Quantitative Data Analysis Projects
CMS has contracted with IMPAQ International, and partners including NORC and Buccaneer Computer Systems & Services, to pioneer the creation, dissemination, and support of Medicare claims public use file (PUF) to conduct comparative effectiveness research. The data products for this project include Basic Stand-Alone, Enhanced, and Synthetic PUFs for a 5% sample of Medicare beneficiaries across 3 years of data using all eight Medicare claims limited data sets (Inpatient, Outpatient, PDE, Carrier, Skilled Nursing Facility, Durable Medical Equipment, Hospice, and Home Health Agency). To guarantee the confidentiality of Medicare beneficiaries’ Protected Health Information (PHI) and assure an overall low risk of disclosure, sophisticated de-identification methods and rigorous re-identification analysis will be employed. In addition to the creation of the public use file, a large component of this project is the establishment of a Technical Expert Panel/Data User’s Group, the development of data access solutions, the creation of user support documentation, and the initiation of outreach/marketing activities. Other tasks to be performed under this contract include: Environmental Scan, Needs Assessment, and Ad Hoc Program and Policy Analysis.
Effective Federal spending requires identification of potential improper payments and development of strategies to reduce payment error . The Improper Payments Elimination and Recovery Act of 2010 (IPERA) requires Federal agencies to review programs which may be susceptible to improper payments. With this new contract award IMPAQ is proud to continue its support of CMS’ initiative to develop and implement methodologies to estimate payment errors and improper payments in Medicare Part C and Part D. CMS reports Part C & Part D payment error rates to the Office of Management and Budget (OMB) each year. IMPAQ continues to support this important CMS initiative by (1) calculating the MARx Payment Error (MPE) Rate for Part C and Part D prospective payments; (2) providing monthly support for the Beneficiary Payment Validation (BPV) process; (3) conducting additional BPV analyses and producing reports; (4) developing and implementing processes for ensuring the integrity of data used in the monthly BPV process and monitoring these activities on a regular basis; and, (5) providing, as needed, consultation and analysis on additional payment error issues to respond to requests by CMS and OMB.
The Centers for Medicare & Medicaid Services (CMS) asked the Institute of Medicine’s Committee on Geographic Variation in Health Care Spending and Promotion of High-Value Care to study “the extent and range of variation [in health care spending and quality] using various units of geographic measurement, including micro areas within larger areas.” Additionally, the Committee is required to examine a wide range of factors that may affect health care spending and quality, especially as these factors affect high-value care under Medicare Parts A and B. The Committee commissioned a body of empirical analyses to explore geographic variation in spending (including price and utilization) and quality, using public and commercial datasets. The goals of the committee’s analyses are to characterize and explain the presence and magnitude of geographic variation in spending and quality across different geographic units, payers, and populations.
IMPAQ’s quality-control review coves five general areas: data sources and data processing; sampling; measurement; statistical analysis; and results and conclusions In addition, IMPAQ provides the IOM and its subcontractors continuing guidance to improve the quality and reporting of research methods and statistical analyses. In addition IMPAQ will produce a final report to the IOM committee describing its quality control methods and findings.
IMPAQ International is supporting USDA Food and Nutrition Services in developing an analysis of the purchases made by Supplemental Nutrition Assistance Program (SNAP) recipients. The analysis aims at making an accurate assessment of the characteristics of these purchases by determining what foods are purchased together, and how households vary their product mixes over a given period of time. The findings of this project will contribute to the knowledge base of SNAP program managers and other program stakeholders, and help inform policy recommendations. The study seeks to answer the following research questions: 1) How do SNAP households use their benefits? 2) During an average month, what are the food items most frequently purchased using SNAP benefits? 3) Do purchase patterns among SNAP households vary by observable characteristics, benefit amount or spell length? 4) Do SNAP households purchase the same food items with their benefits and with other resources? 5) How do food purchased by SNAP households compare to food purchased by non-SNAP households?
Analysis of Case-Mix Growth for Hospitals Paid Under the Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment SystemClient: Centers for Medicare & Medicaid Services,U.S. Department of Health and Human Services
The purpose of this project is to estimate the observed change in national average case-mix between FY 2007 and FY 2008 and between FY 2008 and FY 2009 under the MS-DRG system, and determine what portion of that change is the result of documentation and coding improvements rather than a real increase in patient severity of illness. An additional objective of the study is to perform a separate analysis for Sole Community Hospitals (SCHs), Medicare Dependent Hospitals (MDHs), and Puerto Rico hospitals to see whether these hospitals, which are not fully subject to the documentation and coding adjustment, are experiencing significant increases in case-mix under the MS-DRG system. For long-term care hospitals (LTCHs), the goal is to develop an estimate of annual real case-mix growth, to estimate the observed change in case-mix in FY 2008 based on LTCH claims data, and to estimate the proportion that is a real increase versus an apparent increase.
