Introduction

Emergency department (ED) utilization serves as a foundational metric across health services research. Because ED visits are high-cost and high-intensity, the identification of these events is critical for measurement and evaluation of healthcare quality(1). Health researchers rely heavily on administrative datasets like Medicare claims to do this work. Because there are multiple conceptual frameworks for measuring utilization within administrative datasets, navigating these records requires careful methodological consideration.

Introduction

When analyzing data for research, it is sometimes necessary to code time windows. In this article we present several examples of programming common administrative healthcare data analytics that involve time in SAS.

Download Article

A dummy table is a planning tool that approximates data structure. They serve as a practical method of organizing thoughts and expectations before working with data. For analysts, it can take many forms, such as a dataset, a summary table, or even visual chart formats. It can even be an empty box.

There is no correct way to create or use dummy tables, but I would like to share some examples of how I’ve used them to plan and refine analytic work. Maybe they will inspire you to give it a try!

Background

Medicare beneficiaries may enroll in a private managed care plan (Medicare Advantage (MA)) or in Fee-for-Service (FFS) Medicare (Original Medicare). The Master Beneficiary Summary File (MBSF) includes all beneficiaries enrolled in Medicare for at least one day of the year and contains variables that distinguish MA from FFS enrollment(1). Medicare Research Identifiable Files (RIFs) that contain utilization data include only subsets of beneficiaries depending upon how they are enrolled.

The Provider ID and TAF APR

Provider IDs are state-reported variables, meaning that states can include their own provider numbers when submitting records to T-MSIS. In the TAF data, these numbers are delineated by variables with a specific Provider ID suffix. These identifiers can serve as an alternative form of linkage to the TAF APR, which contains Medicaid provider characteristics.

Background

The TAF Pharmacy files (TAF RX) are a CMS Research Identifiable File (RIF) that contains pharmacy prescription fill and over the counter (OTC) drug information covered by Medicaid. They are sourced from the T-MSIS, which is a repository of service utilization and reimbursement records from state Medicaid agencies. This file contains multiple record types including fee-for-service, when the state reimburses providers for services they provide, and managed care, when the state works with a health plan to administer Medicaid services.

What are Professional and Technical Components and Why Do They Matter?

Professional and technical components are HCPCS modifiers that splits Medicare payment into supervision/interpretative and equipment/facility costs. This allows separate entities to bill for their portion of a service. For example, one facility may manage diagnostic testing while a physician or other health care provider handles interpretation(1). This can also apply in situations where an independent diagnostic facility has two different service locations(2).

The combination of PROC FORMAT and PROC FREQ can be used to quickly identify missingness, or values that are invalid or not present, in data. Straightforward logic and low line count make this code digestible for both new and experienced SAS programmers.