[R01] Enhancing National Quality Measurement through Integrated Medicare Data
Ente: National Institute on Aging
Scadenza: 2031-03-31
Importo max: 433.593 EUR
Paese: US
Descrizione
PROJECT SUMMARY
As of September 2024, 55% of Medicare beneficiaries with coverage for Parts A and B services were enrolled
in Medicare Advantage (MA), a steadily growing segment of Medicare that offers coverage through private,
managed care plans as an alternative to traditional Medicare fee-for-service (FFS) coverage. This shift in
Medicare enrollment towards MA defines a gaping blind spot in U.S. healthcare quality measurement on two
levels. First, despite the preponderance of enrollment in MA, there are currently no hospital measures of
quality, outcomes, or disparities comparable to those in Medicare’s FFS program. This measurement and
information gap may hinder consumer decision-making and hospital quality improvement. Second, because
many hospital quality measurement programs continue to rely on Medicare FFS data, MA growth may have
unintended consequences for Medicare FFS hospital performance measurement and reporting. MA growth
implies smaller FFS measure denominators which may reduce statistical reliability (i.e., ability to detect outlying
performance). At the same time, higher rates of MA enrollment among non-whites and those dually eligible for
Medicare and Medicaid may limit the ability of FFS claims-based measures to capture inpatient disparities. To
address these measurement gaps, our study, “Enhancing National Quality Measurement through Integrated
Medicare Data,” proposes to integrate Centers for Medicare and Medicaid Services (CMS) Medicare fee-for-
service (FFS) and Medicare Advantage (MA) data to improve hospital quality, outcomes, and disparities
measurement. Our Specific Aims are to (1) evaluate the completeness and comparability of MA Inpatient
Encounter data by comparing it against MA records in the Medicare Provider Analysis and Review (MedPAR)
data file, an independent source of inpatient MA data; (2) compare quality, outcomes, and disparities of
inpatient care delivered to MA vs. FFS inpatients using CMS claims-based inpatient measures in MA and FFS
data; and (3) demonstrate integrated measurement of inpatient quality, outcomes, and disparities in a newly
created, integrated MA and FFS inpatient dataset to evaluate changes in measured performance, measure
reliability, and numbers of hospitals meeting reporting thresholds. By integrating Medicare MA and FFS data
for hospital quality, outcomes and disparities measurement, we hope to demonstrate how existing data can be
leveraged to provide unified, robust inpatient measures that will be of value to (1) both MA and Medicare FFS
beneficiaries in consumer decision-making and (2) hospitals and other stakeholders in efforts to improve
quality, outcomes, and healthcare equity. Our project is aligned with the National Institutes of Health National
Institute on Aging’s Health Disparities Framework, CMS’ Framework for Health Equity (2022-2032) and CMS’
National Quality Strategy and Meaningful Measures 2.0.
Istituzione: INDIANA UNIVERSITY INDIANAPOLIS
PI: KARL Y BILIMORIA, Jeanette Wei-Ling Chung
Progetto: 1R01AG092859-01A1
Settori: National Institute on Aging
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