Skilled Nursing Facility Utilization and Payment Data 2016

$179 / year

This dataset provides information on services provided to Medicare beneficiaries residing in skilled nursing facilities. The Skilled Nursing Facility Public Use File contains information on utilization, payment (allowed amount, Medicare payment and standard payment), submitted charges, and beneficiary demographic and chronic condition indicators organized by Centers for Medicare and Medicaid Services (CMS) Certification Number, Resource Utilization Group (RUG), and state of service.

Complexity

This dataset is created annually and contains dozens of variables that describe the characteristics of institutional Medicare providers. The primary data source for theis dataset is CMS’s Chronic Conditions Data Warehouse (CCW). The CCW Part A and Part B data files contain 100 percent of Medicare final action claims for beneficiaries who are enrolled in the Fee-For-Service (FFS) program. The CCW Part A institutional claims and revenue center files, restricted to claims where the claim type code was “20” or “30” indicating that the claim was a Skilled Nursing Facility claim, were used to create the Skilled Nursing Facility Public Use File (PUF). The Skilled Nursing Facility PUF also includes information on the amount of therapy provided to patients who are categorized into two specific Resource Utilization Group (RUG), the RV (Very-high Rehab) and RU (Ultra-high Rehab) categories.

The data source for this data is the 2015 Long-Term Care Minimum Data Set 3.0 (MDS). The MDS is a standardized, primary screening and assessment tool of health status which forms the foundation of the comprehensive assessment for all residents (regardless of payer) of long-term care facilities certified to participate in Medicare or Medicaid. The MDS contains items that measure physical, clinical, psychological, psychosocial functioning, and life care wishes. Provider demographics are also incorporated into the Skilled Nursing Facility PUF including name and complete address from the CMS Provider of Services (POS) file.

Date Created

2018-10-10

Last Modified

2019-05-02

Version

2019-05-02

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

Skilled Nursing Facility, SNF Payment, SNF Charges, Skilled Nursing Facility Data 2016, Nursing Utilization and Payment Data, Skilled Nursing Facility PUF

Other Titles

Medicare Skilled Nursing Facility Utilization and Payment Data 2016, Skilled Nursing Facility Payment Amounts 2016

