Home Health Agency Utilization and Payment Data 2016

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The Home Health Agency Utilization and Payment Data 2016 presents information on services provided to Medicare beneficiaries by home health agencies. The dataset includes data for providers that had a valid identification number and submitted a Medicare Part A institutional claim during the 2015 calendar year. To protect the privacy of Medicare beneficiaries, any aggregated records which are derived from 10 or fewer beneficiaries are excluded.

Complexity

This dataset contains information on utilization, payment (Medicare payment and standardized payment), submitted charges, and demographic and chronic condition indicators organized by CMS (Centers for Medicare and Medicaid Services) Certification Number (6-digit provider identification number), Home Health Resource Group (HHRG), and state of service. This dataset is based on information from CMS’s Chronic Conditions Data Warehouse (CCW) data files. The dataset covers data for the calendar years 2015 and contains 100 percent final-action (i.e., all claim adjustments have been resolved) home health agency institutional claims for the Medicare fee-for-service (FFS) population.

Allowed amounts are not included in these files, since home health services do not have any deductibles or coinsurance and therefore allowed amounts will always equal Medicare payments. In addition, provider charges may sometimes be lower Medicare payments for non-low utilization payment adjustments (non-LUPA) episodes. This is due to the nature of the home health prospective payment system. For home health, payment is determined for each 60-day episode based on an assessment of the patient. Medicare will pay the full payment for this episode, even if charges in the 60-day period are less than the payment.

The prospective payment system works to save Medicare money for a whole group of services over a fiscal year, not by getting savings from an individual provider or home health agency, or in the case of each patient. Therefore, home health agencies will have some episodes for which their charges may be less than Medicare’s payment, and saves Medicare money by keeping all payments, with very few exceptions, within the previously set episode rates. Such payment gives the home health agency an incentive to be efficient in their delivery of services, and saves Medicare money by keeping all payments– with very few exceptions– within the previously set episode rates. It does not have any information on patients who are not covered by Medicare, such as those with coverage from other federal programs (like the Federal Employees Health Benefits Program or Tricare), those with private health insurance (such as an individual policy or employer-sponsored coverage), or those who are uninsured. Even within Medicare, the data does not include information for patients who are enrolled in any form of Medicare Advantage plan.

Although the Home Health Agency Public Use File (PUF) has a wealth of payment and utilization information about home health services, the dataset also has a number of limitations. The information presented in this file does not indicate the quality of care provided by individual home health agencies. The file only contains cost and utilization information. Additionally, the data are not risk-adjusted and thus do not account for differences in the underlying severity of disease of patient populations treated by providers.

Date Created

2018-03-30

Last Modified

2018-08-28

Version

2018-08-28

Update Frequency

Annual

Temporal Coverage

2016

Spatial Coverage

United States

Source

John Snow Labs; Centers for Medicare and Medicaid Services;

Source License URL

Source License Requirements

N/A

Source Citation

N/A

Keywords

Home Health Agency, Utilization and Payment, Home Health Charges, Home Health Agency Data 2016, Medicare Payment and Standardized Payment, HHA Utilization and Payment

Other Titles

Home Health Agency Utilization and Payment Aggregate Report, Medicare Home Health Agency Utilization and Payment Aggregate Report, Medicare Home Health Agency Charges and Amounts Aggregate Report

