Exhibit 2. Metrics Developed to Analyze Medicaid Encounter Data in MAX 2008.
| Data Element | Reference Range (Number of States Meeting Metric) | |||
|---|---|---|---|---|
| Adults | Children | Disabled | Aged | |
| OT—Physician, Clinic, and Outpatient Visits Completeness Measures | ||||
| Average number of OT encounter claims per enrollee | 1.04–12.10 | 1.23–9.46 | 8.35–27.96 | 0.91–19.54 |
| (23 of 24) | (22 of 25) | (15 of 20) | (13 of 16) | |
| Percentage of enrollees with OT encounter claims | 34.33–92.45 | 36.15–93.40 | 66.35–92.39 | 19.57–92.26 |
| (22 of 24) | (23 of 25) | (14 of 20) | (15 of 16) | |
| Quality Measures | ||||
| Percentage of OT encounter claims with place of service code | 83.87–100 | 76.16–100 | 81.89–100 | 84.22–100 |
| (23 of 24) | (25 of 25) | (20 of 20) | (16 of 16) | |
| Percentage of OT encounter claims with primary diagnosis code | 98.17–100 | 86.09–100 | 94.84–100 | 97.02–100 |
| (24 of 24) | (25 of 25) | (20 of 20) | (16 of 16) | |
| Percentage of OT encounter claims with a primary diagnosis code length greater than 3 characters | 90.85–98.81 | 80.92–100 | 88.08–100 | 89.16–99.41 |
| (23 of 24) | (25 of 25) | (20 of 20) | (16 of 16) | |
| Percentage of OT encounter claims with a procedure (service) code | 71.47–100 | 82.13–100 | 78.78–100 | 82.68–100 |
| (20 of 24) | (21 of 25) | (17 of 20) | (13 of 16) | |
| Percentage of OT encounter claims with a procedure code in CPT-4 or HCPCS format | 60.77–100 | 64.32–100 | 66.88–100 | 70.41–100 |
| (21 of 24) | (22 of 25) | (18 of 20) | (15 of 16) | |
| IP—Inpatient Hospital Completeness Measures | ||||
| Average number of IP encounter claims per enrollee | 0.00–0.40 | 0.02–0.15 | 0.10–0.54 | 0.00–0.44 |
| (22 of 24) | (18 of 24) | (16 of 20) | (14 of 15) | |
| Percentage of enrollees with IP encounter claims | 0.21–32.51 | 1.06–13.08 | 7.55–25.39 | 3.62–22.39 |
| (23 of 24) | (20 of 24) | (15 of 20) | (11 of 15) | |
| Quality Measures | ||||
| Average length of stay | 2.01–3.90 | 2.04–6.48 | 5.35–8.61 | 3.32–10.49 |
| (23 of 24) | (22 of 24) | (9 of 20) | (14 of 15) | |
| Average number of diagnosis codes | 2.42–6.43 | 1.89–4.38 | 3.09–9.76 | 3.19–10.72 |
| (20 of 24) | (20 of 24) | (16 of 20) | (12 of 15) | |
| Percentage of IP claims with procedure codes | 48.17–100.00 | 18.72–76.39 | 30.70–71.13 | 25.05–73.55 |
| (18 of 24) | (23 of 24) | (15 of 20) | (13 of 15) | |
| Percentage of IP claims with UB accommodation codes | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% |
| (20 of 24) | (20 of 24) | (13 of 20) | (11 of 15) | |
| RX—Prescription Drugs Completeness Measures | ||||
| Average number of RX encounter claims per enrollee | 1.86–12.95 | 1.80–7.22 | 17.27–50.09 | 0–48.22 |
| (13 of 14) | (14 of 15) | (8 of 10) | (8 of 8) | |
| Percentage of enrollees with RX encounter claims | 26.79–88.04 | 31.46–80.84 | 68.14–89.30 | 12.21–89.82 |
| (13 of 14) | (14 of 15) | (9 of 10) | (7 of 8) | |
| Quality Measures | ||||
| Percentage of RX claims with date prescribed | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% |
| (13 of 14) | (14 of 15) | (9 of 10) | (7 of 8) | |
| Percentage of RX claims with quantity | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% | Values of ≥ 90% |
| (8 of 14) | (9 of 15) | (6 of 10) | (4 of 8) | |
NOTE. The parenthetical data show the number of states that had values within the acceptable range, out of the total number of states that had sufficient participation and encounter claims submitted for analysis.
UB = uniform billing, CPT-4 = Current Procedural Terminology, 4th Edition, HCPCS = Healthcare Common Procedure Coding System
SOURCE: Mathematica's analysis of the MAX 2008 IP, RX, OT, and Person Summary (PS) files.