Medicare Health Outcomes Survey-Modified Overview

Introduction to Medicare HOS-M

The Medicare Health Outcomes Survey-Modified (HOS-M) was fielded for the first time in the spring of 2005. Originally entitled the Program of All-Inclusive Care for the Elderly (PACE) Health Survey, the HOS-M is administered by CMS to vulnerable Medicare beneficiaries at greatest risk for poor health outcomes. These beneficiaries are enrolled in PACE Organizations.

The HOS-M is a modified version of the Medicare HOS. Similar to the HOS, the HOS-M design is based on a randomly selected sample of individuals from each participating PACE Organization. The HOS–M is a cross–sectional survey, measuring the physical and mental health functioning of beneficiaries at a single point in time. This differs from the HOS, which has a follow-up component.

One of the main goals of the HOS-M is to assess annually the frailty of the population in these health plans in order to adjust plan payments. Initial eligibility for payment purposes is based on community-residing members who do not have end-stage renal disease (ESRD) and are age 55 or over.

Note that the Minnesota Senior Health Options, Minnesota Disability Health Options, Wisconsin Partnership Program, and Massachusetts MassHealth Senior Care Options transitioned from Medicare dual eligible demonstration status into the Medicare Advantage program in 2008. As a result, frailty adjusted payment rates for these Special Needs Plans (SNPs) are being phased out after 2010. Starting in 2010, these SNPS are required to participate in HOS as part of CMS' standard Medicare Advantage reporting requirements. PACE Organizations will continue to participate in HOS-M and receive frailty-adjusted payments based on the survey data collected.

Medicare HOS-M Program Timeline

A random sample of Medicare beneficiaries is drawn annually from each participating plan and surveyed in the spring. Members (1,200) are randomly selected for HOS-M if the plan has a population of at least 1,400 members. All eligible members are included in the sample for plans with populations of less than 1,400. The HOS-M timeline is similar to the Medicare HOS Program Timeline.

Program Activity	Timeframe
Survey Preparation, Administration, Data Cleaning
Finalize Survey Specifications	January
Train & Certify Vendors	February
Select Yearly HOS-M Sample	March
Prepare Vendor Materials	March
Field Yearly HOS-M Sample	April - June
Submit Raw Survey Data File	August - September
Test & Clean Data	September - November
Score Data	December
Data Management, Analysis and Dissemination
Aggregate Yearly HOS-M Data	January - February
Produce Yearly HOS-M Report	March - May
Disseminate HOS-M Report	Summer
Produce Yearly HOS-M Data File & Data User's Guide	Summer
Distribute HOS-M data to participating plans	Fall/Early Winter

The Medicare HOS Glossary of HOS and HOS-M related terms is available for download.

HOS-M Instrument

The Medicare HOS-M contains the following core components:

the Veterans RAND 12 Item Health Survey (VR-12)
Activity of Daily Living (ADL) items

The HOS-M instrument is a shorter, modified version of the Medicare Health Outcomes Survey and contains 6 ADL items as the core items used to calculate the frailty adjustment factor. The survey also includes 12 physical and mental health status questions from the VR-12. In addition, the HOS-M includes questions about the following: lifting or carrying objects as heavy as 10 pounds; walking a quarter mile; health or physical problems interfering with daily activities, receiving help with ADLs; physical and emotional health compared to one year ago; memory loss; urinary incontinence; and a question on whether the survey was self-completed or completed by a proxy. If the participant received assistance completing the survey, the respondent was asked information about the proxy respondent. For informational purposes, a copy of the HOS-M instrument is available for download from the Survey Instrument section.

Dissemination of HOS-M Results to Plans

After each yearly administration of the Medicare HOS-M, a plan specific report is produced and is available for each PACE Organization participating in the survey. The HOS-M report presents physical and mental component summary scores, ADL items, and selected health status measures, for the frail, elderly Medicare beneficiaries for each organization compared to the entire HOS-M sample. A sample PACE Report (PDF, 841 KB) is available for download.

The corresponding beneficiary level data for a report are disseminated to all participating plans. In addition to the data files, each plan is provided with a data user's guide that describes the Medicare HOS-M file specifications and the appropriate use of Medicare HOS-M data.

Medicare HOS-M Survey Status Information

DATA COLLECTION YEAR	DATE FIELDED	POPULATION	PLANS	SAMPLE SIZE	INELIGIBLE SURVEYS¹	COMPLETED SURVEYS²	RESPONSE RATE³
2007	April 2007	PACE/SNP	52	23,682	2,861	16,200	77.8%
2008	April 2008	PACE/SNP	52	25,194	3,236	16,360	74.5%
2009	April 2009	PACE/SNP	58	26,743	3,285	17,396	74.2%
2010	April 2010	PACE	58	14,366	1,471	9,652	74.9%
2011	April 2011	PACE	68	16,226	1,646	9,915	68.0%

Updated August 2012

1 Ineligible beneficiaries meet one of the following criteria: deceased; not enrolled in the health plan; have an incorrect address and phone number; or have a language barrier.
2 A completed survey is defined as a survey that can be used to calculate physical or mental health summary scores.
3 Please note, ineligible beneficiaries are removed from the denominator in the response rate calculations. In other words, Response Rate = [Number of Respondents/(Total Sample - Ineligibles)].

Availability of Reports and Data

All distribution of HOS-M reports occurs electronically to participating PACE Organizations through the CMS Health Plan Management System (HPMS). Plans are alerted of report availability through HPMS. If assistance is required, regarding HPMS access, please contact CMS via e-mail at hpms_access@cms.hhs.gov. Following HPMS notification that the data are available, a plan may contact the Medicare HOS Information and Technical Support Line to request their data and data user's guide.

Complete information about the dissemination and availability of Medicare HOS-M reports and data to plans is available in the table below. The HOS-M Data User’s Guides are available for download from the table.

HOS-M Data Collection Year	Report	Data	Data User's Guide
2007	March 23, 2009¹	March 9, 2009²	2007 PDF, 646 KB
2008	Sept 30, 2009¹	Oct 30, 2009²	2008 PDF, 387 KB
2009	Oct 5, 2010¹	Sept 14, 2010²	2009 PDF, 651 KB
2010	Aug 23, 2011 ¹	July 15, 2011²	2010 PDF, 412 KB
2011	Aug 10, 2012 ¹	Aug 10, 2012²	2011 PDF, 457 KB

¹ Reports made available electronically to plans via HPMS
² Plans notified of availability of data