Effect of PACE on Costs, Nursing Home Admissions, and Mortality: 2006-2011. D. Data

03/01/2015

We use Medicare and Medicaid enrollment and claims data from a variety of sources for identifying PACE and HCBS enrollees as well as NH entrants, imposing our sample selection criteria, matching, and outcomes analysis. The specific data sources or files we used are described below together with the purposes for which we used them.

  • Medicare Advantage and Prescription Drug (MARx) data. This dataset includes information on managed care enrollment and Medicare payments for all beneficiaries in a Medicare managed care plan, including PACE. We used MARx data for 2006-2011 to identify new enrollees in PACE as well as their ZIP codes of residence during 2006-2008, track disenrollment from PACE during the followup period, and obtain Medicare capitation payments for every month during the followup period, through 2011.

  • Medicaid Analytic eXtracts (MAX) files. These files are derived from the Medicaid Statistical Information System, contain information on Medicaid-covered services, and are intended for analytic use. MAX consists of the following five files: person summary (PS) file, inpatient (IP) file, long-term care (LT) file, prescription drug (Rx) file, and the other (OT) file. We used the MAX PS file to identify PACE enrollees who were dually eligible for both Medicare and Medicaid; identify new HCBS enrollees and NH entrants in each of the three years (2006-2008). We used the other MAX files to calculate total Medicaid expenditures for HCBS enrollees and NH entrants, and obtain Medicaid capitation payments for PACE enrollees during 2006-2009 (latest available year).

  • Master Beneficiary Summary File (MBSF). The MBSF, produced by the Chronic Conditions Warehouse (CCW), provides summary information on FFS Medicare beneficiaries on a calendar year basis. It consists of the following four segments: base segment with beneficiary enrollment information, demographics, state and county codes, ZIP code, etc.; the chronic conditions segment with CCW flags for several chronic conditions; cost and utilization segment with summarized annual information on service utilization and Medicare payments, by service type; and the national death index segment with cause of death information. We used the MBSF for 2005-2011 to obtain data on pre-enrollment demographics, chronic conditions, and Medicare cost/use for both the PACE and comparison group (HCBS and NH) members in the calendar year prior to the year of enrollment or NH entry, and also for mortality information during the followup period.

  • Medicare Standard Analytic Files (SAFs). These files contain details about Part A and Part B services covered by Medicare, including dates of service, descriptions of services, diagnoses, provider types, and reimbursement amounts for Medicare beneficiaries receiving care on a FFS basis. SAFs are built from "final action, fully adjusted" claims suitable for research. SAFs consist of the following types of Medicare claims files for Part A and Part B services: Carrier (or, physician/supplier Part B claims), durable medical equipment, home health, hospice, inpatient, outpatient, and SNF. We used data from the SAFs over 2006-2011 to measure total Medicare expenditures for members of the matched comparison group in the followup period.

  • Minimum Dataset (MDS) Timeline File. The detailed Timeline file, produced on a calendar year basis, contains a separate variable for each day of the year to identify whether a beneficiary was in the community or in a NH, SNF, or hospital. We used this file during 2006-2009 (latest available year) to obtain information on the utilization of NH services by both PACE and matched HCBS waiver enrollees during the followup period. We specifically used a value of "M" or MDS on the daily flag in the Timeline file to identify PACE or HCBS enrollees in the NH on a particular day during the followup period.11 Our outcome measures for use of nursing facility services, based on the Timeline File, could therefore include some nursing facility stays that initially began as a SNF stay. Since PACE enrollees are in managed care, their use of nursing facility services is not observed in either Medicare or Medicaid claims data. Thus, the Timeline file was the only source of information for consistently identifying the use of nursing facility services for both PACE and matched HCBS enrollees, but it does not enable us to distinguish SNF stays from other NH stays.

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