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SAS Programming with Medicare Administrative Data, 2nd Edition

Book Description

SAS Programming with Medicare Administrative Data is the most comprehensive resource available for using Medicare data with SAS. This book teaches you how to access Medicare data and, more importantly, how to apply this data to your research. Knowing how to use Medicare data to answer common research and business questions is a critical skill for many SAS users. Due to its complexity, Medicare data requires specific programming knowledge in order to be applied accurately. Programmers need to understand the Medicare program in order to interpret and utilize its data. With this book, you'll learn the entire process of programming with Medicare data—from obtaining access to data; to measuring cost, utilization, and quality; to overcoming common challenges. Each chapter includes exercises that challenge you to apply concepts to real-world programming tasks. SAS Programming with Medicare Administrative Data offers beginners a programming project template to follow from beginning to end. It also includes more complex questions and discussions that are appropriate for advanced users. Matthew Gillingham has created a book that is both a foundation for programmers new to Medicare data and a comprehensive reference for experienced programmers. This book is part of the SAS Press program.

Table of Contents

  1. About This Book
  2. About The Author
  3. Acknowledgments
  4. Chapter 1: Introduction
    1. Introduction and Purpose of This Book
    2. Framework of This Book
    3. Our Programming Project
    4. Chapter Outline
    5. How to Use This Book
    6. Disclaimer
    7. Chapter Summary
  5. Chapter 2: An Introduction to the Medicare Program
    1. Introduction and Goals of the Chapter
    2. An Introduction to the Medicare Program
      1. What is Medicare?
      2. Medicare Enrollment and Eligibility
      3. What Is Covered by Medicare?
      4. What Is Not Covered by Medicare?
      5. The Mechanics of Medicare
    3. Chapter Summary
  6. Chapter 3: An Introduction to Medicare Data
    1. Introduction and Goals of This Chapter
      1. A Note on the Source and Structure of Our Claims Data
    2. Part B Carrier Claims Data
    3. Durable Medical Equipment (DME) Data
    4. Outpatient Claims Data
    5. Inpatient Claims Data
    6. Skilled Nursing Facility (SNF) Claims Data
    7. Home Health Claims Data
    8. Hospice Claims Data
    9. Commonly Retained Elements in Administrative Claims Data
    10. Master Beneficiary Summary File
    11. Provider Data
    12. Example: Identification of Emergency Department (ED) Utilization
    13. Example: Identification of Surgical Services
    14. Chapter Summary
  7. Chapter 4: Planning the Research Programming Project
    1. Introduction and Goals of This Chapter
    2. Our Project’s Plan: The SDLC
    3. Our Project’s High-Level Requirements
    4. Our Project’s Quality Assurance Plan
    5. Our Project’s Flowchart
    6. Our Project’s Data Storage and LIBNAMES
    7. Our Research Programming Technical Specifications
    8. Chapter Summary
  8. Chapter 5: Request, Receive, Load, and Transform Data
    1. Introduction
    2. Requesting Medicare Administrative Claims and Enrollment Data
    3. Sources of Medicare Claims and Enrollment Data
    4. Data Available from CMS
    5. Our Project’s Data Requirements and Request Specifications
    6. Contacting ResDAC and Completing Paperwork
    7. Receiving, Decrypting, and Loading Medicare Administrative Claims and Enrollment Data
      1. Receiving Our Medicare Administrative Data
      2. Decrypting Our Medicare Administrative Data
      3. Loading Our Medicare Administrative Data into SAS Data Sets
    8. Algorithms: Transforming Base Claim and Line Level Data Sets into Single Claim-Level Files
      1. Transforming Base Claim and Line-Level Carrier Data into a Claim-Level File
    9. Chapter Summary
  9. Chapter 6: Working with Enrollment Data
    1. Introduction and Goals
    2. Review and Approach
      1. Basics of Medicare Enrollment Data
      2. Our Programming Plan
    3. Algorithms: Identifying Continuously Enrolled FFS Beneficiaries
      1. Why Define Continuously Enrolled FFS Beneficiaries?
      2. How to Specify the Programming for Continuous Enrollment in Medicare FFS
      3. Medicare Part A and Part B Enrollment Variables
      4. HMO Coverage Variable
      5. Date of Death Variable
      6. How to Program in SAS to Define Continuous Enrollment in Medicare FFS
    4. Algorithms: Create or Retain Data Elements for Displaying Results by Certain Characteristics
      1. Coverage Characteristics, Month of Death, Sex, and Race
      2. Age Groups
      3. Geographic Characteristics
    5. Algorithms: Create Final Enrollment Data for Remainder of Programming
    6. Chapter Summary
    7. Exercises
  10. Chapter 7: Measuring Utilization of Services
    1. Introduction and Goals
    2. Review and Approach
      1. Review: Basics of Medicare Claims Data
      2. Our Programming Plan
    3. Algorithms: Delimit Claims by Continuously Enrolled Beneficiary Population
    4. Algorithms: Measuring Evaluation and Management (E&M) Utilization
    5. Algorithms: Measuring Inpatient Hospital Utilization
    6. Algorithms: Measuring Emergency Department Utilization
    7. Algorithms: Measuring Utilization of Ambulance Services
    8. Algorithms: Measuring Outpatient Visit Information
    9. Algorithms: Measuring Utilization of SNF, Home Health Agency, and Hospice Care
    10. Chapter Summary
    11. Exercises
  11. Chapter 8: Measuring Costs to Medicare
    1. Introduction and Goals
    2. Review and Approach
      1. Review: Basics of Medicare Cost
      2. Our Programming Plan
      3. A Note on Payment Standardization and Risk Adjustment
    3. Algorithms: Measuring Evaluation and Management Payments
    4. Algorithms: Measuring Inpatient Hospital Payments
    5. Algorithms: Measuring Total Part A Payments
    6. Chapter Summary
    7. Exercises
  12. Chapter 9: Programming to Identify Chronic Conditions
    1. Introduction and Goals
    2. Review and Approach
      1. Review: Peculiarities of Medicare Data
      2. Our Programming Plan
      3. A Note on the Chronic Conditions Data Warehouse (CCW)
    3. Algorithms: Identifying Beneficiaries with Diabetes or COPD
    4. Algorithms: Evaluation and Management Visits for Beneficiaries with Diabetes or COPD
    5. Algorithms: Diabetic Eye Exams for Beneficiaries with Diabetes
    6. Algorithms: Hospital Readmissions for Beneficiaries with COPD
    7. Chapter Summary
    8. Exercises
  13. Chapter 10: Presenting Output and Project Disposition
    1. Introduction
    2. Synthesis – Review and Approach
      1. Review: Our Accomplishments
      2. Our Programming Plan
    3. Algorithms: Presenting Selected Measurements of Utilization, Cost to Medicare, and Quality Outcomes
      1. Presenting Ambulance Utilization
      2. Presenting Medicare Payments for Evaluation and Management Services by Provider
      3. Presenting Rates of Diabetes and COPD
    4. Algorithms: Presenting Inpatient Length of Stay Information by State
    5. Algorithms: Presenting Mean Medicare Part A Payments per Beneficiary by State and County
    6. Algorithms: Presenting Rates of Diabetic Eye Exams
    7. Production Execution in Batch
    8. Project Disposition
      1. Archiving Materials for Future Use
      2. Data Destruction
    9. Chapter Summary
    10. Exercises
  14. Index