Volcano Case Study Medicare

In 2013, the Centers for Medicare and Medicaid Services (CMS) took the unprecedented step of publishing data about more than 3,000 hospitals for the 100 most common inpatient procedures. One of our senior scientists, Elena Popovici, has analyzed this data and built a set of interactive data exploration tools.

Elena gave a presentation of the analysis and visualization methodology, as well as the intriguing insights, to a joint meeting of the Vancouver DataScience, R Users and Machine Learning meetup groups. Download the slides, play back the recordings, or explore using the interactive visualizations.  Have questions? Send us an email!

Slides & Recordings

 

Interactive Visualizations

Top 100 Medicare-Billed Diagnoses Across the US

Click on each of the plots below to see how our scientists and technology developers transform this data into interactive, actionable tools.  We hope these tools spark discussion that will help further progress toward increased data transparency in health care.

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Where Are Hospitals Needed?
Discover how Medicare-billed discharges for a diagnosis-related group (DRG) are distrbuted across the US and how this compares to the number of hospitals providing treatment for a DRG. See how this comparison changes when the states’ Medicare population is taken into account. View tool >>

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How Do States Compare in Providing Treatment?
Discover how different states compare with respect to number of Medicare discharges and number of hospitals providing treatment in relation to the states’ Medicare population. See which states have the most overall discharges per Medicare capita and which states stand out for the most psychoses or alcohol and drug abuse discharges. View tool >>

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How Are Specialized and Generalized Hospitals Distributed Across States?
Discover how many specialized and generalized hospitals are in each state. See which which diagnosis-related groups (DRGs) are treated in each type of hospital. See which states have no specialized hospitals. View tool >>

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How Are Specialized for Specific Diseases?
Discover the degree to which hospitals specialize in certain diagnosis-related groups (DRGs). See which generalized hospitals treat more than half of their discharges for psychoses. See what is the most prevalent DRG treated in a specialized hospital. View tool >>

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Case Studies

Learn how to address Medicare questions through these hypothetical case stories.

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Mrs. H does not have enough working quarters to qualify for premium-free Medicare Part A.

Problem:

Mrs. H is about to turn 65 and has never worked. She needs Medicare because it will be her primary insurer when she turns 65. Her husband, Mr. H, is 58 and retired. Mr. H worked in the United States for over 25 years. Because of his age, he is not yet eligible for Social Security benefits.

Read MoreMrs. B’s gynecologist did not accept assignment and refused to bill Medicare.

Problem:

Mrs. B’s gynecologist took Medicare but did not accept Medicare assignment. Doctors who do not take assignment do not have to accept Medicare’s approved amount as payment in full. They can charge up to 15% above the Medicare-approved amount for their services. They can also ask their patients to pay for services up front. Mrs. B was paying her gynecologist up front. Medicare had never reimbursed her for the service. Mrs. B called Medicare to find out why she had not been reimbursed and found out that her gynecologist had never submitted a bill to Medicare.

Read MoreMs. M wanted to know how COBRA will work with Medicare.

Problem:

Ms. M had an employer group health plan as her primary insurance and Medicare Part A as her secondary insurance. Ms. M was laid off and became eligible for COBRA through her employer. She wanted to know how COBRA works with Medicare.

Read MoreMr. N was eligible for a Part B Special Enrollment Period through his domestic partner.

Problem:

Mr. N is 50 years old and had Medicare Part A due to a disability. He declined to take Part B because he had his primary insurance through his domestic partner, who worked at a company with more than 100 employees. Recently, his domestic partner found a new job. When Mr. N tried to enroll in Medicare Part B, during his Part B Special Enrollment Period (SEP) Social Security told him he was not eligible for a Special Enrollment Period because his insurance came through a partner, not a spouse. He was also told that he would have to wait to enroll until the next General Enrollment Period (GEP), which goes from January through March of every year with coverage beginning in July.

Read MoreMr. B did not sign up for Medicare when he was first eligible.

Problem:

Mr. B turned 65 in December 2011 and retired from his job in August 2012. The month after he retired, a friend told him that he missed his chance to enroll in Medicare and would have to pay a big penalty.

Read MoreMedicare paid for Ms. B to have her teeth removed but would not pay for dentures.

Problem:

Ms. B has oral cancer and needs radiation therapy to treat it. Her teeth are not healthy, and her doctor wants take them out because they may become infected during the treatments. Her doctor told her she would need dentures before her radiation treatments so she could eat and maintain her health. Medicare covered the cost of removing her teeth but denied her coverage for her dentures. Ms. B could not afford to pay for them herself.

Read MoreMedicare mistakenly told Mr. S that he was entitled to a Part B Special Enrollment Period.

Problem:

Mr. S had health insurance under his wife’s retiree group health plan.

Mr. S enrolled in Medicare Part A when he turned 65 and was told by an 800-MEDICARE representative that he did not need to enroll in Part B at that time since his wife’s retiree plan sufficiently covered his needs. He assumed he could enroll in Part B without penalty when and if his wife’s retiree coverage ended.

When his wife’s retiree coverage ended, he tried to enroll in Part B. Social Security informed him that he would have to wait to enroll between January and March during the General Enrollment Period and be without Part B coverage until the following July. He would also have to pay a premium penalty for late enrollment.

Read MoreMs. Z needed more than 100 days of skilled nursing facility care.

Problem:

Ms. Z was a patient at a skilled nursing facility (SNF) for 100 days to treat a broken hip. She was discharged from the SNF after 100 days because she had run out of days in her benefit period. However, 20 days later she broke the other hip and was admitted to the hospital. She wants to know if Medicare would cover the SNF care she would need after she was discharged from the hospital.

Read MoreAfter being in a VA hospital, Mr. F wanted to transfer to a Medicare-certified facility.

Problem:

Mr. F has Original Medicare Parts A and B. He was in a Department of Veterans Affairs (VA) hospital. After three weeks in the hospital, he wanted to transfer to a Medicare-participating hospital closer to his home. Since VA facilities do not participate in Medicare, Mr. F did not know if the transfer would create any coverage problems.

Read MoreMedicaid mistakenly failed to pay Ms. B’s Medicare Part B premiums.

Problem:

Ms. B was receiving Supplemental Security Income (SSI) and had Medicaid when she became eligible for Medicare. A Medicare representative told her that Medicaid would automatically enroll her into a Medicare Savings Program (MSP) and that the program would pay her Part B premiums. However, six months later, she received a letter from Social Security informing her that her Part B benefits had been terminated because of non-payment of her premiums.

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