The Medicare Part D by Drug dataset presents information on spending for drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other healthcare providers. Drugs prescribed in the Medicare Part D program are drugs patients generally administer themselves. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications. Drug spending metrics for Part D drugs are based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments. The Part D spending metrics do not reflect any manufacturers’ rebates or other price concessions as CMS is prohibited from publicly disclosing such information.

Medicare Spending per Beneficiary

Detailed Hospital Expense Breakdown

By Health [source]

About this dataset

This file allows healthcare executives and analysts to make informed decisions regarding how well continued improvements are being made over time so that they can understand how efficient they are fulfilling treatments while staying within budgetary constraints. Additionally, it’ll also help them map out trends amongst different hospitals and spot anomalies that could indicate areas where decisions should be reassessed as needed

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How to use the dataset

This dataset can provide valuable insights into how Medicare is spending per patient at specific hospitals in the United States. It can be used to gain a better understanding of the types of services covered under Medicare, and to what extent those services are being used. By comparing the average Medicare spending across different hospitals, users can also gain insight into potential disparities in care delivery or availability.

To use this dataset, first identify which hospital you are interested in analyzing. Then locate the row for that hospital in the dataset and review its associated values: value, footnote (optional), and start/end dates (optional). The Value column refers to how much Medicare spends on each particular patient; this is a numerical value represented as a decimal number up to 6 decimal places. The Footnote (optional) provides more information about any special circumstances that may need attention when interpreting the value data points. Finally, if Start Date and End Date fields are present they will specify over what timeframe these values were aggregated over.

Once all relevant data elements have been reviewed successively for all hospitals of interest then comparison analysis among them can be conducted based on Value, Footnote or Start/End dates as necessary to answer specific research questions or formulate conclusions about how Medicare is spending per patient at various hospitals nationwide

Research Ideas

• Developing a cost comparison tool for hospitals that allows patients to compare how much Medicare spends per patient across different hospitals.
• Creating an algorithm to help predict Medicare spending at different facilities over time and build strategies on how best to manage those costs.
• Identifying areas in which a hospital can save money by reducing unnecessary spending in order to reduce overall Medicare expenses

Acknowledgements

If you use this dataset in your research, please credit the original authors. Data Source

License

License: Dataset copyright by authors - You are free to: - Share - copy and redistribute the material in any medium or format for any purpose, even commercially. - Adapt - remix, transform, and build upon the material for any purpose, even commercially. - You must: - Give appropriate credit - Provide a link to the license, and indicate if changes were made. - ShareAlike - You must distribute your contributions under the same license as the original. - Keep intact - all notices that refer to this license, including copyright notices.

Columns

File: Medicare_hospital_spending_per_patient_Medicare_Spending_per_Beneficiary_Additional_Decimal_Places.csv | Column name | Description | |:---------------|:--------------------------------------------------------------------------------------| | Value | The amount of Medicare spending per patient for a given hospital or region. (Numeric) | | Footnote | Any additional notes or information related to the value. (Text) | | Start_Date | The start date of the period for which the value applies. (Date) | | End_Date | The end date of the period for which the value applies. (Date) |

Acknowledgements

If you use this dataset in your research, please credit the original authors. If you use this dataset in your research, please credit Health.

The CMS Program Statistics - Medicare Part A & Part B - All Types of Service tables provide use and payment data by type of coverage and type of service. For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data. Below is the list of tables: MDCR SUMMARY AB 1. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for All Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 2. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Aged Original Medicare Beneficiaries, by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 3. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Disabled Original Medicare Beneficiaries by Type of Coverage and Type of Service, Yearly Trend MDCR SUMMARY AB 4. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage, Demographic Characteristics, and Medicare-Medicaid Enrollment Status MDCR SUMMARY AB 5. Medicare Part A and Part B Summary: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Coverage and by Area of Residence MDCR SUMMARY AB 6. Medicare Part A and Part B Summary: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Amount of Program Payments, Type of Coverage, and Type of Service

The Medicare Geographic Variation by National, State & County dataset provides information on the geographic differences in the use and quality of health care services for the Original Medicare population. This dataset contains demographic, spending, use, and quality indicators at the state level (including the District of Columbia, Puerto Rico, and the Virgin Islands) and the county level. Spending is standardized to remove geographic differences in payment rates for individual services as a source of variation. In general, total standardized per capita costs are less than actual per capita costs because the extra payments Medicare made to hospitals were removed, such as payments for medical education (both direct and indirect) and payments to hospitals that serve a disproportionate share of low-income patients. Standardization does not adjust for differences in beneficiaries’ health status.