Analysis of Case-Mix Growth for Hospitals Paid Under the Inpatient Prospective Payment System and Long-Term Care Hospital Prospective Payment System: 2010 Follow-OnClient: Centers for Medicare & Medicaid Services, U.S. Department of Health and Human Services
In an effort to more fully account for the severity of Medicare patients and its prospective payments to facilities, CMS replaced its Diagnosis Related Group (DRG) System with the Medicare Severity Diagnosis Related Group (MS-DRG) System in FY 2008. In addition to more accurately compensating hospitals, the MS-DRG system was also expected to encourage hospitals to more fully document and code their patients’ conditions. The MS-DRG weights were designed to produce a budget neutral transition from the DRG system to the MS-DRG system. However, changes in coding and documentation behavior threatened this budget neutrality. The purpose of this project is to continue the evaluation of the impact of documentation and coding changes on the increase in the case-mix index for hospitals paid under the inpatient prospective payment system and of long-term care hospitals paid under the prospective payment system. These estimates will be used to inform CMS on how to set payment rates for FY2012 and FY2013 in order to ensure the overall budget neutrality of the implementation of the MS-DRG system. In addition to the analysis, IMPAQ will also contribute to the documents that are submitted to the Federal Registrar and assist with responses generated during this process.
IMPAQ is working for the fourth consecutive year with CMS to provide support in estimating components of payment error and improper payments in Medicare Part C and Part D; support payment validation and data integrity issues related to payments in these programs; and provide consultation and additional analyses regarding Part C and Part D payment error, including BPV and/or MARx payment error.
In this project, IMPAQ International and the National Opinion Research Center are conducting research to evaluate the potential impact of electronic medical record systems on risk adjustment in payments to Medicare Advantage plans. Using diagnostic information from medical encounters and the CMS-Hierarchical Condition Category (HCC) risk adjustment methodology, CMS determines annual risk scores for Medicare Advantage enrollees and uses these scores to adjust the monthly payments to Medicare Advantage organizations. Accurate risk adjustment depends upon the accuracy of the supporting diagnosis data. Thus, our evaluation focuses on the impact of electronic medical record systems and other health information technologies on the quality and quantity of diagnosis data provided to CMS for the purpose of Medicare Advantage risk adjustment. Project activities include:
- Analysis of data from various sources, including the CMS’ Risk Adjustment Data Validation (RADV) system and the Risk Adjustment System (RAS) to determine differences in diagnosis data generated from electronic medical record systems and diagnosis data generated from paper-based medical records.
- A review of the implementation of the American Recovery and Reinvestment Act provisions related to health information technologies, and their potential impact on Medicare Advantage risk adjustment.
- An environmental scan including literature review and key stakeholder interviews to gain an understanding of how available software generate diagnoses.
- The development of recommendations for CMS regarding the collection of diagnosis data generated from electronic medical record systems for the purposes of conducting Medicare Advantage risk adjustment.
Few public health issues have proved as challenging as the quest to determine whether government policies aimed at reducing alcohol consumption in the US would in turn reduce various types of violence that may result in injury or death. While there is strong documented association between alcohol use and violence, there is no strong evidence of a causal link between alcohol consumption and violence. Prior related studies have faced substantial challenges in compiling complete, valid, and reliable measures of the full range of policies and regulatory initiatives that may be implemented by States and other jurisdictions to reduce alcohol related violence and its costs. IMPAQ has contracted with the Division of Violence Prevention, Centers for Disease Control and Prevention to develop an improved statistical approach for estimating this relationship, examining policies from multiple levels of government and multiple types of violence.
The scope of this project is to evaluate the Federal Contractor Selection System (FCSS) used by the Office of Federal Contract Compliance Programs (OFCCP) to identify federal contractors who do not comply with federal laws related to employee discrimination. There are four general goals under this project:
Evaluate the quality of the FCSS data used to identify non-compliant federal contractors
Identify employer characteristics and other factors available in the FCSS data that are strong indicators of non-compliance.
Evaluate the effectiveness of statistical models currently used to predict non-compliance.
Suggest improvements in the OFCCP contractor selection process.
To conduct this evaluation, IMPAQ will review the FCCS data and all documentation relevant to the data and the OFCCP selection process. IMPAQ will also conduct interviews with key OFCCP staff to assess the data collection practices, data quality, and OFCCP selection process. Using this information, IMPAQ will examine the quality of the FCSS data and identify factors that predict non-compliance among federal contractors. IMPAQ will also use rigorous quantitative techniques to evaluate the effectiveness of current statistical models to predict contractor non-compliance. The final deliverable will describe the findings of the evaluation, including suggestions for improving the OFCCP selection process.