Approaches to Identify Nursing Home Specialists Using Medicare Claims Data

Area of Science:

• Health Services Research
• Geriatric Medicine
• Health Informatics

Background:

• Physicians and advanced practice clinicians specializing in nursing homes (NHs) are increasingly common.
• Access to comprehensive data for identifying NH specialists can be restricted by data purchase requirements.

Purpose of the Study:

• To compare the concordance of two alternative methods for identifying NH specialists against a standard approach using Medicare Data on Provider Practice and Specialty (MD-PPAS).
• To evaluate the feasibility of using publicly available Medicare Part B and Part D data for NH specialist identification.

Main Methods:

• Analysis of yearly cross-sections of clinician data from 2016 to 2020.
• Inclusion of physicians and advanced practice clinicians with at least one Medicare-paid service to NH residents and 100 total services annually.
• Classification of NH specialists as clinicians providing ≥90% of annual services to NH residents.

Main Results:

• NH specialists represented 15.4% in MD-PPAS, 18.9% in Part B data, and 2.8% in Part D data.
• The Part B approach demonstrated higher concordance with MD-PPAS (sensitivity 71.8%, specificity 99.7%) compared to the Part D approach (sensitivity 39.4%, specificity 97.6%).

Conclusions:

• Significant discrepancies exist in identifying eligible clinicians and NH specialists across different data sources.
• The Medicare Part B approach offers a viable and cost-effective alternative to MD-PPAS for identifying NH specialists, particularly for researchers with limited financial resources.