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 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.

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.

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 Medicare Part B by Drug dataset presents information on spending for drugs administered in doctors’ offices and other outpatient settings by physicians and other healthcare providers to Medicare Part B enrollees. The dataset focuses on average spending per dosage unit and change in average spending per dosage unit over time. It also includes consumer-friendly descriptions of the drug uses, clinical indications, and manufacturer(s). Drug spending metrics for Part B drugs represent the full value of the product, including the Medicare payment and beneficiary liability. All Part B drug spending metrics are calculated at the HCPCS level.

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.

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 includes a list of all hospitals that have been registered with Medicare and their Medicare Spending per Beneficiary (MSPB). The list includes Hospital Name, Period of hospital admission and Claim Type. It also includes Averages as well as Percentages of Spending per Episode for Hospital, State and Nation.

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 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 dataset includes the data for aged and disabled, Medicare Part A and Part B, beneficiaries reimbursement for the hospice by state and county of residence. The data included cover the years 2016 to 2022.

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.

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.

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 ---

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.

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?

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 CMS Program Statistics - Medicare Physician, Non-Physician Practitioner and Supplier tables provide use and payment data for physicians, other practitioners, limited-licensed practitioners, and durable medical equipment, prosthetic, and orthotic (DMEPOS) suppliers. 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 PHYSSUPP 1. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR PHYSSUPP 2. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR PHYSSUPP 3. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, Cost Sharing, and Balance Billing for Original Medicare Beneficiaries, by Area of Residence MDCR PHYSSUPP 4. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Type of Service MDCR PHYSSUPP 5. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Place of Service MDCR PHYSSUPP 6. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization, Program Payments, and Balance Billing for Original Medicare Beneficiaries, by Physician Specialty MDCR PHYSSUPP 7. Medicare Physicians, Non-Physician Practitioners, and Suppliers: Utilization and Program Payments for Original Medicare Beneficiaries, by Berenson-Eggers Type of Service (BETOS) Classification

The CMS Program Statistics - Medicare Outpatient Facility tables provide use and payment data for all outpatient facilities, including hospitals providing outpatient services, rural health clinics, community mental health centers, federally qualified health centers, outpatient dialysis facilities, comprehensive outpatient rehabilitation facilities, and other outpatient facilities. 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 OUTPATIENT 1. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 2. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 3. Medicare Outpatient Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence MDCR OUTPATIENT 4. Medicare Outpatient Facilities: Utilization and Program Payments for Original Medicare Beneficiaries, by Type of Outpatient Facility MDCR OUTPATIENT 5. Medicare Outpatient Facilities: Utilization for Original Medicare Beneficiaries, by Type of Outpatient Facility and Type of Service MDCR OUTPATIENT 6. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 7. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 8. Medicare Outpatient Prospective Payment System Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence MDCR OUTPATIENT 9. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR OUTPATIENT 10. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR OUTPATIENT 11. Medicare Outpatient Critical Access Hospitals: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence

The CMS Program Statistics - Medicare Skilled Nursing Facility tables provide use and payment data for skilled nursing facilities. 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 SNF 1. Medicare Skilled Nursing Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement, Yearly Trend MDCR SNF 2. Medicare Skilled Nursing Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Demographic Characteristics and Medicare-Medicaid Enrollment Status MDCR SNF 3. Medicare Skilled Nursing Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Area of Residence MDCR SNF 4. Medicare Skilled Nursing Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Entitlement and Covered Days of Care MDCR SNF 5. Medicare Skilled Nursing Facilities: Utilization, Program Payments, and Cost Sharing for Original Medicare Beneficiaries, by Type of Facility and Bedsize MDCR SNF 6. Medicare Skilled Nursing Facilities: Distribution of Medicare Covered Skilled Nursing Facility Days, by State of Provider and Major Resource Utilization Groups (RUG)-III (versions 2013-2018 only)