NameDescriptionTypeConstraints
Provider_IDThe 6-digit identification number for the SNF on the claim.integerlevel : Nominal
Facility_NameThe SNF name, as reported in the POS file.string-
StreetAddress of SNF providerstring-
CityThe city where the SNF is located, as reported in the POS filestring-
State_AbbreviationThe state where the SNF 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_CodeThe SNF’s zip code, as reported in the POS file.integerlevel : Nominal
Total_StaysTotal count of stays provided by an SNF in the calendar year.integerlevel : Ratio
Distinct_Beneficiaries_Per_ProviderNumber of distinct Medicare beneficiaries with a least one SNF stay or SNF day in the calendar year. Beneficiaries may have more than one SNF stay or day per year but are only counted once in this field per row, however they may be double-counted across providers or RUGs. Therefore, this column will not sum to a total count of unique beneficiaries.integerlevel : Ratio
Average_Length_of_Stay_DaysAverage length of stay, in days.numberlevel : Ratio
Total_SNF_Charge_AmountTotal charges that the SNF submitted for stays.number-
Total_SNF_Medicare_Allowed_AmountTotal of the Medicare allowed amount for stays; this figure is the sum of the amount Medicare pays, the deductible and coinsurance amount that the beneficiary is responsible for paying, and any amounts that a third party is responsible for paying.number-
Total_SNF_Medicare_Payment_AmountTotal amount that Medicare paid for the SNF stays after deductible and coinsurance amounts have been deducted.number-
Total_SNF_Medicare_Standard_Payment_AmountTotal amount that Medicare paid for SNF stays adjusted for geographic differences in payment rates.number-
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 beneficiaries.integerlevel : 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 year.integerlevel : 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 American beneficiaries.integerlevel : Ratio
Asian_Pacific_Islander_BeneficiariesNumber of Asian Pacific Islander beneficiaries.integerlevel : Ratio
Hispanic_BeneficiariesNumber of Hispanic beneficiariesintegerlevel : Ratio
American_Indian_Or_Alaska_Native_BeneficiariesNumber of American Indian or Alaska Native beneficiariesintegerlevel : Ratio
Other_Or_Unknown_BeneficiariesNumber of beneficiaries with race not elsewhere classified.integerlevel : Ratio
Average_HCC_ScoreAverage Hierarchical Condition Category (HCC) risk score of beneficiaries.numberlevel : Ratio
Percent_of_Beneficiaries_With_Atrial_FibrillationPercent of beneficiaries meeting the CCW chronic condition algorithm for atrial fibrillation.numberlevel : Ratio
Percent_of_Beneficiaries_With_AlzheimersPercent of beneficiaries meeting the CCW chronic condition algorithm for Alzheimer’s, related disorders, or dementia.numberlevel : Ratio
Percent_of_Beneficiaries_With_AsthmaPercent of beneficiaries meeting the CCW chronic condition algorithm for Asthma.numberlevel : Ratio
Percent_of_Beneficiaries_With_CancerPercent of beneficiaries meeting the CCW chronic condition algorithms for cancer. Includes breast cancer, colorectal cancer, lung cancer and prostate cancer.numberlevel : Ratio
Percent_of_Beneficiaries_With_CHFPercent of beneficiaries meeting the CCW chronic condition algorithm for heart failure.numberlevel : Ratio
Percent_of_Beneficiaries_With_Chronic_Kidney_DiseasePercent of beneficiaries meeting the CCW chronic condition algorithm for chronic kidney disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_COPDPercent of beneficiaries meeting the CCW chronic condition algorithm for chronic obstructive pulmonary disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_DepressionPercent of beneficiaries meeting the CCW chronic condition algorithm for depression.numberlevel : Ratio
Percent_of_Beneficiaries_With_DiabetesPercent of beneficiaries meeting the CCW chronic condition algorithm for diabetes.numberlevel : Ratio
Percent_of_Beneficiaries_With_HyperlipidemiaPercent of beneficiaries meeting the CCW chronic condition algorithm for hyperlipidemia.numberlevel : Ratio
Percent_of_Beneficiaries_With_HypertensionPercent of beneficiaries meeting the CCW chronic condition algorithm for hypertension.numberlevel : Ratio
Percent_of_Beneficiaries_With_IHDPercent of beneficiaries meeting the CCW chronic condition algorithm for ischemic heart disease.numberlevel : Ratio
Percent_of_Beneficiaries_With_OsteoporosisPercent of beneficiaries meeting the CCW chronic condition algorithm for osteoporosis.numberlevel : Ratio
Percent_of_Beneficiaries_with_Rheumatiod_Arthritis_OseoarthritisPercent of beneficiaries meeting the CCW chronic condition algorithm for rheumatoid arthritis/osteoarthritis.numberlevel : Ratio
Percent_of_Beneficiaries_With_SchizophreniaPercent of beneficiaries meeting the CCW chronic condition algorithm for schizophrenia and other psychotic disorders.numberlevel : Ratio
Percent_of_Beneficiaries_With_StrokePercent of beneficiaries meeting the CCW chronic condition algorithm for stroke.numberlevel : Ratio
Provider IDFacility NameStreetCityState AbbreviationZip CodeTotal StaysDistinct Beneficiaries Per ProviderAverage Length of Stay DaysTotal SNF Charge AmountTotal SNF Medicare Allowed AmountTotal SNF Medicare Payment AmountTotal SNF Medicare Standard Payment AmountAverage 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 Rheumatiod Arthritis OseoarthritisPercent of Beneficiaries With SchizophreniaPercent of Beneficiaries With Stroke
10022CHEROKEE MEDICAL CENTER400 NORTHWOOD DRCENTREAL35960968312.633592384494624319135438647928556221822.060.2539490.146369463958690.14.00.14
10034COMMUNITY HOSPITAL INC805 FRIENDSHIP ROADTALLASSEEAL36078938311.9134729442698542247752161980295467166418.02.280.2934540.136372583054690.2364.04.00.28
10044MARION REGIONAL MEDICAL CENTER1256 MILITARY STREET SOUTHHAMILTONAL3557016415012.549310538182408084191006516785793108421441.740.1839410.134754393845480.2163.05.00.13
10045FAYETTE MEDICAL CENTER1653 TEMPLE AVENUE NORTHFAYETTEAL3555512612115.928876318632938525131061525794873903110416.01.980.2337520.14556349364260.0600.186.00.19
10058BIBB MEDICAL CENTER208 PIERSON AVECENTREVILLEAL35042867018.615811186628245789576888347724464624592.10.2349360.09515734436073.0470.1664.07.00.09
10059LAWRENCE MEDICAL CENTER202 HOSPITAL STREETMOULTONAL35650615511.88649212082672069792610677614413817521.480.233350.11566036564775.0670.110.16
10069MEDICAL CENTER BARBOUR820 W WASHINGTON STEUFAULAAL36027636016.010805172985692855283626398122384416501.790.2533300.134065324550500.2567.05.00.25
10073CLAY COUNTY HOSPITAL83825 HIGHWAY 9 P O BOX 1270ASHLANDAL36251686410.39643321911011762892274307925394321601.760.2334450.165856454555630.0956.05.00.16
10086NORTHWEST MEDICAL CENTER1530 U S HIGHWAY 43WINFIELDAL35594827610.431527512786732715893427517829475323732.290.3222450.08627243365364.0570.1251.04.00.07
10095HALE COUNTY HOSPITAL508 GREEN STREETGREENSBOROAL36744847615.776338753318351998164853276274938382254.01.950.1436410.17537441265563.0500.0313.00.14