Medicare Health Outcomes Survey-Modified (HOS-M) Overview
Introduction to Medicare HOS-M
The Medicare Health Outcomes Survey-Modified (HOS-M) was fielded for the first time in the spring of 2005. Originally entitled the Program of All-Inclusive Care for the Elderly (PACE) Health Survey, the HOS-M is administered by CMS to vulnerable Medicare beneficiaries at greatest risk for poor health outcomes. These beneficiaries are enrolled in PACE organizations.
The HOS-M is a modified version of the Medicare HOS. Similar to the HOS, the HOS-M design is based on a randomly selected sample of individuals from each participating PACE organization. The HOS–M is a cross–sectional survey, measuring the physical and mental health functioning of beneficiaries at a single point in time. This differs from the HOS, which has a follow-up component.
One of the main goals of the HOS-M is to assess annually the frailty of the population in these health plans in order to adjust plan payments. Initial eligibility for payment purposes is based on community-residing members who do not have end-stage renal disease (ESRD) and are age 55 or over.
Note that the Minnesota Senior Health Options, Minnesota Disability Health Options, Wisconsin Partnership Program, and Massachusetts MassHealth Senior Care Options transitioned from Medicare dual eligible demonstration status into the Medicare Advantage program in 2008. As a result, frailty adjusted payment rates for these Special Needs Plans (SNPs) were phased out after 2010. Starting in 2010, these SNPs were required to participate in HOS as part of CMS standard Medicare Advantage reporting requirements. In 2012 and 2013, CMS used six Activity of Daily Living (ADL) items collected from the HOS to determine frailty adjusted payments for Fully Integrated Dual Eligible (FIDE) SNPs, if the sample of SNP enrollees had similar average levels of frailty as the PACE program. Since 2014, FIDE SNPs can choose to use either the HOS or HOS-M for their frailty assessment. PACE organizations continue to participate in HOS-M and receive frailty-adjusted payments based on the HOS-M survey data collected.
Medicare HOS-M Program Timeline
A sample of Medicare beneficiaries is drawn annually from each participating plan and surveyed in the spring. Beginning in 2014, 1,200 beneficiaries are randomly selected for the HOS-M if the plan has a population of at least 1,200, and all eligible beneficiaries are included in the sample for plans with populations of less than 1,200. Prior to 2014, 1,200 beneficiaries were randomly selected for the HOS-M if the plan had a population of at least 1,400, and all eligible beneficiaries were included in the sample for plans with populations of less than 1,400. The HOS-M timeline is similar to the Medicare HOS Program Timeline.
The Medicare HOS-M contains the following core components:
The HOS-M instrument is a shorter, modified version of the Medicare Health Outcomes Survey and contains 6 ADL items as the core items used to calculate the frailty adjustment factor. The survey also includes 12 physical and mental health status questions from the VR-12. In addition, the HOS-M includes questions about the following: lifting or carrying objects as heavy as 10 pounds; walking a quarter mile; health or physical problems interfering with daily activities, receiving help with ADLs; physical and emotional health compared to one year ago; memory loss; urinary incontinence; and a question on whether the survey was self-completed or completed by a proxy. If the participant received assistance completing the survey, the respondent was asked information about the proxy respondent. For informational purposes, a copy of the HOS-M instrument is available for download from the Survey Instruments section.
After each yearly administration of the Medicare HOS-M, a plan specific report is produced for each PACE organization participating in the survey. The HOS-M report presents physical and mental component summary scores, ADL items, and selected health status measures, for the frail, elderly Medicare beneficiaries from each organization compared to the entire HOS-M sample. A sample PACE Report (PDF, 642 KB) is available for download.
The corresponding beneficiary level data for a report are disseminated to all participating plans. In addition to the data files, each plan receives a Data Users Guide (DUG) that describes the Medicare HOS-M file specifications and appropriate ways to use Medicare HOS-M data.
Medicare HOS-M Survey Status Information
HOS-M Data Collection Year
1 Ineligible beneficiaries meet one of the following criteria: deceased; not enrolled in the health plan; have an incorrect address and phone number; have a language barrier; or removed from sample due to death, disenrollment, or long-term institutionalization during survey administration.
2 A completed survey is defined as a survey that can be used to calculate physical or mental health summary scores.
3 Please note, ineligible beneficiaries are removed from the denominator in the response rate calculations. In other words,
Response Rate = [Number of Respondents/(TotalSample - Ineligibles)]x100%.
All distribution of HOS-M reports occurs electronically to participating PACE organizations through the CMS Health Plan Management System (HPMS). Plans are alerted of report availability through HPMS. If assistance is required regarding HPMS access, please contact CMS via email at firstname.lastname@example.org. Following HPMS notification that the data are available, a plan may contact the Medicare HOS Information and Technical Support email at hos@HCQIS.org to request their data and the DUG.
Complete information about the dissemination and availability of Medicare HOS-M reports and data to plans is available in the table below. The HOS-M DUGs are available for download from the table below.
1 Reports made available electronically to plans via HPMS
2 Plans notified of availability of data
* Reports and/or Access Information Available in HPMS
This page was last modified on 04/19/2017