Geographic Variation Medicare Public Use Files All Ages
Medicare Hospital Referral Region All Ages Beneficiaries
Medicare Geographic Variation Reports All Ages
Keywords
Medicare Geographic Variation
Medicare Hospital Referral Region
Medicare HHR Variation
Medicare Part A
Medicare Part B
Medicare Beneficiaries
Medicare Costs
Medicare Quality Indicators
All Ages Beneficiaries
Medicare Public Use File
Medicare Cost All Beneficiaries Utilization Quality Indicators by HRR
This dataset shows the Geographic Variation Public Use File that serves as an evaluation of the utilization and quality of healthcare services according to the geographic area of the population covered by Medicare. This dataset incorporates hospital referral region (HRR) level data that covers demographic, cost utilization and quality data for all beneficiaries regardless of age.
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The Centers for Medicare and Medicaid Services (CMS) has developed data that enables researchers and policymakers to evaluate geographic variation in the utilization and quality of healthcare services for the Medicare fee-for-service population. This dataset has been aggregated into a Geographic Variation Public Use File that has demographic, spending, utilization, and quality indicators at the state level (including the District of Columbia, Puerto Rico, and the Virgin Islands), hospital referral region (HRR) level, and county level. The Geographic Variation Public Use File has twelve separate files – two files with state and county-level data, four files with only state-level data, and six files with HRR level data. The HRR level data are presented for beneficiaries under the age of 65, beneficiaries that are 65 or older, and all beneficiaries regardless of age. However, the county-level data are available for all beneficiaries dataset alone.
The data was collected from the CMS Chronic Conditions Data Warehouse, which contains 100% of Medicare claims for beneficiaries who are enrolled in the fee-for-service (FFS) program as well as enrollment and eligibility data and facilitates analyzing differences in cost and/or utilization for the settings inpatient hospital, outpatient hospital, multiple post-acute care settings, hospice, physicians, laboratories and suppliers of durable medical equipment. The HRR-level dataset is presented for beneficiaries under the age of 65, beneficiaries that are 65 or older, and all beneficiaries regardless of age. However, the county-level data are available for all beneficiaries. Each file has a brief Methods section outlining the sample population and methodology that was used to calculate these indicators and a documentation section which explains the individual indicators in more detail.
The study population is described as “FFS Beneficiaries” and is comprised of Medicare beneficiaries that
– had no months of Medicare Advantage enrollment, and
– had both Part A and Part B who were enrolled in a Medicare Advantage (MA) plan for at least one month during the year (a beneficiary must have both Part A and Part B in order to enroll in an MA plan)
Data on beneficiaries who died in the year are also included.
CMS developed a risk-adjustment model that uses HCCs (hierarchical condition categories) to assign risk scores. Those scores estimate how beneficiaries’ FFS spending will compare to the overall average for the entire Medicare population. The risk score for the overall average is set at 1.0. Beneficiaries with scores greater than that are expected to have above-average spending, and vice versa. Risk scores are based on a beneficiary’s age and sex, whether the beneficiary is eligible for Medicaid, first qualified for Medicare on the basis of disability, or lives in an institution (usually a nursing home) and the beneficiary’s diagnoses from the previous year. CMS uses total risk scores to adjust spending data at the geographic level. CMS uses the risk scores to adjust spending data at the beneficiary level rather than in aggregate. As a result, the aggregate standardized, risk-adjusted spending in a region does not equal the aggregate standardized costs divided by the average HCC risk score. In addition, the HCC model was not designed to risk adjust spending at the service level and therefore is not applied to service-level spending.
CMS presents actual total Medicare spending, standardized total Medicare spending, and a risk-adjusted, standardized total Medicare spending. Also present are both actual spending measures and standardized spending measures for certain major types of Medicare covered services. Spending measures were developed based on the amount Medicare pays for services and do not include beneficiary cost sharing. The standardized spending removes geographic differences in payment rates for individual services as a source of variation. To standardize spending, CMS examined Medicare’s various FFS payment systems and identified the factors that lead to different payment rates for the same service. In general, those factors are adjustments that Medicare makes to account for local wages or input prices, and extra payments that Medicare makes to advance other program goals, such as compensating certain hospitals for the cost of training doctors. CMS then estimated what Medicare would have paid for each claim without those adjustments.
