11 Healthcare Analytics & CMS.gov Data Tools

Center for Medicare & Medicaid Services

Data used in this chapter is from the Center for

“CMS is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children’s Health Insurance Program, and the Health Insurance Marketplace. CMS works in partnership with the entire health care community to improve quality, equity and outcomes in the health care system (cms.gov).

The CMS Data Explorer

The data.cms.gov website allows you to locate data for a wide range of contexts and uses. Download the data file for Medicare Inpatient Hospitals – by Provider and Service Information on hospital discharges from Original Medicare (fee-for-service) Part A (Hospital Insurance) beneficiaries by Inpatient Prospective Payment System (IPPS) hospitals; aggregated by provider and service.

“The Medicare Inpatient Hospitals by Provider and Service dataset provides information on inpatient discharges for Original Medicare Part A beneficiaries by IPPS hospitals. It includes information on the use, payment, and hospital charges for more than 3,000 U.S. hospitals that received IPPS payments. The data are organized by hospital and Medicare Severity Diagnosis Related Group (DRG).

Hospitals determine what they will charge for items and services provided to patients, and these charges are the amount the hospital bills for an item or service. The Total Payment Amount includes the DRG amount, claim per diem amount, beneficiary primary payer claim payment amount, beneficiary Part A (Hospital Insurance) coinsurance amount, beneficiary deductible amount, beneficiary blood deductible amount and diagnosis related group outlier amount.”

More About Medicare & Medicaid

This video allows you to learn more about the basics of health plans to understand more about the context of our data before we start working with it.

Analytics in Healthcare

Companies like VIE Healthcare Consulting assist healthcare systems to make better decisions using data. Here are some key ideas from this leading consulting firm from this space:

From VIE Healthcare, Consulting:

“Big data analytics holds many implications for healthcare providers. As the healthcare sector turns to new technologies such as artificial intelligence, machine learning, and Internet of Things device connectivity, big data may be the key to maintaining and improving your hospital or clinic’s patient experience. In addition, as patient outcomes standards continue to evolve, healthcare professionals must be able to utilize internal benchmarking, predictive analytics, and other big data indicators in a way that highlights a clear focus on patient satisfaction best practices. It’s best for your stakeholders and your patient experience alike.

Data analytics in healthcare is disrupting and transforming how organizations operate. The most successful hospitals gather, analyze, and act on their data to guarantee high-quality patient care and profitability. Analytic techniques can help healthcare facilities identify weaknesses, establish a more robust benchmarking process, spot opportunities for lower costs, and invest in scalability at the national level.”

What does an Analyst in Healthcare do?

This video is from a professional who describes what she has done in the field as an analyst in healthcare. Watch this to develop an understanding of the types of tasks you may be asked to complete at work.

Sample Questions

Answer the following questions using the file you download from Medicare Inpatient Hospitals – by Provider and Service Information on hospital discharges from Original Medicare (fee-for-service) Part A (Hospital Insurance) beneficiaries by Inpatient Prospective Payment System (IPPS) hospitals; aggregated by provider and service.

Let’s start with the context because having a general understanding of what we will find in the data will allow us to process it faster.

Warm-up QUESTIONS:

• What does the file name reveal? What do you think of the naming convention?
• What kinds of data do you expect to find in a file?
• Next, open the data file.  Is there a summary of info sheet?
• Is there a Data Dictionary? If it’s not included in the data file, where can you locate it?
• Do the field names make sense? What can you do if there is no data dictionary to be found?
• How much data is in the workbook: how many fields, records, cells with contents are there?
• What types of questions can you answer with the data?
• What functions do you know in Excel that will help you process data?

The next two pages will allow you to download and process data sets using common Excel functions.