Analysis of ‘Medicare Part D Spending by Drug’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/57f64f2c-fb36-42ea-a923-402a7e683f30 on 11 February 2022.

--- Dataset description provided by original source is as follows ---

The Medicare Part D by Drug dataset presents information on spending for drugs prescribed to Medicare beneficiaries enrolled in Part D by physicians and other healthcare providers. Drugs prescribed in the Medicare Part D program are drugs patients generally administer themselves.

The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications.

Drug spending metrics for Part D drugs are based on the gross drug cost, which represents total spending for the prescription claim, including Medicare, plan, and beneficiary payments. The Part D spending metrics do not reflect any manufacturers’ rebates or other price concessions as CMS is prohibited from publicly disclosing such information.

--- Original source retains full ownership of the source dataset ---

This dataset includes the county level Medicare spending claims based data by price, age, sex and race. The variables included are: state, number of Medicare enrollees, total Medicare reimbursements per enrollee, hospital and skilled nursing facility reimbursements per enrollee, physician reimbursements per enrollee, outpatient facility reimbursements per enrollee, home health agency reimbursements per enrollee, hospice reimbursements per enrollee, and durable medical equipment per enrollee.

The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (“episode”) at a specific hospital compared to all hospitals nationally. An MSPB episode includes Medicare Part A and Part B payments for services provided by hospitals and other healthcare providers the 3 days prior to, during, and 30 days following a patient’s inpatient stay. This measure evaluates hospitals’ costs compared to the costs of the national median (or midpoint) hospital. This measure takes into account important factors like patient age and health status (risk adjustment) and geographic payment differences (payment-standardization). The data displayed here are the average measures for each state.

Context

This public dataset was created by the Centers for Medicare & Medicaid Services. The data summarize counts of enrollees who are dually-eligible for both Medicare and Medicaid program, including those in Medicare Savings Programs. “Duals” represent 20 percent of all Medicare beneficiaries, yet they account for 34 percent of all spending by the program, according to the Commonwealth Fund . As a representation of this high-needs, high-cost population, these data offer a view of regions ripe for more intensive care coordination that can address complex social and clinical needs. In addition to the high cost savings opportunity to deliver upstream clinical interventions, this population represents the county-by-county volume of patients who are eligible for both state level (Medicaid) and federal level (Medicare) reimbursements and potential funding streams to address unmet social needs across various programs, waivers, and other projects. The dataset includes eligibility type and enrollment by quarter, at both the state and county level. These data represent monthly snapshots submitted by states to the CMS, which are inherently lower than ever-enrolled counts (which include persons enrolled at any time during a calendar year.) For more information on dually eligible beneficiaries

Querying BigQuery tables

You can use the BigQuery Python client library to query tables in this dataset in Kernels. Note that methods available in Kernels are limited to querying data. Tables are at bigquery-public-data.sdoh_cms_dual_eligible_enrollment.

Sample Query

In what counties in Michigan has the number of dual-eligible individuals increased the most from 2015 to 2018? Find the counties in Michigan which have experienced the largest increase of dual enrollment households

duals_Jan_2015 AS ( SELECT Public_Total AS duals_2015, County_Name, FIPS FROM bigquery-public-data.sdoh_cms_dual_eligible_enrollment.dual_eligible_enrollment_by_county_and_program WHERE State_Abbr = "MI" AND Date = '2015-12-01' ),

duals_increase AS ( SELECT d18.FIPS, d18.County_Name, d15.duals_2015, d18.duals_2018, (d18.duals_2018 - d15.duals_2015) AS total_duals_diff FROM duals_Jan_2018 d18 JOIN duals_Jan_2015 d15 ON d18.FIPS = d15.FIPS )

SELECT * FROM duals_increase WHERE total_duals_diff IS NOT NULL ORDER BY total_duals_diff DESC

The Medicare Spending Per Beneficiary (MSPB) Measure shows whether Medicare spends more, less, or about the same for an episode of care (“episode”) at a specific hospital compared to all hospitals nationally. An MSPB episode includes Medicare Part A and Part B payments for services provided by hospitals and other healthcare providers the 3 days prior to, during, and 30 days following a patient’s inpatient stay. This measure evaluates hospitals’ costs compared to the costs of the national median (or midpoint) hospital. This measure takes into account important factors like patient age and health status (risk adjustment) and geographic payment differences (payment-standardization). The numbers displayed here are: 1) the average MSPB measure for the nation; and 2) the national episode-weighted median MSPB amount used as the denominator in the calculation of each hospital's MSPB measure.

Context

This dataset contains CMS Part D Drug Spending and Utilization for calendar years 2015 - 2019.

