CMS: Market Saturation and Utilization Data Tool

The Market Saturation and Utilization Data Tool was developed to allow the Centers for Medicare & Medicaid Services (CMS) to monitor market saturation as a means to help prevent potential fraud, waste, and abuse (FWA). Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of beneficiaries receiving that service in the area. The data can be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region. There are also a number of secondary research uses for these data, but one objective of making these data public is to assist health care providers in making informed decisions about their service locations and the beneficiary population they serve.

The tool includes interactive maps and datasets that show national-, state-, county-, and Core-Based Statistical Area (CBSA)-level provider services and utilization data for selected health service areas. Provider services and utilization data by these geographic regions are easily compared using the interactive maps above. The tool is available through the CMS website at: https://data.cms.gov/market-saturation. Future releases may include comparable information on additional health service areas.

Release 12 adds four reference periods for a total of eighteen, twelve-month reference periods, for State/County data, and nineteen health service areas: Home Health, Ambulance (Emergency, Non-Emergency, Emergency & Non-Emergency), Independent Diagnostic Testing Facilities (Part A and Part B), Skilled Nursing Facilities, Hospice, Physical and Occupational Therapy, Clinical Laboratory (Billing Independently), Long-Term Care Hospitals, Chiropractic Services, Cardiac Rehabilitation Programs, Psychotherapy, Federally Qualified Health Centers, Ophthalmology, Preventive Health Services, Dialysis, and Telemedicine.

Release 12 adds one reference period, for a total of five reference periods for the Core-Based Statistical Area (CBSA). CBSAs are geographical delineations that encompass both metropolitan statistical areas and micropolitan statistical areas. A micropolitan statistical area is an urban cluster of at least 10,000 people but less than 50,000 people, while a metropolitan statistical area is an urban cluster of at least 50,000 people. CBSAs are Census Bureau-defined urban clusters of at least 10,000 people. In order to better provide appropriate data and services, CMS defines additional custom CBSAs beyond those defined by the US Census Bureau. At this time CBSA-level trend data is not calculated. CMS defined CBSAs are not currently included in the shapefile needed to create the CBSA interactive map. The CMS-defined CBSAs are included in the interactive data set and contribute to the Nation + Territories level totals.

Methodology

The analysis is based on paid Medicare Fee-for-Service (FFS) claims data from the CMS Integrated Data Repository (IDR). The IDR contains Medicare FFS claims, beneficiary data, provider data, and plan data. FFS claims data are analyzed for a 12-month reference period, and state- and county-level results are updated quarterly to reflect a more recent 12-month reference period. CBSA data are also analyzed for a 12-month reference period and results will be updated annually to reflect a more recent calendar year… Read the full notice here.

Source: Market Saturation and Utilization Data Tool – April 21, 2021. CMS

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