From SAS Programming with Medicare Administrative Data. Full book available for purchase here.

Transcription

1 From SAS Programming with Medicare Administrative Data. Full book available for purchase here. Contents About This Book... ix About The Author... xiii Acknowledgments...xv Chapter 1: Introduction... 1 Introduction and Purpose of This Book... 1 Framework of This Book... 2 Our Programming Project... 3 Chapter Outline... 5 How to Use This Book... 6 Disclaimer... 7 Chapter Summary... 8 Chapter 2: An Introduction to the Medicare Program... 9 Introduction and Goals of the Chapter... 9 An Introduction to the Medicare Program What is Medicare? Medicare Enrollment and Eligibility What Is Covered by Medicare? What Is Not Covered by Medicare? The Mechanics of Medicare Chapter Summary Chapter 3: An Introduction to Medicare Data Introduction and Goals of This Chapter A Note on the Source and Structure of Our Claims Data Part B Carrier Claims Data Durable Medical Equipment (DME) Data... 19

2 iv Outpatient Claims Data Inpatient Claims Data Skilled Nursing Facility (SNF) Claims Data Home Health Claims Data Hospice Claims Data Commonly Retained Elements in Administrative Claims Data Master Beneficiary Summary File Provider Data Example: Identification of Emergency Department (ED) Utilization Example: Identification of Surgical Services Chapter Summary Chapter 4: Planning the Research Programming Project Introduction and Goals of This Chapter Our Project s Plan: The SDLC Our Project s High-Level Requirements Our Project s Quality Assurance Plan Our Project s Flowchart Our Project s Data Storage and LIBNAMES Our Research Programming Technical Specifications Chapter Summary Chapter 5: Request, Receive, Load, and Transform Data Introduction Requesting Medicare Administrative Claims and Enrollment Data Sources of Medicare Claims and Enrollment Data Data Available from CMS Our Project s Data Requirements and Request Specifications Contacting ResDAC and Completing Paperwork Receiving, Decrypting, and Loading Medicare Administrative Claims and Enrollment Data Receiving Our Medicare Administrative Data Decrypting Our Medicare Administrative Data Loading Our Medicare Administrative Data into SAS Data Sets Algorithms: Transforming Base Claim and Line Level Data Sets into Single Claim-Level

3 v Files Transforming Base Claim and Line-Level Carrier Data into a Claim-Level File Chapter Summary Chapter 6: Working with Enrollment Data Introduction and Goals Review and Approach Basics of Medicare Enrollment Data Our Programming Plan Algorithms: Identifying Continuously Enrolled FFS Beneficiaries Why Define Continuously Enrolled FFS Beneficiaries? How to Specify the Programming for Continuous Enrollment in Medicare FFS Medicare Part A and Part B Enrollment Variables HMO Coverage Variable Date of Death Variable How to Program in SAS to Define Continuous Enrollment in Medicare FFS Algorithms: Create or Retain Data Elements for Displaying Results by Certain Characteristics Coverage Characteristics, Month of Death, Sex, and Race Age Groups Geographic Characteristics Algorithms: Create Final Enrollment Data for Remainder of Programming Chapter Summary Exercises Chapter 7: Measuring Utilization of Services Introduction and Goals Review and Approach Review: Basics of Medicare Claims Data Our Programming Plan Algorithms: Delimit Claims by Continuously Enrolled Beneficiary Population Algorithms: Measuring Evaluation and Management (E&M) Utilization Algorithms: Measuring Inpatient Hospital Utilization Algorithms: Measuring Emergency Department Utilization Algorithms: Measuring Utilization of Ambulance Services Algorithms: Measuring Outpatient Visit Information Algorithms: Measuring Utilization of SNF, Home Health Agency, and Hospice Care... 85

4 vi Chapter Summary Exercises Chapter 8: Measuring Costs to Medicare Introduction and Goals Review and Approach Review: Basics of Medicare Cost Our Programming Plan A Note on Payment Standardization and Risk Adjustment Algorithms: Measuring Evaluation and Management Payments Algorithms: Measuring Inpatient Hospital Payments Algorithms: Measuring Total Part A Payments Chapter Summary Exercises Chapter 9: Programming to Identify Chronic Conditions Introduction and Goals Review and Approach Review: Peculiarities of Medicare Data Our Programming Plan A Note on the Chronic Conditions Data Warehouse (CCW) Algorithms: Identifying Beneficiaries with Diabetes or COPD Algorithms: Evaluation and Management Visits for Beneficiaries with Diabetes or COPD Algorithms: Diabetic Eye Exams for Beneficiaries with Diabetes Algorithms: Hospital Readmissions for Beneficiaries with COPD Chapter Summary Exercises Chapter 10: Presenting Output and Project Disposition Introduction Synthesis Review and Approach Review: Our Accomplishments Our Programming Plan Algorithms: Presenting Selected Measurements of Utilization, Cost to Medicare, and

5 vii Quality Outcomes Presenting Ambulance Utilization Presenting Medicare Payments for Evaluation and Management Services by Provider Presenting Rates of Diabetes and COPD Algorithms: Presenting Inpatient Length of Stay Information by State Algorithms: Presenting Mean Medicare Part A Payments per Beneficiary by State and County Algorithms: Presenting Rates of Diabetic Eye Exams Production Execution in Batch Project Disposition Archiving Materials for Future Use Data Destruction Chapter Summary Exercises From SAS Programming with Medicare Administrative Data by Matthew Gillingham. Copyright 2014, SAS Institute Inc., Cary, North Carolina, USA. ALL RIGHTS RESERVED.