Identifying types of nursing facility stays using medicare claims data: an algorithm and validation

Abstract

Nursing facilities provide skilled nursing and rehabilitative care to patients for short stays and custodial care to patients for long stays. The type of nursing facility stay (short-or long-term) is a potentially important risk factor and health outcome in health services research and is informative from both medical and fiscal perspectives. The purpose of this study was to develop and validate an algorithm to identify the use of nursing facility services and differentiate short-from long-term care using Medicare claims data. We used claims data for a 5% sample of Medicare beneficiaries to develop an algorithm to detect the use of nursing facility services and to distinguish between short-and long-term stays. We tested this algorithm using residency status from Medicaid long-term care claims for dually eligible beneficiaries and using residency status from the Medicare Current Beneficiary Survey (MCBS). Among 1,694,051 beneficiaries included in the baseline cohort, 25.6% had some indication of nursing facility residency. Using our algorithm, 59.8% of beneficiaries using any nursing facility care were classified as long-term residents. Validation of the algorithm against Medicaid long-term care claims and MCBS yielded high sensitivity and specificity. To our knowledge, this is the first paper to present a

Algorithm for Identifying Nursing Home Days Using Medicare Claims and Minimum Data Set Assessment Data

“…Moreover, similar lengths of NH stay and characteristics were observed between the long-stay residents identified by these 2 approaches. Although the method using Medicare parts A and B data identified a high proportion 16 study using Medicare parts A SNF/B claims data broadly categorized the long-stay residents based on the presence of any part B evidence in a month followed by at least 3 NH months. The Yun and colleagues' approach had 2 major limitations that might lead to the misclassification of NH residents.…”

“…The MDS-only evidence of NH days was determined solely by MDS admission (either reported or imputed) and discharge dates; residents with Z101 days were considered long-stay residents. 6 For NH evidence from Medicare parts A and B data, an algorithm developed by Yun et al 16 (2) at least 3 months with confirmatory NH evidence (either from part A SNF or part B claims data) after their first observed long-stay month. Any SNF claims shown after the initial long-stay month were not treated as evidence of short stay.…”

“…16 Yun and colleagues used Medicare parts A and B claims data and found that over half of the beneficiaries (59.8%) met long-stay criteria. However, the use of Medicare administrative data alone is fraught with difficulties.…”

Obesity and 1-Year Outcomes in Older Americans With Severe Sepsis*

“…Because Medicare does not pay for long-term custodial care provided by nursing facilities, patients residing in a nursing home on a permanent basis cannot be identified on a daily basis through MedPAR records(38, 39). Thus, while our results accurately count inpatient facility care funded by Medicare, they are conservative with respect to total service use.…”

Quality of Care and Racial Disparities in Medicare Among Potential ACOs

“…We also limited our study to beneficiaries classified as black or white in Medicare enrollment files, because other racial and ethnic groups were not as reliably identified by these administrative data. 21,22 Finally, we excluded residents of US territories as well as longterm nursing home residents identified by a validated algorithm 23 to limit provider organizations to those providing outpatient primary care services (the basis for beneficiary attribution to provider groups).…”