Centers for medicare and medicaid services medicare current beneficiary survey

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One sample is used for both community and institutional beneficiaries, without drawing a separate institutional sample. It was calculated that a uniform procedure, with facility residents identified only at the time that interviewers located the sample persons, would yield about 1, institutional residents in each round, with others entering and leaving these settings over time. The actual numbers of beneficiary interviews completed in institutions were in Round 1, in Round 2, and in Round 3.

The sample is replenished annually, starting in the September-December round. This supplementary sample brings in newly eligible Medicare beneficiaries, replenishes sample cells depleted by refusals and death, and corrects for coverage errors in the initial sample frame. The first supplementary sample, fielded at Round 4 September , included 2, new sample members, 48 percent of whom were new beneficiaries, 42 percent who were replacements for attrition, and 8 percent who had addresses in ZIP Codes that were inadvertently omitted from the initial sample frame.

Of the total, were disabled and 1, were aged. Interviews with sampled persons who are living in the community are designed to yield longitudinal series of data on the use of health services, medical care expenditures, health insurance coverage, sources of payment public and private, including out-of-pocket payments , health status and functioning, and a variety of demographic and behavioral information, such as income, assets, living arrangements, family supports, and access to medical care.

An effort is made to interview the sampled person directly, but if the person is unable to answer the questions, he or she is asked to designate a proxy respondent, usually a family member or close acquaintance who is familiar with his or her care.

In Round 1, 11 percent of the community interviews were done with proxies. The typical MCBS interview lasts 1 hour, but there is considerable variation. Not all sections of the questionnaire are asked every time Table 2.

Round 1 includes a brief section on utilization, but focuses on demographic information, insurance coverage, health status, and access to and satisfaction with care. A core of questions designed to obtain detailed information on service utilization, charges, and payments begins in Round 2.

Supplementary items are included in each round to address special topics. NOTE: X indicates that the section is present in a given round of interviewing. The Round 1 questionnaire, fielded in September , introduced the respondents to the survey but did not include the detailed questions about use and expenditures for care that are asked in each subsequent round.

During the first interview, respondents are provided with a calendar to record details of health care use. They are encouraged to collect their Medicare and insurance statements, supporting bills, receipts, and prescriptions in preparation for the next interview.

The actual collection of detailed health care use and expenditure data began in Round 2 January-April In this and subsequent rounds of the survey, respondents are asked about health care events, charges, and payments since the previous interview.

As a result, a definite boundary is established for the recall of health care events. The calendar and accumulated insurance statements and receipts are reviewed as part of the interview. For each episode of health care, respondents are asked what charges were billed, who paid them, and what additional bills are expected. Medicare benefit statements known as Explanation of Medicare Benefits and any bills, insurance statements, checks, and receipts serve as the framework for collecting charge and payment data.

Statements anchor events in time better than recall alone; they also provide claim numbers for later computer linkage to the Medicare files. Anticipated statements and insurance payments not yet received are captured in the next round's summary review. Any gaps or visits for which statements are not available and not expected are filled by conventional survey questions.

In Round 3 May-August and after, a summary of health care events recorded in the previous round is reviewed by the interviewer and respondent together. The summary review establishes a boundary for reporting new events, probes for changes in household composition or insurance coverage, and prompts for missing information about old events.

The MCBS conducts interviews for persons in long-term care facilities using a similar but shortened instrument. The initial contact for the facility interview is always with the facility administrator. Interviews are subsequently conducted with staff members designated by the director as the most appropriate to answer each section of the questionnaire. It was decided early in the design of the study not to attempt facility interviews with the sample person or family members.

The facility questionnaire includes health status, residence history, insurance coverage, and the use and cost of services, but it does not include the attitudinal or other subjective items asked of community respondents.

The community interview, which constitutes more than 90 percent of MCBS data, is conducted using a computerized questionnaire on a notebook-size personal computer.

The decision to use this new technology was made early in the planning process in order to make the complex survey questionnaire easier to administer, to improve the accuracy of the data, and to make the data available for analysis quickly. CAPI greatly increases the efficiency of the questionnaire during the interview in the following ways:.

