Objective:
1. To evaluate the feasibility of using Medicare claims by determining the number of identifiable persons with autism spectrum disorder (ASD) in a three year limited data set (2008-2010)
2. To describe the structure, types, and limitations of Medicare claims files for ASD researc

Benevides, PhD, MS, OTR/L, Teal W.

Carretta, PhD, Henry J.

Graves, MS, Katelyn

Name not available

Use of Medicare Claims as a Source for Research Prevalence and Utilization of Medical Care Services in Persons with Autism Spectrum Disorder Over and Under Age 65

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Thomas Jefferson UniversityJefferson Digital CommonsDepartment of Occupational Therapy, Presentations Department of Occupational Therapy5-16-2015Use of Medicare Claims as a Source for ResearchPrevalence and Utilization of Medical CareServices in Persons with Autism SpectrumDisorder Over and Under Age 65Henry J. Carretta, PhDFlorida State University, College of MedicineKatelyn Graves, MSFlorida State University, College of MedicineTeal W. Benevides, PhD, MS, OTR/LThomas Jefferson University School of Health Professions, Department of Occupational Therapy,Teal.benevides@jefferson.eduLet us know how access to this document benefits youFollow this and additional works at: http://jdc.jefferson.edu/otpresentationsPart of the Occupational Therapy CommonsThis Article is brought to you for free and open access by the Jefferson Digital Commons. The Jefferson Digital Commons is a service of ThomasJefferson University's Center for Teaching and Learning (CTL). The Commons is a showcase for Jefferson books and journals, peer-reviewed scholarlypublications, unique historical collections from the University archives, and teaching tools. The Jefferson Digital Commons allows researchers andinterested readers anywhere in the world to learn about and keep up to date with Jefferson scholarship. This article has been accepted for inclusion inDepartment of Occupational Therapy, Presentations by an authorized administrator of the Jefferson Digital Commons. For more information, pleasecontact: JeffersonDigitalCommons@jefferson.edu.Recommended CitationCarretta, PhD, Henry J.; Graves, MS, Katelyn; and Benevides, PhD, MS, OTR/L, Teal W., "Use ofMedicare Claims as a Source for Research Prevalence and Utilization of Medical Care Services inPersons with Autism Spectrum Disorder Over and Under Age 65" (2015). Department ofOccupational Therapy, Presentations. Paper 28.http://jdc.jefferson.edu/otpresentations/281FLORIDA STATE UNIVERSITY, COLLEGE of MEDICINE 2THOMAS JEFFERSON UNIVERSITY SCHOOL OF HEALTH PROFESSIONS, DEPARTMENT OF OCCUPATIONAL THERAPY Use of Medicare Claims As a Source for Research Prevalence and Utilization of Medical Care Services in Persons with Autism Spectrum Disorder Over and Under Age 65 Henry J. Carretta PhD1 , Katelyn Graves MS1 ,Teal W. Benevides PhD, MS, OTR/L2 OBJECTIVE RESULTS BACKGROUND RESULTS 1. To evaluate the feasibility of using Medicare claims by determining the number of identifiable persons with autism spectrum disorder (ASD) in a three year limited data set (2008-2010) 2. To describe the structure, types, and limitations of Medicare claims files for ASD research CONCLUSION METHODOLOGY  Increased use of restrictive medical care has been documented among adolescent cohorts of persons with ASD (Cidav et al., 2013)    Little is known about the patterns of health care utilization and expendi-tures for persons with ASD who are older than 21 years    Medicare may be a potential source of healthcare claims data for ex-amining service utilization and expenditures for adults with ASD  Most studies using Medicaid claims among children require identifi-cation of ASD with a minimum of two ICD9 claims of 299.xx (ASD, specified and unspecified pervasive developmental disorder, child disintegrative disorder)  It was unclear if a large enough sample of individuals would be identifiable using 2 or more claims in Medicare  We wanted to identify those with ASD (299.00 and 299.80) and those with ASD-related conditions (all 299.xx)   Medicare provides coverage to adults who meet certain criteria:   ≥ 65 years or;  living children with disabilities of existing Medicare beneficiaries or;  persons who have worked for a period of time and have achieved sufficient working time before declaring a disability and receiving Social Security Disability Insurance   The ≥65y+ sample size is very small, as would be expected by the his-toric identification of ASD by Kanner and others in the 1940s   Use of two or more 299.xx claims to track individual outcomes is feasi-ble by linking 5% sample carrier beneficiaries across other files for indi-viduals < 65 years   Sample sizes decrease when choosing to use samples with any 299.xx versus 299.00 and 299.80, as well as when using samples with a claim in both the 5% carrier file and at least one other 100% file   Racial and ethnic composition of individuals with ASD in comparison to 2010 Census estimates suggest more than expected white adults, simi-lar as expected black adults, and fewer than expected Hispanic adults  Limitations of using this data include:   The definition and diagnosis of ASD has changed over time, as  well as the classification of disability, thus affecting identification and eligibility within these claim files. Cohort effects must be considered.  The covered population likely represents a severely disabled subset of the larger population of adults with ASD due to eligibility criteria  Lack of Medicaid claims means some utilization is not observed,  e.g. dual eligibles and persons in long-term-care facilities   The Centers for Medicare and Medicaid Services (CMS) national Limited Data Files (LDS) were used to:  Link ASD patient records to the other four claims types: inpatient hospi-talization (INP), home health (HHA), outpatient facility claims, and skilled nursing facility (SNF) to identify frequency of claim occurrence   Identify the frequency of individuals with at least one ASD ICD-9 claim(299.00 & 299.80) in the 5% Carrier claims or 100% files  Identify the frequency of individuals with at ASD-related diagnoses (299.xx) who had a claim in both the 5% Carrier claim file and a mini-mum of one 100% file  Summarize the age, race and ethnicity and gender of individuals with ASD Table 1.  Number of persons with ASD with at least 1 ICD9 claim of 299.00 or 299.80 in each file by year  Of individuals with at least one ICD9 claim of 299.00 or 299.80:  869 individuals ages 18+ years in 2008-2010 Carrier (5% files)*  n= 422 (2008), n=457 (2009), n=551 (2010)  Of individuals with at least two ICD9 claims of 299.xx, ages 18-64years:  865 individuals 18-64 years in 2008-2010*  n=268 (2008), n=426 (2009), n=485 (2010) * Total n does not add up to the sum total of each year because some individuals are found in more than one claim year  Table 2. Race and ethnicity of individuals 18-64 years with 2 or more claims (299.xx) by year Figure 1.  Age distribution of individuals 18-64 years with two or more 299.xx claims in 2010 files 

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Use of Medicare Claims as a Source for Research Prevalence and Utilization of Medical Care Services in Persons with Autism Spectrum Disorder Over and Under Age 65

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