[medreform] Re: mr. pell, a favor

  • From: "Tamman, Maurice" <Maurice.Tamman@xxxxxxx>
  • To: "'medreform@xxxxxxxxxxxxx'" <medreform@xxxxxxxxxxxxx>
  • Date: Wed, 1 Jul 2009 16:53:39 -0400

Question came up:

Can the Medpar data tell us anything about how sick the patients are or how 
many co-morbidities they have? I think this is sometimes referred to as "case 
mix." Hospitals sometimes can say that their population is "sicker" than 
another hospital's. Perhaps the only way to do it is through diagnosis codes.  
What about race by diagnostic code?

Maurice Tamman
News Editor, Wall Street Journal
914-482-8318 (mobile)
-----Original Message-----
From: medreform-bounce@xxxxxxxxxxxxx [mailto:medreform-bounce@xxxxxxxxxxxxx] On 
Behalf Of Pell, Michael
Sent: Wednesday, July 01, 2009 12:52 PM
To: medreform@xxxxxxxxxxxxx
Subject: [medreform] Re: mr. pell, a favor


I hope this is not too much information, nor too brief. I hate it when I'm too 
brief. The shame is unbearable.

At any rate...

1.) LDS MEDPAR Files

The National MedPAR Files contain inpatient hospital final action stay records. 
The Long Term Care Hospital (LTCH) MedPAR is a subset of the National MedPAR 
and contains only long term care hospital discharges. The Skilled Nursing 
Facility (SNF) MedPAR File contains SNF final action stay records.

Each MedPAR record represents a stay in an inpatient hospital or SNF. An 
inpatient "stay" record summarizes all services rendered to a beneficiary from 
the time of admission to a facility through discharge. Each MedPAR record may 
represent one claim or multiple claims, depending on the length of a 
beneficiary's stay and the amount of inpatient services used throughout the 
stay. The lowest level of geographic identification in the LDS MedPAR File is 
the state.

Data Available:
*         National MedPAR File available from 1997-2007 [pricing and record 
*         Long-Term Care Hospital (LTCH) Expanded Modified MedPAR available 
from 2004-2006 [pricing and record 
*         SNF MedPAR file is available from 2002-2006 [pricing and record 
What this data can do:

Generally the MEDPAR data is used for comparing medical facilities. Each record 
contains information about all the procedures of a single beneficiary's stay in 
a medical facility. Obviously we could also make comparisons by region and 
state as well. You can join the MEDPAR data to the Hospital Provider ID file 
(attached) on the facility's unique Medicare file number to find out the name 
of the facility, it's address, and what city it's located in, basic information 
that could be helpful for mapping purposes. There is also a "provider of 
services file" that provides more detailed facility information, such as number 
of beds, facility owner, and facility type. That data costs $100 per quarter, 
but I think we'd only need the first quarter. The interesting thing about that 
data is that we'd also be able to compare hospital owners. I have not issued a 
FOIA for that file, but I will today. The weakness of this data is that we 
can't use it to study things like reshospitalization because it contains no 
unique patient ID number.

2.) The Standard Analytical Files

The Standard Analytical Files (SAFs) contain information collected by Medicare 
to pay for health care services provided to a Medicare beneficiary. SAFs are 
available for each institutional (inpatient, outpatient, skilled nursing 
facility, hospice, or home health agency) and non-institutional (physician and 
durable medical equipment providers) claim type. The record unit of SAFs is the 
claim (some episodes of care may have more than one claim).

Data Available: SAFs are calendar year files and are available for the years 
1991 and forward. The most current file available is 2007.
*         Inpatient SAF [brief file 
*         Skilled Nursing Facility SAF [brief file 
*         Outpatient SAF [brief file 
*         Home Health Agency SAF [brief file 
*         Hospice SAF [brief file 
*         Carrier SAF [brief file 
*         Durable Medical Equipment [brief file 
What this data can do:

This data is broken down by claims, which means that a single hospital visit 
could appear multiple times in this database, if a facility submitted multiple 
claims. This might happen if a patient had a long stay or had multiple 
procedures performed. Because this data has a unique patient ID, you can use 
this to examine things like rehospitalization and how Medicare recipients use 
the system. This does contain some physician information, but I was advised not 
to use this because it's unreliable.

If you have any follow up questions, please let me know and I'll get on it.


From: medreform-bounce@xxxxxxxxxxxxx [mailto:medreform-bounce@xxxxxxxxxxxxx] On 
Behalf Of Tamman, Maurice
Sent: Wednesday, July 01, 2009 12:06 PM
To: medreform@xxxxxxxxxxxxx
Subject: [medreform] mr. pell, a favor
Can u give me a brief description of what is contained in each FOIAed dataset 
and generally what they can be used for (strengths and weakness.)


Maurice Tamman
News Editor, Wall Street Journal
914-482-8318 (mobile)

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