Use of Claims Data to Screen for Functional Limitations Among Medicare Beneficiaries

Can Medicare claims data be used to identify beneficiaries with a high likelihood of having functional limitations?In this cross-sectional study of data from 67 596 survey respondents, an algorithm based on a parsimonious set of claims indicators achieved a positive predictive value of 80% in identifying Medicare fee-for-service beneficiaries who were functionally limited. Nearly 63% of those identified by the algorithm were not identified as functionally limited in Centers for Medicare & Medicaid Services administrative data, which focuses on limitations that arise before age 65 years.These finding suggest this claims-based algorithm may serve as an effective screening tool to identify beneficiaries who should be prioritized for a survey assessment to verify the results of the algorithm.

Corresponding Author: Steven C. Martino, PhD, RAND, 4570 Fifth Ave, Ste 600, Pittsburgh, PA 15217-2665 (martino@rand.org).

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