CMS presents three different types of utilization measures for certain major types of Medicare-covered services:
– the number of times beneficiaries used a particular service,
– the number of beneficiaries who used a particular service, and
– the percentage of beneficiaries who used a particular service.
Readmissions are defined as admissions that occur within 30 days of the initial discharge and the readmission rates presented are not risk-adjusted. CMS presents two readmission measures:
– number of readmissions, and
– a readmission rate.
CMS presents two measures of Emergency Department (ED) utilization:
– a total count of ED visits, and
– ED visits per 1000 beneficiaries.
ED visits include both visits to the ED that result in an admission and visits that do not result in an admission.
CMS presents Agency for Healthcare Research and Quality Prevention (AHRQ) Quality Indicators (PQIs) which measure hospital admission rates for ambulatory care sensitive conditions. CMS limited the analyses to measures that were applicable to the Medicare-aged population and measures where the sample size was large enough for analyses at the HRR or state level.
The state of Maryland has a unique waiver that exempts it from Medicare’s prospective payment systems for inpatient and outpatient care. Maryland instead uses an all-payer rate setting commission to determine its payment rates. Medicare claims for hospitals in other states break out additional payments for indirect medical education (IME) costs and disproportionate share hospital (DSH) adjustments, and CMS removed those amounts when the payments were standardized in those states. However, the claims for Maryland’s hospitals do not identify IME or DSH payments. Until 2011, to standardize claims for Maryland’s hospitals CMS worked with Maryland’s Health Services Cost Review Commission to develop a series of the year and hospital-specific factors that would back out Maryland’s equivalent of IME/DSH spending from the state’s hospital payments for both inpatient and outpatient services. Starting in 2011, CMS standardized claims for Maryland’s hospitals using the same methodology that was employed in all other states.
Counts for less than 11 beneficiaries were suppressed.
The above dataset plays an important role in the use of generative AI in healthcare organizations to improve workflows and communication.
About this Dataset
Data Info
Date Created
2011-07-01
Last Modified
2018-05-11
Version
2018-05-11
Update Frequency
Annual
Temporal Coverage
2016
Spatial Coverage
United States
Source
John Snow Labs; Centers for Medicare and Medicaid Services;
Source License URL
No data
Source License Requirements
N/A
Source Citation
N/A
Keywords
Medicare Geographic Variation, Medicare Hospital Referral Region, Medicare HHR Variation, Medicare Part A, Medicare Part B, Medicare Beneficiaries, Medicare Costs, Medicare Quality Indicators, All Ages Beneficiaries, Medicare Public Use File
Other Titles
Geographic Variation Medicare Public Use Files All Ages, Medicare Hospital Referral Region All Ages Beneficiaries, Medicare Geographic Variation Reports All Ages
Data Fields
Name
Description
Type
Constraints
State_Abbreviation
The abbreviated name of state
string
-
Hospital_Referral_Region
The hospital referral region name
string
-
Hospital_Referral_Region_Code
The hospital referral region number
string
-
Beneficiaries_Part_A_B
The number of Medicare beneficiaries who have both Part A and Part B coverage; suppressed where count of Part A and Part B beneficiaries < 11 or count of MA beneficiaries is < 11 and count of FFS beneficiaries >= 11
integer
level : Ratio
Medicare_Fee_For_Service_Beneficiaries
The number of Medicare fee-for-service (FFS) beneficiaries; suppressed where count of FFS beneficiaries < 11
integer
level : Ratio
Medicare_Advantage_Beneficiaries
The number of beneficiaries who are enrolled in a Medicare Advantage (MA) program; suppressed where count of MA beneficiaries < 11 or count of MA beneficiaries is >= 11 and count of FFS beneficiaries < 11
integer
level : Ratio
Medicare_Advantage_Participation_Rate
The proportion of Part A and Part B beneficiaries who are in enrolled in a MA program; suppressed where count of MA beneficiaries < 11 or count of MA beneficiaries is >= 11 and count of FFS beneficiaries < 11
number
level : Ratio
Beneficiaries_Average_Age
The average age of the Medicare fee-for-service beneficiaries
number
