The Centers for Medicare and Medicaid Services released an updated data tool that produces interactive state and county maps with metrics illustrating health service utilization, such as emergency, non-emergency and skilled nursing facilities.
Using ambulance and HHA paid claims data within CMS systems for Medicare fee-for-service beneficiaries, the maps show whether an area has an active moratorium in a specified geographic area. The maps also have color variations to show distribution of the metric.
The data enables comparisons of provider services and utilization data by geographic areas, enabling drilldown comparisons to the county level of states. Maps are coded to reveal which areas are in specific quartiles of distribution.
Data can show the number of Medicare providers serving a geographic region, as well as the number of Medicare beneficiaries who use a health service in an area.
CMS used authority provided by the Affordable Care Act in 2013 to impose temporary enrollment moratoria to combat fraud, waste and abuse, according to a blog post by CMS’ Center for Program Integrity Director Shantanu Agrawal. CMS has extended the moratoria in six month phases since then; the most recent occurred on January 29.
The moratoria applied to the enrollment of new home health agencies and ground ambulance suppliers. Agrawal wrote that the moratoria gave “CMS the opportunity to analyze and monitor the existing provider and supplier base, as well as further focus additional fraud prevention and detection tools in these areas.”
The analysis is based on paid Medicare claims data from the CMS Integrated Data Repository (IDR). Claims data are analyzed for a 12-month reference period, and results are updated quarterly. The reference period dates back as far as October 2014.
The methodology differs from other types of public use data in determining the geographic location of a provider. Claims are used to define the geographic area served by a provider, rather than the provider’s practice address.
The data set is available for download and as an interactive tool on CMS’ website.
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