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  • Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH)

    The Mapping Medicare Disparities Tool

    Technical Documentation

    Prepared by

    NORC at the University of Chicago 55 East Monroe Street, 30th Floor

    Chicago, IL 60603

    Version 8.0 │ October 10, 2019

  • NORC | Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH)

    THE MAPPING MEDICARE DISPARITIES TOOL TECHNICAL DOCUMENTATION | i

    Table of Contents

    1. Revisions and Updates to the Technical Documentation ................................................ 1

    2. Purpose of the Analysis...................................................................................................... 2 2.1 Mapping Medicare Disparities (MMD) Tool - Population View ....................................... 2 2.2 Mapping Medicare Disparities (MMD) Tool - Hospital Tool ............................................ 3

    3. Data and Analysis ............................................................................................................... 3 3.1 MMD Tool -- Population View ........................................................................................ 3 3.2 MMD Tool -- Hospital View ............................................................................................ 4

    4. Methodology ........................................................................................................................ 4 4.1 MMD Tool -- Population View ........................................................................................ 4

    4.1.1 Prevalence Rates and Total Costs .................................................................... 4 4.1.2 Hospitalization Rates ..................................................................................... 12 4.1.3 Preventable Hospitalizations - Agency for Healthcare Research and Quality

    (AHRQ) Prevention Quality Indicators (PQIs) ............................................... 12 4.1.4 Readmission Rates ....................................................................................... 13 4.1.5 Mortality Rates .............................................................................................. 13 4.1.6 Emergency Department Visit Rates ............................................................... 14 4.1.7 Preventive Services Uptake Rates ................................................................ 14 4.1.8 Admission Rates by Admission Type .............................................................. 16 4.1.9 Admission Rate by Discharge Destination ...................................................... 16 4.1.10 Preventable Hospital Complications - Agency for Healthcare Research and

    Quality (AHRQ) Patient Safety Indicators (PSIs) .......................................... 16 4.1.11 Average Inpatient Days and Average Medicare Reimbursement .................. 17

    4.2 MMD Hospital View ..................................................................................................... 17 4.2.1 Readmission and Unplanned Hospital Visit Rates .......................................... 20 4.2.2 Patient Safety ................................................................................................. 21 4.2.3 Medicare Spending ......................................................................................... 22 4.2.4 Patient Experience .......................................................................................... 23 4.2.5 Hospital Value Based Purchasing (HVBP) ...................................................... 23 4.2.6 Inpatient Psychiatric Facility Quality Reporting (IPFQR) ................................. 24 4.2.7 Prospective Payment System (PPS) – Exempt Cancer Hospital Quality

    Reporting (PCHQR) ..................................................................................... 24

    5. Analysis of Measures by the Number of Chronic Conditions in the Population View . 25

    6. Age Standardization of Measures in the Population View ............................................. 25

    7. Spatial Smoothing of Measures in the Population View ................................................. 25

  • NORC | Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH)

    THE MAPPING MEDICARE DISPARITIES TOOL TECHNICAL DOCUMENTATION | ii

    8. Analysis Population in the Population View ................................................................... 26

    9. Suppression in the Population View ................................................................................ 26

    10. Utilizing the MMD Tool ...................................................................................................... 27 10.1 Population View ........................................................................................................ 27 10.2 Hospital View ............................................................................................................ 29

    11. Other Features of the MMD Tool ...................................................................................... 30 11.1 Population View ........................................................................................................ 30 11.2 Hospital View ............................................................................................................ 31

    Appendix A: Expanded Data and Methodology – Population View ..................................... 32 A.1 Data ......................................................................................................................... 32 A.2 Expanded Methodology ........................................................................................... 33

    A.2.1 Prevalence Rates and Total Costs ................................................................ 33 A.2.2 Hospitalization Rates ..................................................................................... 36 A.2.3 Preventable Hospitalizations - AHRQ PQIs ................................................... 39 A.2.4 Readmission Rates ....................................................................................... 40 A.2.5 Mortality Rates .............................................................................................. 41 A.2.6 Emergency Department Visit Rate ................................................................ 42 A.2.7. Preventive Services Uptake Rates ................................................................ 43 A.2.8. Analysis of Measures by the Number of Chronic Conditions ......................... 51 A.2.9 Inpatient Admission Measures ........................................................................ 51 A.2.10 Age Standardization of Measures ................................................................. 52

    A.3 Socio-Economic Data Updates ................................................................................ 53

    Appendix B: Expanded Data and Methodology - Hospital View .......................................... 55 B.1 Data ............................................................................................................................ 55 B.2 Expanded Methodology .............................................................................................. 55

    B.2.1 Readmission Rates ........................................................................................ 55 B.2.2 Patient Safety ................................................................................................. 55 B.2.3 Patient Experience ......................................................................................... 57 B.2.4 Hospital Value-Based Purchasing (HVBP) ..................................................... 58 B.2.5 Inpatient Psychiatric Facility Quality Reporting (IPFQR) ................................. 60 B.2.6 Prospective Payment System (PPS) – Exempt Cancer Hospital Quality

    Reporting (PCHQR) ..................................................................................... 61

    Glossary .................................................................................................................................. 62

  • NORC | Centers for Medicare & Medicaid Services Office of Minority Health (CMS OMH)

    THE MAPPING MEDICARE DISPARITIES TOOL TECHNICAL DOCUMENTATION | iii

    List of Tables

    Table 1. Revision History for the Mapping Medicare Disparities Tool .................................... 1

    Table 2. Data and Definitions Used in the Mapping Medicare Disparities Tool – Chronic Conditions ............................................................................................................... 7

    Table 3. Data and Definitions Used in the Mapping Medicare Disparities Tool – Other Chronic or Potentially Disabling Conditions ........................................................... 10

    Table 4. Definitions Used in the Mapping Medicare Disparities Tool – Preventive Services 14

    Table 5. Definitions Used in the Mapping Medicare Disparities Tool – Hospital View ......... 17

    Table 6. National Unadjusted Average Readmission (or Unplanned Hospital Visit) Rate per Condition ............................................................................................................. 20

    Table A.1. Deriving Analysis Population for Prevalence Rates of Chronic Conditions and Total Costs of Chronic Conditions and End Stage Renal Disease and Disability ........... 33

    Table A.2. Deriving Analysis Population for Prevalence Rates of End Stage Renal Dise

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