Content

1) Brand Name 2) Generic Name 3) Manufacturer 4) Year 5) Total Spending 6) Total Dosage Units 7) Total Claims 8) Total Beneficiaries 9)Average Spending Per Dosage Unit 10) Average Spending Per Claim 11) Average Spending Per Beneficiary 12) Outlier Flag

Acknowledgements

Data was pulled from CMS.gov (https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Information-on-Prescription-Drugs/MedicarePartD)

Inspiration

What were the brands, manufacturers, and generic molecules with the highest total spend and total claims each year? What about the least total spending and total claims?

What are the top brands/molecules in the top manufacturers' portfolios? How have these brands evolved over time in terms of claims and total spending?

What disease categories are responsible for the majority of CMS spending on Part D drugs?

The Medicare Home Health Agency tables provide use and payment data for home health agencies. The tables include use and expenditure data from home health Part A (Hospital Insurance) and Part B (Medical Insurance) claims. For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data. Below is the list of tables: MDCR HHA 1. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR HHA 2. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR HHA 3. Medicare Home Health Agencies: Utilization and Program Payments for Original Medicare Beneficiaries, by Area of Residence MDCR HHA 4. Medicare Home Health Agencies: Persons with Utilization and Total Service Visits for Original Medicare Beneficiaries, Type of Agency and Type of Service Visit MDCR HHA 5. Medicare Home Health Agencies: Persons with Utilization and Total Service Visits for Original Medicare Beneficiaries, by Type of Control and Type of Service Visit MDCR HHA 6. Medicare Home Health Agencies: Persons with Utilization, Total Service Visits, and Program Payments for Original Medicare Beneficiaries, by Number of Service Visits and Number of Episodes

Also known as Medicare Spending per Beneficiary (MSPB) Spending Breakdowns by Claim Type file. The data displayed here show average spending levels during hospitals’ Medicare Spending per Beneficiary (MSPB) episodes. An MSPB episode includes all Medicare Part A and Part B claims paid during the period from 3 days prior to a hospital admission through 30 days after discharge. These average Medicare payment amounts have been price-standardized to remove the effect of geographic payment differences and add-on payments for indirect medical education (IME) and disproportionate share hospitals (DSH). CMS uses the information on this webpage to calculate a hospital’s MSPB Measure value, which is reported on Hospital Compare. Specifically, the MSPB Measure methodology risk-adjusts the values on this webpage to account for beneficiary age and severity of illness. This data set provides the pre-risk-adjusted values to help the public understand the MSPB Measure and its composition.

This dataset presents the footprint of the percentage of patients with costs, the total out-of-pocket cost per patient at the 25th, 50th, 75th and 90th percentile and various statistics for all patients. The data spans the financial year of 2016-2017 and is aggregated to Statistical Area Level 3 (SA3) geographic areas from the 2016 Australian Statistical Geography Standard (ASGS). The data is sourced from the Medicare Benefits Schedule (MBS) claims data, which are administered by the Australian Government Department of Health. The claims data are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim has been processed by the Department of Human Services. Data are reported for claims processed between 1 July 2016 and 30 June 2017. The data also contains the results from the ABS 2016-17 Patient Experience Survey, collected between 1 July 2016 and 30 June 2017. The Patient Experience Survey is conducted annually by the Australian Bureau of Statistics (ABS) and collects information from a representative sample of the Australian population. The Patient Experience Survey is one of several components of the Multipurpose Household Survey, as a supplement to the monthly Labour Force Survey. The Patients' spending on Medicare Services data accompanies the Patients' out-of-pocket spending on Medicare services 2016-17 Report. For further information about this dataset, visit the data source:Australian Institute of Health and Welfare - Patients' out-of-pocket spending on Medicare services Data Tables.

This dataset includes the Hospital Service Areas (HSA) level Medicare spending claims based data by price, age, sex and race. Hospital service areas (HSAs) are local healthcare markets for hospital care. An HSA is a collection of ZIP codes whose residents receive most of their hospitalizations from the hospitals in that area. HSAs were defined by assigning ZIP codes to the hospital area where the greatest proportion of their Medicare residents were hospitalized.

This dataset includes the Hospital Referal Region (HRR) level Medicare spending claims based data by price, age, sex and race. Hospital referral regions (HRRs) represent regional healthcare markets for tertiary medical care that generally requires the services of a major referral center. The regions were defined by determining where patients were referred for major cardiovascular surgical procedures and for neurosurgery.