level : Ratio
Percent_Of_Females
The proportion of Medicare fee-for-service female beneficiaries
number
level : Ratio
Percent_Of_Males
The proportion of Medicare fee-for-service male beneficiaries
number
level : Ratio
Percent_Of_Non_Hispanic_White
The proportion of Medicare fee-for-service non-Hispanic White beneficiaries
number
level : Ratio
Percent_Of_African_American
The proportion of Medicare fee-for-service African American beneficiaries
number
level : Ratio
Percent_Of_Hispanic
The proportion of Medicare fee-for-service Hispanic beneficiaries
number
level : Ratio
Percent_Of_Other_Or_Unknown_Race_Ethnicity
The proportion of Medicare fee-for-service beneficiaries of other or unknown race/ethnicity
number
level : Ratio
Percent_Of_Eligible_Medicaid
The proportion of Medicare fee-for-service beneficiaries, eligible for Medicaid for at least one month in the year
number
level : Ratio
Average_Hierarchical_Condition_Categories_Score
The average Hierarchical Condition Category (HCC) Score level
number
level : Ratio
Total_Actual_Cost
The total actual Medicare cost
number
level : Ratio
Total_Standardized_Cost
The total standardized Medicare cost
number
level : Ratio
Total_Standardized_Risk_Adjusted_Cost
The total standardized, risk-adjusted Medicare cost
number
level : Ratio
Actual_Cost_Per_Capita
The actual Medicare cost, per capita
number
level : Ratio
Standardized_Cost_Per_Capita
The standardized Medicare costs, per capita
number
level : Ratio
Standardized_Risk_Adjusted_Cost_Per_Capita
The standardized risk-adjusted Medicare cost, per capita
number
level : Ratio
Hospital_Inpatient_Actual_Cost
The actual Medicare cost for hospital inpatient (IP) services
number
level : Ratio
Percent_Of_Hospital_Inpatient_Actual_Cost
The proportion of actual Medicare costs for hospital inpatient (IP) services from the total actual Medicare costs
number
level : Ratio
Hospital_Inpatient_Actual_Cost_Per_Capita
The actual Medicare costs for hospital inpatient (IP) services, per capita
number
level : Ratio
Hospital_Inpatient_Actual_Cost_Per_User
The actual Medicare costs for hospital inpatient (IP) services, per user
number
level : Ratio
Hospital_Inpatient_Standardized_Cost
The standardized Medicare costs for hospital inpatient (IP) services
number
level : Ratio
Percent_Of_Hospital_Inpatient_Standardized_Cost
The proportion of standardized Medicare costs for hospital inpatient (IP) services from the total standardized Medicare costs
number
level : Ratio
Hospital_Inpatient_Standardized_Cost_Per_Capita
The standardized Medicare costs for hospital inpatient (IP) services, per capita
number
level : Ratio
Hospital_Inpatient_Standardized_Cost_Per_User
The standardized Medicare costs for hospital inpatient (IP) services, per user
number
level : Ratio
Hospital_Inpatient_Users_With_A_Covered_Stay
The number of beneficiaries who used hospital inpatient (IP) services with at least one covered stay
integer
level : Ratio
Percent_Of_Hospital_Inpatient_Beneficiaries
The proportion of beneficiaries who used hospital inpatient (IP) services with at least one covered stay
number
level : Ratio
Hospital_Inpatient_Covered_Stays_Per_1000
The ratio of hospital inpatient (IP) covered admissions per 1,000 Medicare beneficiaries
integer
level : Ratio
Hospital_Inpatient_Covered_Days_Per_1000
The ratio of hospital inpatient (IP) covered days per 1,000 Medicare beneficiaries
integer
level : Ratio
Long_Term_Care_Hospital_Actual_Cost
The actual Medicare costs for long term care hospital
number
level : Ratio
Percent_Of_Long_Term_Care_Hospital_Actual_Cost
The proportion of actual Medicare costs for long term care hospital (LTCH) from the total Medicare actual costs
number
level : Ratio
Long_Term_Care_Hospital_Actual_Cost_Per_Capita
The actual Medicare costs for long term care hospital (LTCH), per capita
number
level : Ratio
Long_Term_Care_Hospital_Actual_Cost_Per_User
The actual Medicare costs for long term care hospital (LTCH), per user
number
level : Ratio
Long_Term_Care_Hospital_Standardized_Cost
The standardized Medicare costs for long term care hospital (LTCH)
The proportion of actual Medicare costs for federally qualified health centers (FQHC)/rural health centers (RHC) services from the total actual Medicare costs
The proportion of standardized Medicare costs for federally qualified health centers (FQHC)/rural health centers (RHC) services from the total standardized Medicare costs
