The Medicare Current Beneficiary Survey (MCBS), since its inception in 1991, has been an invaluable source of information for administering the Medicare program, estimating health care expenditures and sources of payment outlays for beneficiaries (including both Medicare covered and non-covered services), and creating a more-nuanced understanding of the health status of beneficiaries and of how program changes impact health status. It is the leading source of information about the Medicare program and plays an essential role in monitoring and evaluating key provisions of the Affordable Care Act (ACA). Data from the MCBS are used to inform many government programs and analyses, including fiscal projections produced by the Congressional Budget Office and the Medicare Payment Advisory Commission.
In the MCBS rotating panel design, each sampled beneficiary is selected as part of an annual panel and is interviewed three times, or rounds, per year for four consecutive years. Interviews are administered in person by approximately 200 NORC field interviewers using Computer Assisted Personal Interviewing technology. Roughly one-third of the existing sample is retired each year, and a new panel is selected to replace it. A key feature of the MCBS design is that sampled persons are followed into and out of long term care facilities during their panel participation.
The MCBS is a continuous, in-person survey of a representative national sample of the Medicare population. It is sponsored by the Office of Enterprise Data and Analytics (OEDA) of the Centers for Medicare and Medicaid Services (CMS) in partnership with the Center for Medicare and Medicaid Innovation. Linked to Medicare claims data, the survey was designed to aid CMS in administering, monitoring, and evaluating the Medicare programs. It has been carried out for more than 20 years, encompassing more than one million interviews.
In February of 2014, NORC was awarded a new three-year contract to continue the MCBS. NORC conducts the full gamut of MCBS survey activities including sampling, data collection, data processing, editing, imputation, and data delivery.
Two main data products are delivered each year from the MCBS: the Access to Care file and the Cost and Use file. The Access to Care file is defined to represent the population of all persons enrolled in Medicare throughout the entire data collection year (referred to as the “always-enrolled” beneficiary population). To facilitate analysis, the information collected in the survey is augmented with data on the use and program cost of Medicare services from Medicare claims data under fee-for-service. The Access to Care file is released approximately 12 months after the data are collected.
The Cost and Use (CAU) file represents the population of all persons enrolled in Medicare at any point during the data collection year (referred to as the “ever-enrolled” beneficiary population). The MCBS Cost and Use files link Medicare claims data to survey-reported events and provides complete expenditure and source of payment data on all health care services, including those not covered by Medicare. Expenditure data are developed through a reconciliation process that combines information from survey respondents and Medicare administrative files. The process produces a comprehensive picture of health services received by beneficiaries, amounts paid, and sources of payment. The Cost and Use file is released approximately 2 years after the data are collected.
NORC has embarked upon work with the CMS Office of Minority Health to expand analytic capabilities using the MCBS to measure and improve the reporting of health disparities among vulnerable populations. NORC has also been instrumental in developing the first-ever Public Use File, released in May 2016, that facilitates research on health disparities. In collaboration with CMS, NORC is also implementing a series of innovations to the MCBS program. Building a more adaptive and cost effective MCBS will maximize its contributions to tracking program changes within Medicare and addressing the information needs of the Agency and the data user community. These exciting innovations aim to modernize the survey, realize survey efficiencies, and improve data quality.