NameDescriptionTypeConstraints
Provider_IDThe 6-digit identification number for the home health agency on the claimintegerlevel : Nominal
Agency_NameName of home health agency as reported in the Provider of services (POS) filestring-
AddressThe home health agency address, as reported in the POS filestring-
CityThe city where the home health agency is located, as reported in the POS filestring-
State_AbbreviationThe state where the home health agency is located, as reported in POS file. The fifty U.S. states and the District of Columbia are reported by the state postal abbreviation.string-
Zip_CodeZip code of the agency as reported in POS fileintegerlevel : Nominal
Total_Episodes_Non_LUPATotal count of non-LUPA episodes provided by a specific home health agency or in a unique HHRG category in the calendar year.integerlevel : Ratio
Distinct_Beneficiaries_Non_LUPANumber of distinct Medicare beneficiaries receiving at least one non-LUPA home health episode in the calendar year. Beneficiaries may receive multiple home health episodes per year but are only counted once in this fieldintegerlevel : Ratio
Average_Number_of_Total_Visits_Per_Episode_Non_LUPAAverage number of total visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_Skilled_Nursing_Visits_Per_Episode_Non_LUPAAverage number of skilled nursing visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_PT_Visits_Per_Episode_Non_LUPAAverage number of physical therapy visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_OT_Visits_Per_Episode_Non_LUPAAverage number of occupational therapy visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_ST_Visits_Per_Episode_Non_LUPAAverage number of speech therapy visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_Home_Health_Aide_Visits_Per_Episode_Non_LUPAAverage number of home health aide visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Average_Number_of_Medical_Social_Visits_Per_Episode_Non_LUPAAverage number of medical-social visits provided by the HHA during a non-LUPA episodenumberlevel : Ratio
Total_HHA_Charge_Amount_Non_LUPATotal charges that the home health agency submitted for non-LUPA episodesnumber-
Total_HHA_Medicare_Payment_Amount_Non_LUPATotal amount that Medicare paid for non-LUPA episodes. Home health services do not have any cost-sharing requirements and the Medicare payment amount will equal the allowed amountnumber-
Total_HHA_Medicare_Standard_Payment_Amount_Non_LUPATotal amount that Medicare paid for non-LUPA episodes adjusted for geographic differences in payment ratesnumber-
Outlier_Payments_Percent_of_Medicare_Payment_Amount_Non_LUPAThe percent of total Medicare payments for non-LUPA episodes paid to an HHA for outlier episodesnumber-
Total_Episodes_LUPATotal count of low utilization payment amount episodes provided by a specific HHA in the calendar yearintegerlevel : Ratio
Total_HHA_Medicare_Payment_Amount_for_LUPAsTotal amount that Medicare paid for LUPA episodes provided by a specific HHA in the calendar yearnumber-
Average_AgeAverage age of beneficiaries. Beneficiary age is calculated at the end of the calendar year or at the time of deathintegerlevel : Ratio
Male_BeneficiariesNumber of male beneficiariesintegerlevel : Ratio
Female_BeneficiariesNumber of female beneficiariesintegerlevel : Ratio
Nondual_BeneficiariesNumber of Medicare beneficiaries qualified to receive Medicare only benefits. Beneficiaries are classified as Medicare only entitlement if they received zero months of any Medicaid benefits (full or partial) in the given calendar yearintegerlevel : Ratio
Dual_BeneficiariesNumber of Medicare beneficiaries qualified to receive Medicare and Medicaid benefits. Beneficiaries are classified as Medicare and Medicaid entitlement if in any month in the given calendar year they were receiving full or partial Medicaid benefitsintegerlevel : Ratio
