Frequently Asked Questions about the Medicare HOS

Where can I obtain copies of the HOS survey questionnaire?

Copies of the HOS and HOS-Modified (HOS-M) survey instruments may be downloaded from the Survey Instrument section of the HOSonline.org (HOS) Web site. In addition, the HOS and HOS-M questionnaires may also be found in the corresponding NCQA HEDIS, Volume 6 Specifications for the Medicare Health Outcomes Survey manuals, which may be purchased by calling the NCQA Customer Support Telephone Line at 1-888-275-7585 or via NCQA's Secure Online Order Center (www.ncqa.org).

How will I know when the HOS reports are available?

The HOS program and administration timelines are posted on the HOS Web site on the Program Timeline and Program Overview sections to provide a reasonable estimate of when the HOS reports will be completed and ready for distribution each year. The approved users for CMS' Health Plan Management System (HPMS) at your MAO will receive an announcement through HPMS of the availability of the reports. If you do not have an HPMS User ID, you may contact your organization's CMS Quality Point of Contact to access the reports. Fee-for-Service (PFFS) plans and Regional Preferred Provider Organizations (RPPOs) are excluded from any state or regional measures in the reports, although they are included in the national HOS numbers.

How can MAOs obtain their HOS reports?

All HOS report distribution (HOS and HOS-M) occurs electronically to participating Medicare Advantage Organizations (MAOs) and PACE Organizations through HPMS. For individual MAOs and PACE Organizations to access their HOS reports, an HPMS User ID is required. If you do not have an HPMS User ID, you may contact your organization's CMS Quality Point of Contact to obtain access to the reports. If assistance is required regarding HPMS access, you may contact CMS via e-mail at hpms_access@cms.hhs.gov. The most recent sample reports are available in the Overview portion of the Publications section.

What does it mean if my MAO has been identified as an “outlier” in a HOS Performance Measurement Report?

Outliers are MAOs that performed significantly better (i.e., better than expected) or significantly worse (i.e., worse than expected) when compared to the national average. The national average is based on all MAOs that participated in performance measurement. MAOs can be outliers on a measure of physical health (which is based on death and the VR-12 Physical Component Summary score), or on a measure of mental health (which is based on the VR-12 Mental Component Summary score). Additional information is available in the Methodology section of the Performance Measurement report. A sample Performance Measurement report is available for download from the Overview part of the Publications section.

Where can I obtain ideas for quality improvement activities based upon the HOS results for my MAO?

The Medicare HOS Web site contains a section entitled “Real World” Uses of HOS Data to assist MAOs in obtaining ideas for quality improvement initiatives. The HOS Publications section is an excellent source of journal articles and technical reports that use HOS data. For example, the resource “Opportunities for Improving Medicare HOS Results through Practices in Quality Preventive Health Care for the Elderly” is available to help MAOs develop and apply strategies that address the HOS items used in the CMS Medicare Advantage Part C Star Ratings. The literature review “Functional Status in Older Adults: Intervention Strategies for Impacting Patient Outcomes” is a synthesis of selected articles of functional status outcomes in older adults and is designed to supplement the resource guide. In addition, the “Featured Uses of HOS Data” section in the Reader's Guide of each HOS report contains suggestions for using HOS data to target quality improvement strategies. Examples of the most recent reports are available in the Overview portion of the Publications section.

Is there any training available to assist MAOs in understanding how to use their HOS Reports?

Two self-paced training webinars are available in the “Real World” Uses of HOS Data section. The first webinar in the series entitled “Introduction to the Medicare Health Outcomes Survey (HOS)” is a basic training session that provides an overview of the HOS; describes how MAOs may obtain HOS reports, data sets, and Data User's Guides; and discusses additional available resources. The second in the series of webinars entitled “Getting the Most from Your Medicare Health Outcomes Survey (HOS) Baseline Report” is an intermediate level training session that discusses how to maximize the use of the HOS baseline report to provide information on the health of beneficiaries and to develop chronic care improvement programs (CCIPs). Watch for upcoming training sessions in this section.

What HOS data sets are available to the MAOs?

The data files distributed to the MAOs are the analytic data sets, which contain the data for a completed cohort (combined baseline and two year follow up). These data sets are available after the distribution of the Performance Measurement Reports. Additional information about the data sets that have been distributed to the MAOs, may be found in the Data Dissemination section on the HOS Web site.

