New CMS Data Contains Wealth of Hospice Information
August 22, 2017 06:18 AM
Recently updated data sources from the Centers for Medicare and Medicaid Services (CMS) provide in-depth detail on hospice payments, utilization, and patient demographics at the individual hospice and state levels, as well as market saturation data for hospices and other provider types.
The releases are part of CMS’ efforts to achieve greater transparency in healthcare. The CY 2015 Hospice Utilization and Payment Public Use File (PUF) contains information on utilization, payment, submitted charges, primary diagnoses, sites of service, and hospice beneficiary demographics organized by CMS Certification Number (6-digit provider identification number), and by state. When this data for CY2014 was first released during 2016, it represented some of the most detailed hospice data available to the public. This PUF is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The data in the Hospice PUF covers calendar year 2015 and contains 100% final-action (i.e., all claim adjustments have been resolved) hospice claims for the Medicare population including beneficiaries enrolled in a Medicare Advantage plan.
Although the Hospice PUF has a wealth of payment and utilization information about hospice services, the data set also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual hospice providers – it only contains cost and utilization information. Additionally, the data are not risk-adjusted and thus do not account for differences in patient populations. The Hospice PUF contains two tables:
Aggregated information by provider: Medicare Provider Aggregate Table, CY 2015, Microsoft Excel (.xlsx), and
Aggregated information by state: Medicare State Aggregate Table, CY 2015, Microsoft Excel (.xlsx)
Additional in formation and access to all currently available Hospice PUF data may be accessed here. Inquiries regarding this data can be sent to MedicareProviderData@cms.hhs.gov.
The Market Saturation and Utilization Data Tool includes interactive maps and supporting data sets that show national-, state-, and county-level provider services and utilization data for five reference periods and covering 12 different health service areas, including hospice.
Market saturation refers to the density of providers of a particular service within a defined geographic area relative to the number of beneficiaries receiving that service in the area. The Market Saturation and Utilization Data can be used by CMS to monitor market saturation as a means to prevent fraud, waste, and abuse. The data can also be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region. Provider services and utilization data by geographic regions are easily compared using an interactive map. There are a number of research uses for these data, but one objective of making these data public is to assist health care providers in making informed decisions about their service locations and the beneficiary populations they serve.
The following metrics are included in the interactive map:
Number of Fee-for-Service Beneficiaries
Number of Providers
Average Number of Users per Provider
Percentage of Users out of FFS Beneficiaries
Number of Users
Average Number of Providers per County
The map will update based on the selection of reference period, health service area, metric of interest, and color scale to indicate states and counties independent of moratoria status (Single Color Scale) versus states and counties based on their moratoria status (Color by Moratoria Status).