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Health Status Monitoring

On January 1, 2011, the Centers for Medicare & Medicaid Services (CMS) launched the first phase of the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program in nine different areas of the country. In order to protect the interests of potentially affected Medicare beneficiaries, CMS has been conducting real-time claims analysis to monitor health status for groups of Medicare beneficiaries in competitive bidding areas (CBAs). Health status results are shown in the files on this page. Each file includes a written summary of results and graphical displays of key indicators reflective of the health status of beneficiaries and their access to DMEPOS items and services. The data is derived from claims for Medicare populations in each CBA and a corresponding "comparator" region that is similar to the CBA. CMS initially published monthly updates to this information. Because the first full year of data indicated no change in beneficiary health status outcomes resulting from the competitive bidding program, CMS is now issuing quarterly updates. See the Downloads section below for the latest results.

NOTE: Beginning with public use files utilizing data through the third quarter of 2014, CMS has redefined access groups to include only beneficiaries with ICD-9 diagnosis codes that are considered highly related to product use. Prior to this update, access groups were defined using related condition categories (CCs) based on the CMS beneficiary risk adjustment model. Because Medicare makes periodic updates to its risk adjustment model, the ICD-9 diagnosis codes that are aggregated under a given CC can change over time. As a result, the CC-defined access groups may include ICD-9 diagnosis codes that are not as closely associated with product category usage. Redefining access groups using pre-specified sets of ICD-9 diagnosis codes, instead of CCs, allows CMS to remove these unrelated diagnoses and improve the accuracy of access groups. If you would like to reference how the access groups were previously defined, please view the archive folder below.