How do I obtain the HOS data sets for my MAO?

An announcement of the availability of the new cohort data is sent to the participating MAOs through the HPMS. Contact the HOS team via email at hos@azqio.sdps.org to request your data. MAO data sets will be formatted as Comma Separated Value (CSV) files that are accessible with MS Excel. The data will be sent on CD to the designated recipient (one per company) within approximately two to three weeks of the request. Documentation for the data file will be included on the CD. Data are encrypted in a self-extracting file using the Pointsec Media Encryption Technology. The recipient must call the HOS team after the CD arrives to get the encryption password (1-888-880-0077).

How can QIOs obtain their state's reports?

The HOS reports for QIOs are distributed through CMS' QualityNet application, as well as through the HPMS. For those QIOs that do not have any participating MAOs in their state, a sample state-level HOS report is distributed to provide information about HOS activities. The sample QIO report contains example state-level data only; however, all references to the HOS Total reflect actual national-level data.

What data sets are available to the QIOs?

Beneficiary level data files in a SAS^® format are provided to the QIOs following the distribution of both Baseline and Performance Measurement Reports. The QIOs receive state-level HOS data for all MAOs within their state, including survey respondents, non-respondents, and those identified as ineligible. Fee-for-Service (PFFS) plans and Regional Preferred Provider Organizations (RPPOs) are excluded from the QIO data files. SAS^® is a registered trademark of the SAS Institute Inc., Cary, NC.

What types of data sets are available to researchers?

Three basic types of data sets are available to researchers: Public Use Files (PUFs), Limited Data Sets (LDS) and Research Identifiable Files (RIFs). The PUFs have been constructed so that all the beneficiary identifying information, including the Medicare Health Insurance Claim (HIC) numbers, Social Security Numbers (SSN), name and address fields have been removed. In addition, some demographic fields such as race and age are aggregated to prevent identification of any individuals.

There are two types of PUFs, baseline and analytic. Analytic PUFs contain a completed cohort of data for all baseline correspondents and are constructed to be self-contained with a baseline and follow up component for each beneficiary's record. There is no field that allows identification of a particular individual across the cohorts in the analytic PUFs. Baseline PUFs have been constructed with a unique anonymous ID field that does allow identification of the same individual across multiple baseline cohorts.

LDSs and RIFs are comprised of the entire national sample for a given cohort (including both respondents and non-respondents), and contain all of the HOS survey items, the physical and mental health summary scores, as well as plan identifiers and additional variables describing the plan's characteristics. They also contain protected beneficiary-level health information such as date of birth. However, there are differences between the two types of data sets. For example, the specific direct person identifiers (i.e., name, address, Medicare Health Insurance Claim [HIC] number, and Social Security Number) are included in the RIFs and allow identification of the same individual across multiple cohorts; however, these identifiers are excluded in the LDSs. For more information, go to the Research Data section.

How can I obtain the research files?

The PUFs are available for download on the HOS Web site. A signed Data Use Agreement with CMS is required to obtain either LDS or RIF data files. A small fee is assessed for each cohort of data. The Research Data Assistance Center (ResDAC) at the University of Minnesota is a CMS contractor that provides assistance to academic, government and non-profit researchers interested in using Medicare and/or Medicaid data. ResDAC is available to assist in the completion and/or review of data requisition forms for Medicare HOS research data files prior to their submission to CMS. For additional information and assistance with obtaining Medicare HOS LDS and RIF files, please visit the ResDac Medicare HOS Web page at http://www.resdac.org/OtherDataSets/HOS.asp. ResDAC may also be contacted by calling 1-888-9RESDAC (1-888-973-7322) between the hours of 8:00 a.m. to 4:30 p.m. CST Monday through Friday or by e-mailing resdac@umn.edu.

Where can I obtain information about the CMS MA Part C Five Star Quality and Performance Ratings System?

For information about the HOS results included in the MA Part C Star Ratings System, you may go to the Survey Results section of the HOS Web site and to the Survey Administration Timeline table on the Program Overview section. Additional information is available on the CMS Web site at www.cms.gov/PrescriptionDrugCovGenIn/06_PerformanceData.asp. For any questions related to Part C MA Star Ratings, you may send an e-mail inquiry directly to PartCRatings@cms.hhs.gov. Part D MA Star Rating questions may be sent to PartDRatings@cms.hhs.gov.