Examining Medicare Advantage Encounter Data Quality
Author Information
Author(s): Yun Hyunkyung, Kosar Cyrus
Primary Institution: Brown University
Hypothesis
How well do Medicare Advantage encounter data capture post-acute care utilization?
Conclusion
The study found that while the match rates for skilled nursing facility and home health encounter records have improved, there is still significant variability and a need for quality improvement.
Supporting Evidence
- In 2019, 82% of MDS assessments matched to SNF encounter records, up from 75% in 2016.
- 63% of OASIS assessments matched to HH encounter records, an increase from 52% in 2016.
- There was substantial variation in match rates across different MA contracts.
Takeaway
This study looked at how well Medicare Advantage data shows what happens after hospital stays, and found that it’s getting better but still needs work.
Methodology
The study assessed Medicare Advantage encounter data by matching Minimum Data Set and Outcome and Assessment Information Set assessments to skilled nursing facility and home health encounter records.
Limitations
The study may not fully capture the quality of encounter data outside of the acute care setting.
Digital Object Identifier (DOI)
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