Data? • Public-use data indicating whether respondent was linked to Medicare data and whether there is a record on the various Medicare files • Match status (CMS_MATCH) • 1 = Linked • 2 = Not linked • 3 = Ineligible • 80 variables indicating which of the specific Medicare files and for which of the 10 years of Medicare data data is available

  25. Feasibility study data are in ascii format and are survey specific. Feasibility data can be downloaded from:http://www.cdc.gov/nchs/data_access/data_linkage_activities.htm

  26. Restricted Data Access Methods • NCHS RDC, Hyattsville, MD • On site • Remote access • Staff assisted, i.e. on-site programming for remote researchers • Census RDC sites (9 locations) • Restricted data files remain in RDC and output is inspected for disclosure violations

  27. Future Linkage Activities • Continue Medicare Linkage • Periodicity of linkages is outside NCHS control • Current agreement includes Medicare Part D • Medicaid • Linkage of 1999-2004 Medicaid enrollment and claims data linked to 1999-2004 NHIS and NHANES

  28. It’s too complicated???What to do???? • Review documentation • http://www.cdc.gov/nchs/data_access/data_linkage_activies.htm • Contact ResDAC – http://www.resdac.umn.edu/ • Free assistance in obtaining and using CMS data for research • Workshops and presentations • Statistics and other research resources

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