Concerns that CAPI would cause respondents to refuse or object to the interview, or that interviewers would have difficulties handling the computer were found to be groundless in the pilot test. For most interviewers, any hesitancy to rely on the advanced technology of the survey was outweighed by the satisfaction and prestige of mastering it. CAPI also has strategic implications for survey design and planning, some of which are not easily predicted. First, the MCBS took a year of intense activity from contract award to the start of pretesting of the CAPI questionnaire, largely because of the complexity of the instrument The length of the MCBS development phase was due more to the instrument's complexity and the length of the clearance process than any difficulties inherent in CAPI.

CAPI strongly influences the shape of the questionnaire itself: It can be more complex, more tailored to the characteristics of respondents, with more cross-references and rosters, and have more error checks. Finally, the speed of data delivery through CAPI is unprecedented for a large survey: By the end of the 4-month field period of Round 1, 75 percent of the data on the cases had been delivered to HCFA.

A pilot study for the MCBS, conducted during the first half of , confirmed the viability of the basic design. In particular, the issues of the acceptance of CAPI and a lengthy instrument by both respondents and interviewers were answered favorably.

Bills, statements, and calendars proved useful in collecting charge and payment data. CAPI worked—both hardware and software—though not without corrections.

The main results of the pilot were to give insights into the kinds of training needed to prepare interviewers to use CAPI and to account for charges and payments. The pilot also confirmed the importance of the calendar for improving the reporting of events, and led to improvements in the statement series.

For the actual data collection, which began in September , MCBS took a number of steps to ensure data quality:. Response rates for each of the first four rounds are presented in Table 3. For the continuing sample, the cross-sectional response rate thus rose to For the 2, persons added to the sample in Round 4, the response rate was Refusals declined as a percent of eligibles from 9. NOTE: The number of persons eligible for Rounds 2, 3, and 4 is less than the number who completed the preceding round because of deaths during the earlier round.

By the end of Round 3, 11, sampled persons had 3 complete rounds of interviewing, Another had partially completed the 3 rounds, raising the total response rate to Based on preliminary Round 4 refusals, the longitudinal response rate including completes and partial completes at the end of Round 4 will approximate 77 percent. The institution of overlapping rotating samples for fixed periods each i. Data sent electronically by the interviewers are received by microcomputers in Westat's headquarters and transported to VAX minicomputers.

As mentioned previously, many of the edits are performed by the CAPI program as the responses are collected. Most of these are logical checks, ensuring that answers to questions are consistent with each other e. Other edits check for correct links between segments of the data base. Errors remaining when the data are reviewed in the central office are examined in the edit shop, which employs about nine full-time staff members for the community and three for the facility questionnaires.

The editors spend most of their time on non-automated aspects of editing, such as reviewing interviewer comments and making complex corrections in the data base.

The estimation program has two major parts. The first is a set of general purpose small weights that reflect the probabilities of selection for the sample, adjusted for under-coverage and non-response. The weights have also been adjusted to reflect the July 1, , Medicare enrollment by age and gender. The general purpose weights can be used for most round and annual tables and are part of the public use files.

The second part of the estimation program is a set of replicated weights using balanced repeated half samples that are appropriate to calculate variances for data elements collected in a sample with a complex cluster design such as that of the MCBS.

These replicate weights are calculated so that users may compute their own standard errors for MCBS variables. These weights are not part of the public use files but are available from HCFA. MCBS interview data have been linked to Medicare claims and other administrative data to enhance their analytic power. This results in a data base combining data that can be obtained only from personal interviews with Medicare administrative data.

The survey data and Medicare claims data together constitute a more complete data set for the MCBS sample than is available from either source. Administrative data, such as buy-in status and capitated plan membership, are also added to the file. The final file consists of survey, administrative, and claims data. All personal identifying information is removed. Public-use data tapes are issued on a calendar year basis.

The first tape, for calendar year , includes Round 1 baseline interviews September-December and has Medicare claims for all of for these beneficiaries. These data were released to the public through the National Technical Information Service in January , about 12 months after the end of field work for that round. As previously noted, Round 1 introduces the respondents to the survey, and does not contain information on utilization and costs.

It does, however, contain valuable information on the characteristics of the sample, health insurance coverage, health status, and access to and satisfaction with care, as well as Medicare claims for all of Release of this file was followed in May by the release of a file containing the income and assets supplement from Round 3, including imputations and weights.

