At the Intersection of Health, Health Care and Policy Cite this article as: Dale N. Schumacher and Eric D. Dobkin Medicare Spending Per Beneficiary Health Affairs, 33, no.10 (2014):1878 doi: 10.1377/hlthaff.2014.0919

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doi:

10.1377/hlthaff.2014.0919

Medicare Spending Per Beneficiary “Using Big Data to Transform Care” is an outstanding issue. In addition to the data resources discussed by Niall Brennan and coauthors (Jul 2014), the Medicare spending per beneficiary (MSPB) data represent an extraordinary data source from the Centers for Medicare and Medicaid Services (CMS). The Affordable Care Act established the MSPB measure as integral to CMS’s Hospital Value-Based Purchasing (VBP) Program. Beginning in fiscal year 2015, MSPB will account for 20 percent of hospitals’ VBP payments. The MSPB measure will also be one of six cost measures in the 2016 Physician Feedback/ValueBased Payment Modifier Program. In 2013, 3,261 hospitals participating in the VBP program received MSPB scores. For each qualifying patient episode, CMS provides all claims-paid data for three days before the index admission through thirty days after the hospital discharge. The hospital’s MSPB data are compared to Medicare’s national risk-adjusted expected episode spending, and the hospital’s MSPB score is used in VBP payment calculations. The CMS Hospital-Specific Report summarizes the hospital’s MSPB

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score; a national hospital distribution table; MSPB spending by claim type; and MSPB spending by major diagnostic category (MDC).1 Hospital results for 2013 were provided in May 2014 in QualityNet. MSPB data identify Part A and Part B providers and practitioners using the CMS certification number and the national provider identifier. The data also document the care settings through which a beneficiary transitions during an episode of care. Although using the data requires substantive analytics, the information suggests opportunities for care redesign. We use these data to understand patient care pathways, MDC efficiency, and physician episode performance. MSPB data are an additional useful metric that should be considered as part of the big-data revolution. Dale N. Schumacher Rockburn Institute ELKRIDGE , MARYLAND Eric D. Dobkin Crozer Keystone Health System SPRINGFIELD , PENNSYLVANIA NOTE 1 QualityNet. Medicare spending per beneficiary (MSPB) measure overview [Internet]. Baltimore (MD): Centers for Medicare and Medicaid Services; [cited 2014 Jul 21]. Available from: http:// www.qualitynet.org/dcs/ContentServer?c=Page &pagename=QnetPublic%2FPage%2FQnet Tier3&cid=1228772053996

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Medicare spending per beneficiary.

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