The ratio of hospital admissions for diabetes long term complications to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 3)
The ratio of hospital admissions for diabetes long term complications to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 3)
The ratio of hospital admissions for diabetes long term complications to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 3)
integer
level : Ratio
COPD_Or_Asthma_Admission_Rate_Age_40_64
The ratio of hospital admissions for chronic obstructive pulmonary disease (COPD) or asthma to Medicare beneficiaries ages 40-64 years old per 100,000 beneficiaries (Prevention Quality Indicator 5)
integer
level : Ratio
COPD_Or_Asthma_Admission_Rate_Age_65_74
The ratio of hospital admissions for chronic obstructive pulmonary disease (COPD) or asthma to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 5)
integer
level : Ratio
COPD_Or_Asthma_Admission_Rate_75_And_Over
The ratio of hospital admissions for chronic obstructive pulmonary disease (COPD) or asthma to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 5)
integer
level : Ratio
Hypertension_Admission_Rate_Under_65
The ratio of hospital admissions for hypertension to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 7)
integer
level : Ratio
Hypertension_Admission_Rate_Age_65_74
The ratio of hospital admissions for hypertension to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 7)
integer
level : Ratio
Hypertension_Admission_Rate_75_And_Over
The ratio of hospital admissions for hypertension to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 7)
integer
level : Ratio
Congestive_Heart_Failure_Admission_Rate_Under_65
The ratio of hospital admissions for congestive heart failure (CHF) to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 8)
integer
level : Ratio
Congestive_Heart_Failure_Admission_Rate_Age_65_74
The ratio of hospital admissions for congestive heart failure (CHF) to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 8)
The ratio of hospital admissions for congestive heart failure (CHF) to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 8)
integer
level : Ratio
Dehydration_Admission_Rate_Under_65
The ratio of hospital admissions for dehydration to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 10)
integer
level : Ratio
Dehydration_Admission_Rate_Age_65_74
The ratio of hospital admissions for dehydration to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 10)
integer
level : Ratio
Dehydration_Admission_Rate_75_And_Over
The ratio of hospital admissions for dehydration to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 10)
integer
level : Ratio
Bacterial_Pneumonia_Admission_Rate_Under_65
The ratio of hospital admissions for bacterial pneumonia to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 11)
integer
level : Ratio
Bacterial_Pneumonia_Admission_Rate_Age_65_74
The ratio of hospital admissions for bacterial pneumonia to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 11)
integer
level : Ratio
Bacterial_Pneumonia_Admission_Rate_75_And_Over
The ratio of hospital admissions for bacterial pneumonia to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 11)
integer
level : Ratio
Urinary_Tract_Infection_Admission_Rate_Under_65
The ratio of hospital admissions for urinary tract infections (UTI) to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 12)
integer
level : Ratio
Urinary_Tract_Infection_Admission_Rate_Age_65_74
The ratio of hospital admissions for urinary tract infections (UTI) to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 12)
The ratio of hospital admissions for urinary tract infections (UTI) to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 12)
integer
level : Ratio
Asthma_Admission_Rate_Under_40
The ratio of hospital admission for asthma of younger adults to Medicare beneficiaries ages less than 40 years old per 100,000 beneficiaries (Prevention Quality Indicator 15)
The ratio of hospital admission for lower extremity amputation to Medicare beneficiaries ages less than 65 years old per 100,000 beneficiaries (Prevention Quality Indicator 16)
The ratio of hospital admission for lower extremity amputation to Medicare beneficiaries ages 65-74 years old per 100,000 beneficiaries (Prevention Quality Indicator 16)
The ratio of hospital admission for lower extremity amputation to Medicare beneficiaries ages 75 years old and over per 100,000 beneficiaries (Prevention Quality Indicator 16)
Demos
