Market saturation and usage data tool
The Medicare & Medicaid Services (CMS) has developed a market saturation and usage data tool that includes interactive maps and a data set that shows provider services at the national, state, and county levels and usage data for individual health areas. Market saturation in the modern context refers to the density of providers of a particular service in a particular geographical area compared to the number of beneficiaries receiving that service in that area.
The seventh issue of the data tool includes quarterly updates of data on fourteen areas of health services from issue 6, as well as data from the Federal Centers for Health and Ophthalmology. Thus, Issue 7 will include seven twelve-month reference periods and the following areas of health services: home health, emergency care (emergency, non-emergency, emergency and non-emergency), independent diagnostic testing tools (Part A and Part B), qualified Nursing Institutions, hospice, physiotherapy and occupational therapy, clinical laboratory (exhibition accounts independently), long-term treatment hospitals, chiropractic services, cardiac rehabilitation programs, psychotherapy, federally qualified health centers and ophthalmology. Also new in Issue 7 is the Trend Analysis Tool, which allows users to map percentage changes and trends over time nationally for available indicators and areas of health services.
The Market Saturation and Usage Data Tool is one of the many tools used by CMS to monitor and manage market saturation as a means of preventing potential fraud, waste and abuse. Data can also be used to identify the extent to which service usage is related to the number of providers serving a geographic region. Provider services and usage data by geographic region are easily compared using an interactive map. These data can be used in a number of secondary studies, but one of the purposes of publishing these data is to assist health professionals in making informed decisions about their places of care and public services. The tool is available through the CMS website at: Â https://data.cms.gov/market-saturation. Future issues may include comparable information on additional areas of health care.
The analysis is based on Medicare Paid Service Fee (FFS) data from the Integrated CMS Data Warehouse (IDR). The IDR contains Medicare FFS claims, beneficiary data, vendor data and plan data. FFS claims data is analyzed over a 12-month reference period, and the results are updated quarterly to reflect the more recent 12-month reference period.
The methodology of market saturation and use differs from other public data in determining the geographical location of the supplier. In this analysis, claims are used to determine the geographical area (s) served by the provider, rather than the practical address of the provider. In addition, a provider is defined as “serving the county” if, within a 12-month period, the provider has paid claims to more than ten beneficiaries located in the county. A provider is defined as a “serving state” when that provider serves any state county.
The market saturation and utilization methodology also differs from other public data in determining the number of Medicare beneficiaries participating in the Service Payment Program (FFS). In this analysis, the FFS beneficiary is defined as enrolled in Part A and / or Part B with a coverage type code of â € œ9â € (FFS coverage) for at least one month of the 12-month reference period. There should be no date of death this month or no zip code for the beneficiary so that the recipient can be appointed to the county. Other public data may identify the FFS beneficiary using a variety of criteria, such as the requirement that the beneficiary be enrolled in the FFS program each month during the reference period.
Beginning in issue 7 (April 2018), the interactive data set for all reference periods includes state and county data for the following United States, Commonwealth, and Freely Associated States territories: American Samoa (AS); Micronesia (FM); Guam (GU); Northern Mariana Islands (Mariana Islands); Puerto Rico (PR); and the US Virgin Islands (VI). National-level data in the interactive data set for all previous reference periods reflect the U.S. plus the aforementioned territories.
The Market Saturation and Utilization Tool does not include information on market saturation and usage for Medicaid or private insurance. However, the Medicare information included in the Tool may be a useful proxy for researchers or providers in these markets.
The Market Saturation and Usage Data Tool includes an interactive map that has color-coded analysis that divides the distribution into the following categories of states / counties for the selected metric: lowest 25 percent, second lowest 25 percent, third lowest 25 percent , the top 25 percent excluding extremes and extremes. An extreme value is one that differs significantly from other values in its field (for example, the number of suppliers). Counties excluded from the analysis are highlighted in gray on the interactive map.
For those interested in states and counties affected by the temporary moratorium on CMS provider registration during reference periods for which data is available, the interactive map allows visualization that identifies those states and counties. In this visualization, home emergency and home health areas for states / counties without a moratorium are defined based on a color scheme.
The following examples use ambulance service data (emergency and non-emergency) (selected for illustration only). Similar maps can be created using the Data Tool for all areas of health services included in the seventh issue and for seven twelve-month reference periods: from 2014-10-01 to 2015-09-30, 2015-01-01 to 2015-12-31 , 2015-04-01 to 2016-03-31, 2015-07-01 to 2016-06-30, 2015-10-01 to 2016-09-30, 2016-01-06- to 12-31 and 2016- 04-01 to 2017-03-31.Â
Map 1 shows the distribution of suppliers by state for the operating period from October 1, 2014 to September 30, 2015. The double color scale distinguishes moratorium (blue) and states without moratorium (green).
Map 1. Ambulance (ambulance and emergency):
National distribution of the number of suppliers
October 1, 2014 – September 30, 2015
Color by Moratoria Status
Map 2 goes to the county level and shows the distribution of suppliers by county in Texas for the period from October 1, 2014 to September 30, 2015. The dual color scheme distinguishes moratorium (blue) and constituencies without moratorium (green).
Map 2. Ambulance (ambulance and emergency):
County Distribution of the number of suppliers
October 1, 2014 – September 30, 2015
Color by Moratoria Status
Similar maps can be created nationally and nationally for other indicators included in the Data Tool: number of FFS beneficiaries, average number of users per provider, percentage of users from FFS beneficiaries, number of users, average number of Providers by counties and total payments.
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