CMS issues service utilization data by state and county

The Centers for Medicare and Medicaid Services issued an updated data device that produces interactive state and county maps with metrics explaining the health service utilization, like emergency, non-emergency and skilled nursing services.

Utilizing the ambulance and HHA paid claims information within CMS systems for Medicare fee-for-service beneficiaries, the maps indicate whether a place has an active moratorium in a specified geographic place. The maps also have color variations to demonstrate distribution of the metric.

The information enables comparisons of contributor services and utilization information by geographic places, enabling drilldown comparisons to the county level of states. Maps are coded to unveil which places are in particular quartiles of distribution.

Information can show the number of Medicare contributors serving a geographic region, as well as the number of Medicare beneficiaries who utilize a health service in an area.

CMS used authority given by the Affordable Care Act in the year of 2013 to enforce temporary enrollment moratoria to combat fraud, waste and abuse, in accordance to a blog post by CMS’ Center for Program Integrity Director Shantanu Agrawal. CMS has expanded the moratoria in 6 month phases since then; the most recent occurred on the day of January 29.

The moratoria implemented to the enrollment of new home health agencies and ground ambulance suppliers. Agrawal wrote that the moratoria offered “CMS the chance to observe and monitor the existing provider and supplier base, as well as further focus extra fraud prevention and detection tools in these places.”

The analysis is deployed on the paid Medicare claims data from the CMS Integrated Data Repository (IDR). Claims data are observed for a 12-month reference period, and outcomes are updated quarterly. The reference period dates back as far as the month of October 2014.

The methodology differs from other kinds of public use data in determining the geographic location of a contributor. Claims are utilized to define the geographic area served by a provider, instead of the provider’s practice address.