White_BeneficiariesNumber of non-Hispanic white beneficiariesintegerlevel : Ratio
Black_BeneficiariesNumber of non-Hispanic black or African Amercian beneficiariesintegerlevel : Ratio
Asian_Pacific_Islander_BeneficiariesNumber of Asian Pacific Islander beneficiariesintegerlevel : Ratio
Hispanic_BeneficiariesNumber of Hispanic beneficiariesintegerlevel : Ratio
American_Indian_Or_Alaska_Native_BeneficiariesNumber of American Indian or Alaskan native beneficiariesintegerlevel : Ratio
Other_Or_Unknown_BeneficiariesNumber of beneficiaries with race not elsewhere classifiedintegerlevel : Ratio
Average_HCC_ScoreAverage Hierarchical Condition Category (HCC) risk score of beneficiariesnumberlevel : Ratio
Percent_of_Beneficiaries_with_Atrial_FibrillationPercent of beneficiaries meeting the CCW chronic condition algorithm for Atrial Fibrillationnumberlevel : Ratio
Percent_of_Beneficiaries_with_AlzheimersPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzhemersnumberlevel : Ratio
Percent_of_Beneficiaries_with_AsthmaPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthmanumberlevel : Ratio
Percent_of_Beneficiaries_with_CancerPercent of beneficiaries meeting the CCW chronic condition algorithm for cancernumberlevel : Ratio
Percent_of_Beneficiaries_with_CHFPercent of beneficiaries meeting the CCW chronic condition algorithm for CHFnumberlevel : Ratio
Percent_of_Beneficiaries_with_Chronic_Kidney_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney diseasenumberlevel : Ratio
Percent_of_Beneficiaries_with_COPDPercent of beneficiaries meeting the CCW chronic condition algorithm for COPDnumberlevel : Ratio
Percent_of_Beneficiaries_with_DepressionPercent of beneficiaries meeting the CCW chronic condition algorithm for depressionnumberlevel : Ratio
Percent_of_Beneficiaries_with_DiabetesPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetesnumberlevel : Ratio
Percent_of_Beneficiaries_with_HyperlipidemiaPercent of beneficiaries meeting the CCW chronic condition algorithm for Atrial Fibrillationnumberlevel : Ratio
Percent_of_Beneficiaries_with_HypertensionPercent of beneficiaries meeting the CCW chronic condition algorithm for Hypertensionnumberlevel : Ratio
Percent_of_Beneficiaries_with_IHDPercent of beneficiaries meeting the CCW chronic condition algorithm for ischemaic heart disease (IHD)numberlevel : Ratio
Percent_of_Beneficiaries_with_OsteoporosisPercent of beneficiaries meeting the CCW chronic condition algorithm for Osteoporosisnumberlevel : Ratio
Percent_of_Beneficiaries_with_Rheumatic_Arthritis_OsteoarthritisPercent of beneficiaries meeting the CCW chronic condition algorithm for Rheumatic arthritis osteoarthritisnumberlevel : Ratio
Percent_of_Beneficiaries_with_SchizophreniaPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenianumberlevel : Ratio
Percent_of_Beneficiaries_with_StrokePercent of beneficiaries meeting the CCW chronic condition algorithm for strokenumberlevel : Ratio
Provider IDAgency NameAddressCityState AbbreviationZip CodeTotal Episodes Non LUPADistinct Beneficiaries Non LUPAAverage Number of Total Visits Per Episode Non LUPAAverage Number of Skilled Nursing Visits Per Episode Non LUPAAverage Number of PT Visits Per Episode Non LUPAAverage Number of OT Visits Per Episode Non LUPAAverage Number of ST Visits Per Episode Non LUPAAverage Number of Home Health Aide Visits Per Episode Non LUPAAverage Number of Medical Social Visits Per Episode Non LUPATotal HHA Charge Amount Non LUPATotal HHA Medicare Payment Amount Non LUPATotal HHA Medicare Standard Payment Amount Non LUPAOutlier Payments Percent of Medicare Payment Amount Non LUPATotal Episodes LUPATotal HHA Medicare Payment Amount for LUPAsAverage AgeMale BeneficiariesFemale BeneficiariesNondual BeneficiariesDual BeneficiariesWhite BeneficiariesBlack BeneficiariesAsian Pacific Islander BeneficiariesHispanic BeneficiariesAmerican Indian Or Alaska Native