This file is designed to be merged with the information on the Round 1 file for analysis. The third file that was released October contains data from Round 4, i. This file is similar to the Round 1 public-use file: Claims for the year are appended but not matched to interview data; cost and utilization data from the survey are not included; and no new imputations have been done. Cross-sectional and longitudinal weights are included. This release is of special interest because it permits before-and-after comparisons Rounds 1 and 4 of health status and functioning, access to care, satisfaction with care, and usual source of care.

The Fully Linked public-use file, expected late in , will be the first complete annual file. It will contain all survey data for services obtained during calendar year , and thus include not only Round interviews, but also those data from Rounds 5 and 6 that refer to Medicare claims for services will be matched to events reported in the survey. Imputations will be done after this matching. Cross-sectional and longitudinal weights will be included.

The MCBS monitors the effects of recent changes to the Medicare program and provides the basic information needed to estimate the cost of program changes and expansions, including the effects of wider system reforms on the Medicare population Stone, Most of the potential of the MCBS data remains to be tapped because the data are so new. However, indicated here are some important uses of the MCBS data for policy analysis, including some work in progress.

MCBS data will be used to assess the effects of Medicare physician payment reform on access to and costs of care. This use was built into the Round 1 and Round 4 supplements on access and satisfaction at the request of the Physician Payment Review Commission Specific attention can be paid to subpopulations vulnerable to loss of access under the new fee schedule.

Any effects of the payment reforms on service use and expenditures, especially the portion paid by beneficiaries themselves, can be monitored through the MCBS. The MCBS is well suited to examine health care use and expenditures by the near-poor elderly, who are not eligible for Medicaid and relatively unprotected against increasing health care costs.

Some relief is offered by the recent Qualified Medicare Beneficiary QMB program, under which some low-income elderly are eligible for coverage of Medicare premiums, copayments, and deductibles. These data are being analyzed by the staff of Project HOPE under a HCFA grant The MCBS sample also allows the analysis of differences in utilization by near-poor elderly of different races, and the extent to which the near-poor spend down to Medicaid in the community. Under OBRA , insurers have to offer policies which conform to 1 of 10 prototype benefit packages Rice and Thomas, Different years of data can be merged to enhance the analytic sample, although each module has its own sampling weights that must be used to produce accurate estimates.

Nationally representative survey of Medicare beneficiaries from Data is collected using a panel methodology, where patients are recruited and followed with 12 interviews over a 4-year period, with successive waves of patients entering and exiting the study.

Each fall approximately one-quarter of the sample is retired and new respondents are added to maintain a stable sample size of approximately 16, respondents. Interviews are conducted in-person. Both institutionalized and non-institutionalized Medicare beneficiaries are included, and subjects with the full range of eligibility criteria for Medicare are represented. The oldest old and people eligible for Medicare due to disability are oversampled.

MCBS contains two types of files, each of which include both patient survey data and linked data from Medicare claims. The focus of this file is to provide data on expenditures and sources of payment on all health care services, both inside and outside of the Medicare program.

Medicare claims data includes use and cost information on inpatient hospitalizations, outpatient hospital care, physician services, home health care, durable medical equipment, skilled nursing home services, hospice care, and other medical services. Detailed information on variables provided each year can be found at the following links.

Note that there are hundreds of questionnaires, reflecting multiple questionnaires per year and multiple years of the survey. To provide a sense of the data available, questionnaires from the most recent published year include the following:.

Information obtained from Medicare beneficiaries in facilities e. Various supplements are available for different years. For example, in recent years supplements are available about prescription drug coverage, patient activation, and knowledge and information needs about the Medicare Program. As noted above, MCBS contains internal linkages that merge survey and claims data for the same Medicare beneficiaries. Click here for a PubMed search for articles using this dataset.

Cost-related medication nonadherence and spending on basic needs following implementation of Medicare Part D. Frailty predicts some but not all adverse outcomes in older adults discharged from the emergency department.

J Am Geriatr Soc. Racial and ethnic disparities in the treatment of dementia among Medicare beneficiaries. Hidden in plain sight: medical visit companions as a resource for vulnerable older adults. Arch Intern Med. Medicare beneficiaries and free prescription drug samples: a national survey.

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