health_access_quality_county_year
Medicare utilization and quality-of-care metrics by county. CMS Geographic Variation Public Use File: standardized spending, readmissions, preventable admissions, and chronic condition shares.
tier aadmin_record
overview
overview
~3,000 counties. CMS Medicare PUF covers Medicare beneficiaries; quality measures from hospital reporting.
current vintage — 2022
history — CMS Medicare GV PUF: 2007-present
provenance
source & licensing
authority
U.S. Centers for Medicare & Medicaid Services
dataset
CMS Medicare Geographic Variation Public Use File
source url
methodology
license
Public domain (U.S. Federal Government work)
citation
U.S. Centers for Medicare & Medicaid Services. Medicare Geographic Variation Public Use File, 2022.
schema
fields
| name | type | definition |
|---|---|---|
| _ingested_at | timestamp | Timestamp when this record was written to BigQuery.Pipeline metadata field. |
| country_id | string | ISO alpha-2 country code (always 'US' for domestic tables). |
| county_idkey | string | 5-character FIPS code identifying the county.Joins dim.counties on county_id. |
| dual_enrollment_pct | float64 · percent (0–100) | Percentage of Medicare beneficiaries who are also enrolled in Medicaid (dual-eligible). Higher values indicate a greater share of low-income, typically higher-need beneficiaries in the county. |
| er_visits_per_1000_benes | float64 · rate per 1,000 beneficiaries | Annual emergency department visits per 1,000 FFS Medicare beneficiaries. Higher values may indicate greater acute illness burden or barriers to timely primary and ambulatory care access. |
| ffs_beneficiary_count | int64 · count | Number of Medicare fee-for-service beneficiaries enrolled in the county. Higher values indicate larger FFS Medicare populations, which affects the reliability of utilization and spending metrics. |
| fqhc_rhc_visits_per_1000_benes | float64 · rate per 1,000 beneficiaries | Annual visits to Federally Qualified Health Centers or Rural Health Clinics per 1,000 FFS Medicare beneficiaries. Higher values indicate greater reliance on safety-net primary care providers, common in underserved urban and rural areas. |
| hcc_risk_score | float64 · index (national average = 1.0) | Hierarchical Condition Category risk score summarizing the expected Medicare expenditure of the beneficiary population relative to the national average. Scores above 1.0 indicate a sicker-than-average population; scores below 1.0 indicate a healthier-than-average population. |
| ip_stays_per_1000_benes | float64 · rate per 1,000 beneficiaries | Annual inpatient hospital stays per 1,000 FFS Medicare beneficiaries. Higher values indicate greater acute-care utilization, which may reflect higher illness burden or lower access to preventive and ambulatory care. |
| ma_participation_rate | float64 · percent (0–100) | Share of Medicare-eligible beneficiaries enrolled in Medicare Advantage plans rather than traditional fee-for-service. Higher values indicate greater penetration of managed care among the Medicare population. |
| medicare_actual_per_capita | float64 · dollars (nominal) | Total Medicare payments per FFS beneficiary at actual local payment rates, reflecting both utilization and geographic price variation. Higher values indicate greater total Medicare expenditure per beneficiary. |
| medicare_standardized_per_capita | float64 · dollars (nominal) | Medicare spending per FFS beneficiary adjusted to remove geographic variation in input prices (wages, practice costs), isolating differences in utilization patterns. Higher values indicate greater use of Medicare-covered services. |
| readmission_rate_30d | float64 · percent (0–100) | Percentage of inpatient stays followed by a readmission to any acute-care hospital within 30 days of discharge. Higher values indicate poorer care transitions, discharge planning, or post-acute follow-up. |
| state_id | string | 2-character FIPS code identifying the state.Joins dim.states on state_id. |
| yearkey | int64 | Reference year of the observation. |
relationships
joins
primary key
county_id, year
common joins
dim.geographies on county_id
health_access_capacity_county_year on (county_id, year)
scorecard_health_county on county_id
usage
how to use this table
method
CMS aggregates fee-for-service Medicare claims to county. 30-day readmission rates risk-adjusted via HCC. ER visits per 1,000 beneficiaries.
do not use for
Non-Medicare populations (FFS Medicare only); Medicare Advantage enrollees (excluded); under-65 populations except disability.
known issues
FFS Medicare only - as MA enrollment grows (~50%+), FFS sample shrinks and selection effects worsen.
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last updated · May 5, 2026