BeneficiariesOther Or Unknown BeneficiariesAverage HCC ScorePercent of Beneficiaries with Atrial FibrillationPercent of Beneficiaries with AlzheimersPercent of Beneficiaries with AsthmaPercent of Beneficiaries with CancerPercent of Beneficiaries with CHFPercent of Beneficiaries with Chronic Kidney DiseasePercent of Beneficiaries with COPDPercent of Beneficiaries with DepressionPercent of Beneficiaries with DiabetesPercent of Beneficiaries with HyperlipidemiaPercent of Beneficiaries with HypertensionPercent of Beneficiaries with IHDPercent of Beneficiaries with OsteoporosisPercent of Beneficiaries with Rheumatic Arthritis OsteoarthritisPercent of Beneficiaries with SchizophreniaPercent of Beneficiaries with Stroke
17008JEFFERSON COUNTY HOME CARE2201 ARLINGTON AVENUEBESSEMERAL350201335411.67.42.10.00.02.20.03818702545042985750.0311054666203448.00.00.00.02.280.074070000000000010.20370.185190000000000020.129630.314810.444439999999999950.166670.185190000000000020.574070.444439999999999950.29630.00.481480.277780.07407000000000001
17009ALACARE HOME HEALTH & HOSPICE2970 LORNA ROADBIRMINGHAMAL3521612879661618.99.24.91.10.33.20.23532255731341021391001350.4129341813975245741595077.01539.05495.01034.033.033.02.260.195740.322850.403109999999999970.142990.450730.549430.383160.393890.451180.674270.564390.132859999999999980.646310.05230.12757000000000002
17013GENTIVA HEALTH SERVICES1239 RUCKER BLVDENTERPRISEAL36330123661223.48.56.63.80.54.10.04959795351920245648240.8631951476228384459.0153.0514.081.00.015.01.980.179740.312090000000000030.356209999999999970.125820000000000020.374180.464050.325160.382350.452610.661760.511440.165029999999999980.671570.0522899999999999960.12745
17014AMEDISYS HOME HEALTH68278 MAIN STREETBLOUNTSVILLEAL3503168540321.48.26.63.11.32.10.12839579190681324326770.2742166475135268293.0110.0392.00.02.180.18610.39950.379650.084370.488830000000000040.523570.364760.468980.444170.60793999999999990.545910.129030.67246000000000010.086850.1737
17016SOUTHEAST ALABAMA HOMECARE804 GLOVER AVENUEENTERPRISEAL3633068536215.58.54.22.40.20.10.13769291160467520977220.0561627875151211242.0120.0291.063.02.010.196130.281769999999999960.419890.13260.447510.54143999999999990.403310.359120.524860.69336999999999990.582870.149170.607730.0524899999999999950.15192999999999998
17018GENTIVA HEALTH SERVICES3225 RAINBOW STREET, SUITE 256RAINBOW CITYAL359062925120620.08.67.11.90.42.00.110726327766531299321140.21544546675432774823.0383.01121.068.02.310.17910.369820.473470.112770000000000010.48010.52570.451080000000000040.413760.485070.601160.57960.120229999999999990.674130.077110.16418
17020AMEDISYS HOME HEALTH CARE273 AZALEA ROAD, SUITE 204, BLDG 2MOBILEAL36609139983915.58.33.51.40.81.10.44197214317047840215130.71815915276295544673.0166.0639.0180.02.090.259830.330150.344460.140640000000000020.486289999999999940.533970.320619999999999960.272940.448150.669850.604290.115609999999999990.512510.059590.13707
17024SOUTHEAST ALABAMA HOMECARE810 HEDSTROM DRIVE, SUITE ONEDOTHANAL36301166795817.78.75.72.10.80.50.110045509417333255062000.41815375675369589604.0354.0663.0278.00.02.310.215030000000000030.295410.340290.139870.409190.568890.307930000000000040.359080.511480.726510.538620.15240.648230.062629999999999990.13779
17025SAAD HEALTHCARE1515 UNIVERSITY BLVD, SOUTHMOBILEAL366092496126318.78.45.62.70.81.10.17858814631557580778640.62678425575521742978.0285.0835.0403.013.02.450.207440.378460.31750.131430.446560.54236000000000010.300080.328580000000000040.462389999999999970.60570.539190.155980.55740.0554200000000000040.13143
17026GENTIVA HEALTH SERVICES2200 RIVERCHASE PARKWAY, BUILDING 700BIRMINGHAMAL35244172892822.98.17.93.10.73.10.16992870548375164601640.31425008677320608759.0169.0598.0319.00.02.370.183190000000000020.417030.351290.136850.399780.549570.311420.406250.463360000000000050.709050.530170.157330.700430.076510000000000010.13362000000000002