The data displayed here describes average spending levels during hospitals’ Medicare Spending per Beneficiary (MSPB) episodes by Medicare claim type. The data presented on Hospital Compare provide price-standardized, non-risk-adjusted values for hospital spending by claim type because risk adjustment is done at the episode level rather than at the service category/claim level. An MSPB episode includes all Medicare Part A and Part B claims paid during the period from 3 days prior to an inpatient hospital admission through 30 days after discharge.

The CMS Program Statistics - Medicare Part D tables provide use and Part D drug costs by type of Part D plan (stand-alone prescription drug plan and Medicare Advantage prescription drug plan). For additional information on enrollment, providers, and Medicare use and payment, visit the CMS Program Statistics page. These data do not exist in a machine-readable format, so the view data and API options are not available. Please use the download function to access the data. Below is the list of tables: MDCR UTLZN D 1. Medicare Part D Utilization: Average Annual Prescription Drug Fills by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Generic Dispensing Rate, Yearly Trend MDCR UTLZN D 2. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 3. Medicare Part D Utilization: Average Annual Gross Drug Costs Per Part D Enrollee, by Type of Plan, Low Income Subsidy (LIS) Eligibility, and Brand/Generic Drug Classification, Yearly Trend MDCR UTLZN D 4. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan and Demographic Characteristics MDCR UTLZN D 5. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan and Demographic Characteristics MDCR UTLZN D 6. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Enrollee, by Type of Plan, by Area of Residence MDCR UTLZN D 7. Medicare Part D Utilization: Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Type of Plan, by Area of Residence MDCR UTLZN D 8. Medicare Part D Utilization: Number of Part D Utilizers and Average Annual Prescription Drug Fills by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 9. Medicare Part D Utilization: Number of Part D Utilizers and Drug Costs by Type of Part D Plan, Low Income Subsidy (LIS) Eligibility, and Part D Coverage Phase, Yearly Trend MDCR UTLZN D 10. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Events (Fills) and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Demographic Characteristics MDCR UTLZN D 11. Medicare Part D Utilization: Number of Part D Utilizers, Average Annual Prescription Drug Fills and Average Annual Gross Drug Cost Per Part D Utilizer, by Part D Coverage Phase and Area of Residence

This dataset presents the footprint of the percentage of patients with imaging costs, and out-of-pocket cost per diagnostic imaging service attendance at the 25th, 50th, 75th and 90th percentile. The data spans the financial year of 2016-2017 and is aggregated to 2015 Department of Health Primary Health Network (PHN) areas, based on the 2011 Australian Statistical Geography Standard (ASGS). The data is sourced from the Medicare Benefits Schedule (MBS) claims data, which are administered by the Australian Government Department of Health. The claims data are derived from administrative information on services that qualify for a Medicare benefit under the Health Insurance Act 1973 and for which a claim has been processed by the Department of Human Services. Data are reported for claims processed between 1 July 2016 and 30 June 2017. The data also contains the results from the ABS 2016-17 Patient Experience Survey, collected between 1 July 2016 and 30 June 2017. The Patient Experience Survey is conducted annually by the Australian Bureau of Statistics (ABS) and collects information from a representative sample of the Australian population. The Patient Experience Survey is one of several components of the Multipurpose Household Survey, as a supplement to the monthly Labour Force Survey. The Patients' spending on Medicare Services data accompanies the Patients' out-of-pocket spending on Medicare services 2016-17 Report. For further information about this dataset, visit the data source:Australian Institute of Health and Welfare - Patients' out-of-pocket spending on Medicare services Data Tables.

The Medicaid by Drug dataset presents information on spending for covered outpatient drugs prescribed to beneficiaries enrolled in Medicaid by physicians and other healthcare professionals. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. Units refer to the drug unit in the lowest dispensable amount. It also includes spending information for manufacturer(s) of the drugs as well as consumer-friendly information of drug uses and clinical indications. Drug spending metrics for Medicaid represent the total amount reimbursed by both Medicaid and non-Medicaid entities to pharmacies for the drug. Medicaid drug spending contains both the Federal and State reimbursement and is inclusive of any applicable dispensing fees. In addition, this total is not reduced or affected by Medicaid rebates paid to the states.

The Shared Savings Program Performance Year Financial and Quality Results data provides Medicare Shared Savings Program (Shared Savings Program) ACO-specific quality, expenditure, benchmark, and shared savings/loss metrics, as well as summarized beneficiary and provider information for each performance year of the Shared Savings Program. DISCLAIMER: This information is current as of the last update. Changes to Shared Savings Program ACO information occur periodically. Each Shared Savings Program ACO has the most up-to-date information about their organization. Consider contacting the Shared Savings Program ACO for the latest information. Contact information is available in the ACO Public Use File (PUF) and the ACO Participants PUF.